Cleft Lip and Palate

Riley Hospital for Children at Indiana University Health has one of the largest and longest standing cleft care units in the country. We treat more children with cleft lip and palate than any hospital in Indiana. Our comprehensive multidisciplinary team continues to set the national standard of excellence in cleft lip and palate care. Through our comprehensive, multidisciplinary team approach we can successfully treat all aspect of cleft care while limiting visits to our hospital and improving the appearance and function of your child.

Definition

A cleft lip is a separation of the lip. The cleft could be a small notch in the lip, or a complete separation of not only the lip but also the gum line (alveolar ridge) and the floor of the nose. There is often a nasal deformity associated with a cleft lip. A cleft can affect one or both sides of the lip.

A cleft palate is an opening in the roof of the mouth, which occurs when the two sides of the palate do not join together before birth. In some children, the cleft involves only the uvula (the small u-shaped portion of the back of the palate which hangs down into the throat). In other children, the cleft extends the entire length of the palate from the uvula to the gum line (alveolar ridge).

Cleft lip and palate is the most common birth defect affecting the face. One out of every 700 newborns is affected by cleft lip and/or palate.

What causes cleft lip and palate?

The causes of cleft lip and palate are not well understood. The majority of cases are spontaneous, meaning there is no known cause. Studies suggest that in selected cases genetics, as well as environmental factors such as drugs, infections, maternal illness, maternal alcohol use and, possibly, deficiency of B vitamin folic acid may be involved. There are known cases of family history of cleft lip and palate. At Riley Hospital for Children, experts in genetics are available to counsel families.

How are cleft lip and palate treated?

Treatment of cleft lip and palate consists of surgical reconstruction, done in stages, with close attention paid to any related speech, hearing, middle ear or dental disorders.

The cleft lip is typically repaired between 3 and 5 months of age. The cleft palate is usually repaired by the first year of life. Both surgeries require an overnight stay in the hospital. Additional surgical procedures often are needed as your child grows.

What special problems are associated with clefts?

Infants with cleft lip and palate may have problems with feeding, hearing, speech and tooth development.

• Feeding: While most babies with cleft lip only usually don’t have much trouble feeding, those with cleft palate or cleft lip and palate often do. A cleft in the roof of the mouth makes it difficult for the baby to suck forcefully enough to draw milk through a nipple. Use of special nipples and careful positioning of the baby are sometimes helpful. Our cleft team nurses will give you proper guidance during your initial visit with us.
• Hearing: Babies with a cleft palate are especially vulnerable to the build up of fluid in the inside of the ear (middle ear). The fluid can block sound making it difficult for the baby to hear. If treated properly in infancy and childhood, the hearing loss should not be permanent. If fluid is detected, it is often treated with a minor surgical procedure. The surgeon inserts a tiny tube into the eardrum to drain fluids and help prevent infections. This procedure is performed by an ear doctor (otolaryngologist). Surgeons at Riley Hospital for Children often perform this procedure at the time of a scheduled cleft surgery to reduce the number of times the baby and their family must come to the hospital.
• Speech: Children with cleft lip generally have normal or near normal speech. Children with cleft palate may develop speech a little more slowly than other children. Before the palate is repaired, the structure of the child’s mouth may make difficult to make some sounds and form words normally. It is important to talk to your child and encourage your child to talk to you to help develop these skills. After cleft palate repair, it is very important to enroll your child in a speech therapy program. This will help your child develop normal speech.
• Tooth Development: Children with clefts may have special dental problems because the number, size, shape and position of both the baby teeth and the adult (permanent) teeth can be affected by the cleft. With proper dental care, children born with clefts can have healthy teeth. Dental specialists and surgeons will often work together in creating long-term care plans for the child as they grow (click for more dental information).