Definition

An oral-facial cleft is a birth defect. It occurs when the lip or the roof of the mouth do not form properly. The defect may include a cleft lip, a cleft palate, or both. A cleft lip is a gap in the upper lip, usually just below the nose. A cleft palate is a gap in the roof of the mouth or in the soft tissue at the back of the mouth. In the majority of cases, a cleft lip and cleft palate occur together.

Causes

Early in pregnancy, all babies have an opening in the lip and palate. As the baby grows, these openings should gradually grow together. By birth, the openings should be closed. For some reason, in children with oral-facial clefts, these openings fail to close. The exact reason these openings do not close is not known.

Risk Factors

Oral-facial clefts are more common in males. Other factors in the infant that may increase the chance of oral-facial clefts include:

• Having other birth defects
• Having a sibling, parent, or other close relative born with an oral-facial cleft

Factors in the mother during pregnancy that may increase the chance of oral-facial clefts include:

• Taking certain medications, such as antiseizure drugs, thalidomide, or retinoic acid
• Smoking
• Consuming alcohol
• Having diabetes

Symptoms

The major symptom of a cleft lip and/or cleft palate is a visible opening in the lip or palate.

Complications that can occur as a result of an oral-facial cleft include:

• Feeding problems, especially with cleft palate
• Problems with speech development
• Dental problems, including missing teeth, especially when cleft lip extends to the upper gum area
• Symptoms of middle ear infections
• Hearing problems
• Symptoms of sleep-disordered breathing

Diagnosis

Cleft lip or cleft palate can be diagnosed by examining the newborn baby. A newborn with an oral-facial cleft may be referred to a team of medical specialists soon after birth. Rarely, a mild cleft palate may go undiagnosed for several months or even years.

Your doctor may be able to see a cleft lip before birth. It may be seen during a prenatal ultrasound examination. A cleft lip can be seen as early as 18 weeks into pregnancy. Cleft palate may be harder to see before birth because it is inside the mouth. Treatment cannot be started until after birth. However, diagnosis during pregnancy will give the parents and the medical team time to prepare a care plan.

Cleft lip and palate are sometimes associated with other medical conditions. Your doctor should be able to tell you whether or not your child’s cleft is a sign of a larger condition. Some of these conditions may need additional treatment.

Treatment

Surgery is the main treatment. The primary goal of surgery is to close the gap in the lip and palate. Other surgery may also be needed for:

• Bite alignment surgery if the jaw is not aligned properly
• Plastic and/or nasal surgery to improve facial appearance and function

A cleft defect can make it difficult for your child to eat or drink. Your child may be given a dental plate, which is placed in the roof of the mouth. It should make it easier to eat and drink until surgery can be done.

Cleft palates may also be associated with ear and hearing problems. If your child has a middle ear infection or fluid build-up, your doctor may recommend:

• Medications to treat infection or prevent fluid build-up
• Surgery to drain built-up fluid and prevent future infections

Hearing testing should be done regularly. Rarely, children with cleft palate may benefit from hearing aids.

Prevention

Pregnant women and women who are likely to become pregnant can do the following to help prevent oral-facial clefts in their unborn children:

• Consume 400 micrograms of folic acid every day. Folic acid intake may include a daily multivitamin and eating foods containing folic acid, such as:
  • Fruits and orange juice
  • Green, leafy vegetables
  • Dried beans and peas
  • Pasta, rice, bread, flour, and cereals
• Do not smoke or drink alcohol during pregnancy.
• Talk to your doctor about any medications during pregnancy. Only use them as directed by your doctor.
• Get early and regular prenatal care.
• If you are thinking about having a child and have risk factors for oral-facial cleft:
  • Seek medical advice on additional ways to prevent the disorder.
  • Consider genetic counseling.

Cleft Lip and Palate Association http://www.clapa.com

Women’s Health Matters http://www.womenshealthmatters.ca

Cleft lip and palate. Nemours Kid’s Health website. Available at:
http://kidshealth.org/parent/medical/ears/cleft_lip_palate.html
Updated January 2011. Accessed July 17, 2013.

Facts about cleft lip and cleft palate. Centers for Disease Control and Prevention (CDC) website. Available at:
http://www.cdc.gov/ncbddd/birthdefects/CleftLip.html
Updated July 15, 2013. Accessed July 17, 2013.

Risk of oral birth defects in children born to mothers taking topiramate. Food and Drug Administration website. Available at:
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm245594.htm
March 4, 2011. Accessed July 17, 2013.