<p>Sometimes, things fail to get fully “zipped up” around the mouth during development in the womb. When the structures that form the upper lip or palate don’t join properly, you get a cleft lip or palate. It’s a highly recognizable congenital deformity that you’ve probably seen on a baby or two before, and it can impact feeding, speech, hearing, and dental development if not addressed. </p> <p>While cleft lips and palates are often lumped together, they are distinct conditions that can occur separately or simultaneously.</p> <h2>Cleft lip versus cleft palate</h2> <h3>What is a cleft lip?</h3> <p>A cleft lip is a physical split or separation of the two sides of the upper lip, appearing as a narrow opening or gap in the skin of the upper lip. The severity can range from a small notch in the lip to a large opening extending up into the nose. A cleft lip can occur on one side (unilateral) or both sides (bilateral) of the lip.</p> <h3>What is a cleft palate?</h3> <p>This type occurs when the tissue that composes the roof of the mouth doesn’t join completely during pregnancy. The result is an opening that can extend into the nasal cavity, affecting the hard palate (bony front portion) and/or the soft palate (muscular back portion). </p> <figure><img src="https://cdn.storymd.com/optimized/1dmZMbILqp/original.jpg" alt width="795" height="447" /> <figcaption>Cleft Lip and Palate Repair <em>Source: BruceBlaus</em></figcaption> </figure> <h2>Causes and risk factors for both</h2> <p>It isn’t always clear why a cleft lip or palate manifests, but a combination of genetic and environmental factors is thought to be behind them. It is unlikely that either would be caused by anything you did or didn’t do during pregnancy, but in some limited cases, the issue may be linked back to:</p> <ul> <li>Family history of cleft lip or palate</li> <li>Smoking or drinking alcohol during pregnancy</li> <li>Certain medications taken during pregnancy</li> <li>Nutritional deficiencies, particularly a lack of folic acid</li> </ul> <p>Sometimes, a cleft lip or palate may come about as part of a condition connected to a wider group of birth defects, like 22q11 deletion syndrome (also known as DiGeorge or velocardiofacial syndrome) and Pierre Robin sequence.</p> <h2>Diagnosing cleft lip and palate</h2> <p>Typically, such an abnormality will be picked up by a prenatal ultrasound, perhaps as early as 16 weeks. Not all cleft lips are obvious on such a scan, however, and it isn’t always possible to detect a cleft palate using ultrasound. </p> <p>If neither shows up on the scan, they’ll be diagnosed immediately after birth or during the newborn physical examination done within 72 hours. </p> <h2>Challenges</h2> <p>Both cleft lips and palates lead to difficulties with feeding. Infants may struggle to create the necessary suction for breastfeeding or bottle-feeding.</p> <p>Speech problems are common, especially with cleft palate, because of the disruption caused to normal vocal resonance and articulation. Hearing issues can also arise (again, especially with cleft palate) due to the increased risk of ear infections and fluid buildup in the middle ear.</p> <h2>Treatment</h2> <h3>Surgery</h3> <p>Both cleft lips and palates are treated via surgery. The timing and type of surgery depend on the severity and needs of the child. Operations to correct cleft lips are normally done between 3 and 6 months of age, and for cleft palates, it’s between the ages of 6 and 12 months.</p> <figure><img src="https://cdn.storymd.com/optimized/Nq4RZZh7oK/original.png" alt width="500" height="500" /> <figcaption>Movement of the flaps; flap A is moved between B and C. C is rotated slightly while B is pushed down. <em>Source: F. Buiting</em></figcaption> </figure> <h3>Feeding support</h3> <p>Depending on the situation, you may need advice on how to correctly position your baby to help them breastfeed. Sometimes a special bottle is necessary to feed them. </p> <h3>Keeping an eye on hearing</h3> <p>Close monitoring of kids with cleft palates is particularly important as they have a higher chance of developing “glue ear”, a buildup of sticky fluid that may affect their hearing. If this is the case, a hearing aid may be installed, or else small tubes (known as grommets) may be placed in their ears to empty the fluid buildup.</p> <h3>Speech and language therapy</h3> <p>Throughout childhood, a speech and language therapist may be necessary to monitor your kid’s progress and help with any issues that arise. </p> <h3>Dental hygiene</h3> <p>Your doctor will give you advice on how to look after your child’s teeth properly with this condition in mind. They may need braces if their adult teeth don’t come in properly. </p> <h2>Facts on cleft lip and palate</h2> <ul> <li>Around 1 in 700 babies worldwide are affected. It is the fourth most common birth defect in the US.</li> <li>A case can be categorized as unilateral (affecting only one side of the mouth and face) or bilateral (affecting both).</li> <li>Cleft lips and palates are more common in boys than girls.</li> <li>They affect more children of Asian, Latin, or Native American backgrounds (fewer of African-American descent) than kids of other ethnicities.</li> </ul><h2>More on Cleft Lip and Palate</h2><ul><li><a href="https://soulivity.storymd.com/journal/pwgr5do14j-cleft-lip-and-palate" target="_blank">Cleft Lip and Palate: Causes, Diagnosis, Treatment</a></li><li><a href="https://soulivity.storymd.com/journal/vj6koy31zm-congenital-anomalies" target="_blank">Congenital Anomalies (Birth Defects): Types, Causes, Prevention</a></li><li><a href="https://soulivity.storymd.com/journal/m8k6e74hpm-birth-defects-across-lifespan" target="_blank">Birth Defects Through All Phases of Life</a></li></ul>