Cleft lip and cleft palate are congenital birth defects that affect the development of facial structures, resulting in a gap or opening in the lip or palate. Cleft lip and cleft palate can occur individually or together, and they are caused by a combination of genetic and environmental factors.

A cleft lip is a separation or split in the upper lip, which can range from a small notch to a complete separation that extends into the nostril. A cleft palate is a separation or opening in the roof of the mouth, which can affect the soft palate at the back of the mouth or the hard palate at the front.

The condition can cause a range of problems, including difficulty with feeding, speech and language development, and dental problems. Children with cleft lip and cleft palate often require a multidisciplinary team of healthcare providers, including plastic surgeons, otolaryngologists, speech pathologists, and dental specialists, to manage their condition.

Treatment for cleft lip and cleft palate typically involves surgical repair, which is typically performed within the first year of life. The surgery aims to close the gap in the lip or palate, improve facial appearance, and restore normal function of the affected structures. Speech therapy, dental care, and other supportive therapies may also be necessary to address long-term complications associated with the condition.

While the prognosis for cleft lip and cleft palate varies depending on the severity of the condition and the individual's response to treatment, early diagnosis, and intervention can help improve outcomes and reduce the risk of complications.

Cleft lip and cleft palate occur when tissues in the baby's face and mouth don't fuse properly. Normally, the tissues that make up the lip and palate fuse together in the second and third months of pregnancy. But in babies with cleft lip and cleft palate, the fusion never takes place or occurs only part way, leaving an opening (cleft).

Researchers believe that most cases of cleft lip and cleft palate are caused by an interaction of genetic and environmental factors. In many babies, a definite cause isn't discovered.

The mother or the father can pass on genes that cause clefting, either alone or as part of a genetic syndrome that includes a cleft lip or cleft palate as one of its signs. In some cases, babies inherit a gene that makes them more likely to develop a cleft, and then an environmental trigger actually causes the cleft to occur.

After a baby is born with a cleft, parents are understandably concerned about the possibility of having another child with the same condition. While many cases of cleft lip and cleft palate can't be prevented, consider these steps to increase your understanding or lower your risk:

• Consider genetic counseling. If you have a family history of cleft lip and cleft palate, tell your doctor before you become pregnant. Your doctor may refer you to a genetic counselor who can help determine your risk of having children with cleft lip and cleft palate.
• Take prenatal vitamins. If you're planning to get pregnant soon, ask your doctor if you should take prenatal vitamins.
• Don't use tobacco or alcohol. Use of alcohol or tobacco during pregnancy increases the risk of having a baby with a birth defect.

The goals of treatment for cleft lip and cleft palate are to improve the child's ability to eat, speak and hear normally and to achieve a normal facial appearance.

Care for children with cleft lip and cleft palate often involves a team of doctors and experts, including:

• Surgeons who specialize in cleft repair, such as plastic surgeons or ENTs
• Oral surgeons
• Ear, nose and throat doctors (ENTs, also called otorhinolaryngologists)
• Pediatricians
• Pediatric dentists
• Orthodontists
• Nurses
• Auditory or hearing specialists
• Speech therapists
• Genetic counselors
• Social workers
• Psychologists

Treatment involves surgery to repair the defect and therapies to improve any related conditions.

Surgery

Surgery to correct cleft lip and palate is based on your child's particular situation. Following the initial cleft repair, your doctor may recommend follow-up surgeries to improve speech or improve the appearance of the lip and nose.

Surgeries typically are performed in this order:

• Cleft lip repair — within the first 3 to 6 months of age
• Cleft palate repair — by the age of 12 months, or earlier if possible
• Follow-up surgeries — between age 2 and late teen years

Cleft lip and palate surgery takes place in a hospital. Your child will receive a general anesthetic, so he or she won't feel pain or be awake during surgery. Several different surgical techniques and procedures are used to repair cleft lip and palate, reconstruct the affected areas, and prevent or treat related complications.

In general, procedures may include:

• Cleft lip repair. To close the separation in the lip, the surgeon makes incisions on both sides of the cleft and creates flaps of tissue. The flaps are then stitched together, including the lip muscles. The repair should create a more normal lip appearance, structure and function. Initial nasal repair, if needed, is usually done at the same time.
• Cleft palate repair. Various procedures may be used to close the separation and rebuild the roof of the mouth (hard and soft palate), depending on your child's situation. The surgeon makes incisions on both sides of the cleft and repositions the tissue and muscles. The repair is then stitched closed.
• Ear tube surgery. For children with cleft palate, ear tubes may be placed to reduce the risk of chronic ear fluid, which can lead to hearing loss. Ear tube surgery involves placing tiny bobbin-shaped tubes in the eardrum to create an opening to prevent fluid buildup.
• Surgery to reconstruct appearance. Additional surgeries may be needed to improve the appearance of the mouth, lip and nose.

Surgery can significantly improve your child's appearance, quality of life, and ability to eat, breathe and talk. Possible risks of surgery include bleeding, infection, poor healing, widening or elevation of scars, and temporary or permanent damage to nerves, blood vessels or other structures.

Treatment for complications

Your doctor may recommend additional treatment for complications caused by cleft lip and cleft palate. Examples include:

• Feeding strategies, such as using a special bottle nipple or feeder
• Speech therapy to correct difficulty with speaking
• Orthodontic adjustments to the teeth and bite, such as having braces
• Monitoring by a pediatric dentist for tooth development and oral health from an early age
• Monitoring and treatment for ear infections, which may include ear tubes
• Hearing aids or other assistive devices for a child with hearing loss
• Therapy with a psychologist to help the child cope with the stress of repeated medical procedures or other concerns