Cleft Lip and Palate

A cleft lip (CL) is a separation in the upper lip. A cleft palate (CP) is an opening in the roof of the mouth.

Clefts result from incomplete development of the lip and/or palate in the early weeks of pregnancy. During this time the face is being formed – the top and the two sides develop at the same time and grow towards each other, finally fusing in the middle. The lip and primary palate develop at 4 to 6 weeks of gestation, while the secondary palate develops at approximately nine weeks. Clefts affect approximately 1 in every 700 babies in Ireland.

n the instance of a cleft forming, case the final closing does not fuse properly and an opening remains. The cause or causes for this failure to close are as yet not clearly understood, although research has been and continues to be undertaken. Genetics and environmental factors are both considered instrumental in causing clefts.

A submucous cleft palate is where, although the surface layers of the soft palate (mucous membrane) are complete, the underlying muscle is incomplete. A submucous cleft of the hard palate is where the bony element is incomplete. In its most minor form only the uvula is cleft, but even this leads to an abnormality in the muscles in the palate and, if the speech is affected, a repair will be required. Normal speech production is the primary goal of any surgical repair of a submucous cleft. A submucous cleft palate can prove difficult to identify, the palate appearing normal in some children. Special tests may be necessary to properly identify it.

A cleft lip or cleft palate can be either unilateral (one-side only) or bilateral (both sides). A cleft can be either complete or incomplete. A complete palatal cleft involves both the primary and secondary palate, while an incomplete cleft involves the secondary palate only.

A child may be born with either a cleft lip or cleft palate or both. Combined cleft lip and palate (CLP) represents approximately 50% of incidents, cleft palate alone c.30%, and cleft lip alone c.20%. ((Young, Greg, M.D. (1998). Cleft Lip and Palate. [Online] 28 January 1998. Available from http://www2.utmb.edu/otoref/Grnds/Cleft-lip-palate-9801/Cleft-lip-palate-9801.htm [verified 26 March 2001])) (These ratios are at slight variance with figures reported from Denmark and the UK. SEE The Incidence of Cleft. Other reports have also given slightly variant figures).

What can be done?

Cleft lip and cleft palate are correctable birth defects. Treatment of cleft begins within months of birth with corrective surgery, and continues in one form or another until the person reaches their late teens.

Primary surgery begins with the lip repair at about 3 or 4 months and palate repair between 6 and 12 months. Cosmetic surgery on the nose may occur before the child attends school. A corrective rhinoplasty may be performed on the nose in the teenage years. Orthodontic surgery begins with maxilla expansion at around 9 to 10 years followed by bone grafting. Further corrective surgery (an osteotomy) may be carried out at about 18 years.

Cleft lip and palate treatment involves a multidisciplinary team including a plastic surgeon, ENT surgeon, maxillofacial surgeon, orthodontist, and speech and language therapist.