Cleft Lip & Palate

During early pregnancy, areas of the face develop individually and later join together. This includes the left and right sides of the roof of the mouth and lips. In some cases, the two sides do not join properly, and the result is a cleft.

If the separation occurs in the palate, the child is said to have a cleft palate. A completely formed palate is important not only for a normal facial appearance, but also for eating,sucking and speech.

A cleft lip is a condition that creates an opening in the upper lip between the mouth and nose. It looks as though there is a split in the lip. It can range from a slight notch in the colored portion of the lip to complete separation in one of both sides of the lip, extending up and into the nose. A cleft on one side is referred to as a unilateral cleft. If a cleft occurs on both sides, it is called a bilateral cleft.

A cleft in the gum (oralucolus) may occur in association with a cleft lip and/or palate.

Cleft Palate

The palate refers to the roof of your mouth. It is made of bone and muscle and is covered by a thin, wet skin that forms the red covering inside the mouth. Its purpose is to separate your nose from your mouth. The palate has an extremely important role in speech. When you talk, it prevents air from blowing out of your nose instead of your mouth. The palate is also important when eating, as it prevents food and liquids from going up into the nose.

As in cleft lip, a cleft palate occurs in early pregnancy when separate areas of the face have developed individually do not join together properly. A cleft palate occurs when there is an opening in the roof of the mouth. Its purpose is to separate your nose from your mouth. The back of the palate is called the soft palate, and the front is referred to as the hard palate. A cleft palate can range from just an opening at the back of the soft palate to a nearly complete separation of the roof of the mouth (soft and hard palate).

In some cases, a baby with a cleft palate may have a small chin, and a few babies with this combination may have difficulties breathing. This condition is referred to as Pierre Robin sequence.

Since the lip and palate develop separately, it is possible for a child to be born with a cleft lip, palate or both. Cleft defects occur in approximately one out of every 800 births.

Children born with either, or both, of these conditions typically need the skills of several professionals to manage the problems associated with the defect, including feeding, speech, hearing and psychological development. In most cases, surgery is recommended. When surgery is done by an experienced, qualified oral and maxillofacial surgeon the results can be very positive. The OMS Specialists surgeons serve on the Cleft Lip and Palate teams at the Minneapolis Children’s Hospital and the University of Minnesota.

Cleft Lip Treatment

Cleft lip surgery is typically performed when the child is about three months old. The goal of surgery is to close the separation, restore muscle function and provide a normal shape to the mouth. The nostril deformity may be improved as a result of the procedure, or may require a subsequent surgery.

Cleft Palate Treatment

A cleft palate is initially treated with surgery safely when the child is seven to eighteen months old. This depends on the individual child and their circumstances. If there are other associated health problems, surgery is often delayed.

Surgery's Major Goals

  1. To close the gap or hole between the roof of the mouth and the nose
  2. Reconnect the muscles to make the palate function properly
  3. Make the repaired palate long enough so that the palate can perform properly

There are many techniques surgeons use to accomplish these goals. The choice of techniques may vary between surgeons and should be discussed between the parents and the surgeon prior to the procedure.

The cleft hard palate is generally repaired between the ages of five and eight, before the cuspid teeth begin to develop. The procedure involves placement of bone from the hip into the bony defect, and closure of the communication from the nose to the gum tissue in three layers. It may also be performed in teenagers and adults as an individual procedure or combined with corrective jaw surgery.

What Can Be Expected After Cleft Palate Surgery?

After the palate has been repaired, children will immediately have an easier time swallowing food and liquids. However, about one in every five children following cleft palate repair will have a portion of their repair split, causing a new hole to form between the nose and mouth. If small, this hole may result in only an occasional, minor leakage of fluids into the nose. However, if the split is large it could cause eating problems, and most importantly, could impact how the child speaks. This hole is referred to as a fistula, and may need further correction through surgery.