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A cleft of the lip or palate happens when a baby is born with an opening in the upper lip or the roof of the mouth (the palate). These orofacial clefts are some of the most common birth defects.
A baby with a cleft might have:
A cleft palate (PAL-it) is when a baby is born with an opening (a cleft) in the roof of the mouth. This leaves a hole between the nose and the mouth.
The opening can:
Babies who are born with have a gap or opening in the upper lip. This happens when the baby's lip doesn't form properly early in pregnancy, resulting in a split.
A cleft lip can be:
Clefts can range in size:
If the opening in the palate connects with the opening in the gums and the lip, a baby has cleft lip and palate.
During the first 6 to 10 weeks of pregnancy, the bones and skin of a baby's upper jaw, nose, and mouth normally come together (fuse) to form the roof of the mouth and the upper lip. A cleft happens when parts of the lip and/or palate do not fuse together completely.
Doctors don't always know why a baby develops a cleft, though some may be related to genetic (inherited) factors. Also, some environmental factors can increase the risk of a birth defect, such as:
Usually, clefts are found when a baby is born. Sometimes, they're seen before a baby is born on a prenatal ultrasound. Without a cleft lip, a cleft palate is harder to see on ultrasound. Doctors usually find a cleft palate when they look and feel inside a baby's mouth during the first newborn exam.
Cleft lip and cleft palate can cause problems with:
It's important to correct a cleft palate with cleft lip with surgery while a child is young.
A plastic surgeon will repair the baby's cleft lip first, usually when the baby is about 3 months old. This is done with a surgery called cheiloplasty (KY-lo-plass-tee). It's done in the hospital while the baby is under general anesthesia.
The goals of cleft lip repair are to:
If the cleft lip is wide, special procedures like lip adhesion or nasal alveolar molding (NAM) might help bring the parts of the lip closer together and improve the shape of the nose before the cleft lip repair. Cleft lip repair leaves a small scar under the nose in place of the cleft.
A cleft palate usually is repaired with surgery called palatoplasty (PAL-eh-tuh-plass-tee) when the baby is 10–12 months old. The goals of palatoplasty are to:
In palate repair surgery, the surgeon will:
The surgeon may need to make two incisions (cuts) on each side of the palate behind the gums to ease tension on the palate repair. These are called “relaxing incisions.” In some cases, the surgeon may also borrow some tissue from the inner surface of the cheeks to help complete the repair.
Cleft palate repair requires general anesthesia and takes about 2–3 hours. Most babies can go home after 1 or 2 days in the hospital. The stitches will dissolve on their own.
Your child will need a liquid or blenderized (puréed) diet for about 3 weeks after surgery before starting to eat foods that are hard or crunchy. You may be asked to keep your baby in special sleeves ("no-nos") that prevent the elbows from bending. This is so your baby can't put any fingers or hard objects into the mouth, which could make the cleft palate repair come open.
Cleft lip and palate surgeries have greatly improved in recent years. Most kids who undergo them have very good results. There are risks with any surgery, though, so call the doctor if your child:
A child with a cleft lip and palate can sometimes have other health problems, such as:
It's important to work with a care team experienced in treating children with cleft lip and palate. Besides the pediatrician, a child's treatment team will include:
You might also work with:
Some kids with cleft lip and palate may need other surgeries as they get older. These might include:
Most kids with cleft lip and palate are treated successfully with no lasting problems. A team experienced in treating children with cleft lip and palate can create a treatment plan tailored to your child's needs.
The psychologists and social workers on the treatment team are there for you and your child. Turn to them to help guide you through any hard times. You also can find more information and support online:
Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.
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