Cleft Palate & Lip

A cleft lip is a separation and probable deficiency of tissue of the upper lip. It is the result of the failure of the tissues to fuse during the first trimester of pregnancy.

It can occur on one side only (unilateral) or on both sides (bilateral). It may involve only a notch in the lip or extend into the nose and through the gum line (alveolar ridge).

Associated findings:

  • Breast feeding may be possible for an isolated cleft of the lip. (intact palate)
  • Associated nasal deformity
  • The cleft lip is usually not associated with other birth defects.

Initial lip and nasal reconstruction usually occurs at approximately 10 weeks of age. The alveolar cleft is repaired with a bone graft later  (at approximately 6-10 years old) depending on growth and dental development in conjunction with orthodontic management.

What is Cleft Palate?

A cleft palate is an opening in the roof of the mouth. It results from the failure of the palatal shelves to fuse during the 10-12th week of pregnancy. 

It can occur with or without a cleft lip. A submucous cleft (a separation of palatal muscles with intact mucosa) may not be detected on physical examination.

Associated findings:

  • Feeding difficulties with nasal regurgitation
  • Eustachian tube dysfunction with possible effusions, ear infection, andconductive hearing loss
  • Speech disorder

The palate is usually repaired at 9 to 12 months age. There may be a need for additional reconstruction as the child grows.

Nasal shape differences are common in people who are born with a cleft. In years past, the standard of care was to do little to the nose at the time of infant lip repair because of concerns of disturbing nasal growth. Left untreated, the resultant nasal difference was often quite severe and difficult for the affected child.

Fortunately research studies revealed surgical correction of the nose at the time of infant lip repair did not harm growth and the resultant nasal difference was much milder. Further research revealed that the infant cartilage can be molded during the first six weeks of life.

Cartilage molding has been used to correct external ear irregularities for several years. This technique has also been applied to children with cleft lip, to influence the shape of their nose prior to the initial surgery. This further improves nasal shape and alveolar position.

A range of molding techniques is used depending on the extent of the cleft. A prefabricated conformer held with special tape is often effective. Sometimes custom appliances are made in conjunction with an orthodontic type retainer.