Word On Cleft Lip/Palate

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Cleft means 'split' or 'separation'. During early pregnancy, separate areas of the face develop individually and then join together. If some parts do not join properly the result is a cleft, the type, and severity of which can vary.

Cleft lip is a condition that creates an opening in the upper lip between the mouth and nose. It looks as though there is a split in the lip. It can range from a slight notch in the coloured portion of the lip to complete separation in one or both sides of the lip extending up and into the nose. A cleft on one side is called a unilateral cleft. If a cleft occurs on both sides it is called a bilateral cleft.

A cleft in the gum may occur in association with a cleft lip. This may range from a small notch in the gum to a complete division of the gum into separate parts.

Cleft palate occurs when the roof of the mouth has not joined completely. The back of the palate (towards the throat) is called the soft palate and the front (towards the mouth) is known as the hard palate. If you feel the inside of your mouth with your tongue, you will be able to notice the difference between the soft and the hard palate. A cleft palate can range from just an opening at the back of the soft palate to a nearly complete separation of the roof of the mouth (soft and hard palate).

Sometimes a baby with a cleft palate may have a small lower jaw (or mandible) and a few babies with this combination may have difficulties with breathing easily. This condition may be called Pierre Robin Sequence.

How does it happen?  The cause of clefts is not understood very well. Whilst we know what happens, we do not know why. Sometimes clefts run in families and sometimes a baby is born with a cleft without anyone else in the family having one.

Who treats cleft lip & palate patients?  Treatment will be provided by a team of specialists working together to make sure that the best possible treatment is given. The specialists making up a team may include the following:

    * Surgeon
    * Cleft Nurse 
    * Orthodontist
    * Paediatrician 
    * Speech and Language Therapist
    * Psychologist
    * Geneticist 

The parents of a baby born with a cleft should be contacted by someone from the regional cleft team within 24 hours of diagnosis.

When is a cleft lip repaired?  A cleft lip is usually surgically repaired by the time a baby is 2-3 months old. It requires a general anesthetic and takes roughly one and a half hours. The surgeon re-arranges the skin and muscles of the lip so no skin grafting from other parts of the body is needed.

Most babies recover very quickly and will not experience much pain after this operation. Medication is given for any discomfort. The hospital stay for this operation is between 3 - 5 days. A parent is usually welcome to stay in a hospital with the child.

Feeding after the lip operation is not usually a problem. The nurse or the speech and language therapist on the cleft team will be able to answer any questions about feeding.

When is a cleft palate repaired? The palate is usually repaired by the time a baby is a year old. The tissues of the palate are re-arranged but no extra tissue from other parts of the body is used. The operation is, like the lip repair, carried out under general anesthetic and takes approximately one and a half hours.

What other operations may be necessary? Minor improvements to the lip or nose may sometimes be required. Sometimes these are done while the child is still very young and sometimes when the child is much older when they have stopped growing.

A few children may require an extra operation to improve speech by reducing the amount of air going into the nose.

A bone graft operation is now routine where there is a cleft that extends into the gum. This normally takes place when the child is 9 or 10 and will allow the second teeth to come through in the normal positions.

Other surgery to align the top and bottom jaws may occasionally be necessary. This is carried out when a child has reached his or her full growth at about 16 to 18 years of age. Speak to someone on your cleft team for further information.

Is speech development affected by a cleft lip? Children with a cleft lip or cleft lip and gum usually develop normal speech. In infancy, the child's communication skills are usually monitored by the speech therapist on the cleft team.

What effect is cleft palate likely to have on speech?  Following the repair of the palate, the majority of children develop good speech. However, a repaired cleft palate may make it harder for a child to pronounce some sounds clearly, and this may affect the quality of speech by giving it a nasal tone.

As a result, some children will need help from a speech and language therapist.

A few children require an extra operation to improve speech by reducing the amount of air going into the nose. In infancy, the child's communication skills are checked regularly so that advice and treatment can be given to overcome any problems as early as possible.

Does a cleft affect hearing? A child with a cleft palate may sometimes have hearing problems as a result of middle ear infections and catarrh. Fluid in the middle ear is often described as "glue ear" and is also quite common in children who do not have a cleft.

In infancy, the child's hearing is monitored carefully by an ENT surgeon. Regular checks are arranged as good hearing is needed for speech and language development.

If a child has frequent middle ear problems, surgery to the ear may be recommended. This may involve placing a grommet tube into the eardrum to allow air into the middle ear. This operation can significantly improve the child's hearing.

Do a cleft child's teeth develop normally? As a child's teeth are growing in the jaw at the time a cleft occurs, the normal development of some of them may be affected. This will depend on the type of cleft the child has. The teeth of children with clefts often come through a little later than those of children who do not have clefts.

If the gum is affected by the cleft, teeth near the position of the cleft may be missing, twisted or not the right shape. Sometimes extra teeth develop. The teeth in the top and bottom jaws may not meet together properly.

It is rare for any orthodontic treatment to be carried out on a child's milk teeth. When the permanent teeth come through a brace is usually needed to correct irregularities. It is important that children born with cleft lip and/or palate, just as others, should see a local dentist from an early age for regular check-ups. He or she will need to be happy about dental examinations. It is important that the teeth are well cared for with special attention to cleaning and avoidance of too many sweets and sugary or fizzy drinks.

For more information please contact CLAPA on 0207 833 4883 

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