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Cleft Lip and Cleft Palate

Cleft lip and/or cleft palate are disorders of the skull and face that create a separation of the parts of the lip or roof of the mouth, which are usually joined together during the early weeks of fetal development. A cleft lip is a separation of the two sides of the lip and often includes the bones of the upper jaw and the upper gum. A cleft palate is an opening in the roof of the mouth that occurs when the two sides of the palate do not fuse during fetal development. Cleft lip and cleft palate can vary in severity.

The incidence of cleft lip with or without cleft palate varies according to ethnic origin. It is most common in Native Americans and Asian-Americans and least common in African-Americans. Cleft lip occurs more frequently in males and cleft palate more frequently in females. The majority of children born with both cleft lip and palate are otherwise normal with no associated syndromes.

Parents who have had a baby with a cleft, or who have a family history of clefts, can consult a genetic counselor to discuss the risk of having future children with a cleft.

The cause of clefting is usually unknown and likely involves a combination of genetic and environmental factors. Smoking, alcohol use, poor nutrition and certain medications during pregnancy may increase the risk of clefting.

Associated Problems

Children with only a cleft lip and no cleft of the gum line or palate frequently have no other problems.

Children with a cleft palate may have ear infections and hearing loss, dental problems and difficulty with feeding and speech.

Feeding Difficulties

A child with a cleft palate can have difficulty feeding through a regular nipple due to the gap in the roof of the mouth and cannot generate enough suck to breast-feed. Both of these situations can be compensated for with the use of a special cleft palate nipple.

Speech Issues

Children with unrepaired cleft palate have difficulty generating enough air pressure to produce certain sounds and have a nasal quality to their speech due to air escaping through the gap in the roof of the mouth. Cleft palate repair, and speech therapy
if needed, can help most children with cleft palate develop near normal speech.

Hearing and Ear Infections

A child with a cleft palate is at risk of developing frequent ear infections due to malfunction of the eustachian tubes, which are supposed to drain fluid away from the middle ear. The combination of chronic fluid buildup and repeat ear infections
can lead to hearing loss. The placement of eardrum tubes can reduce the risk of ear infections and hearing loss.

Dental Concerns

A child with a cleft palate or a cleft through the gum line may have missing or abnormally shaped baby and permanent teeth. Also, jaw growth may be unequal, necessitating corrective surgery later in life.