Cleft Lip and Palate - Specialists & Information

The malformation develops in the womb when certain parts of the face do not fuse completely—or at all—during fetal development. In addition, tissue that has already fused may split open again.

The resulting malformations vary greatly depending on when they occur during embryonic development:

In the case of a simple cleft lip, for example, only the upper lip is affected. The cleft is located between the red lips and the nostril.

Children with a cleft lip and palate have a cleft along the philtrum (the groove between the nose and the center of the upper lip) and the lateral upper incisor.

In the worst-case scenario with a cleft palate, the mouth and nasal cavity are not separated from one another. If the child has both malformations, they have a cleft lip, jaw, and palate.

Based on current medical knowledge, it is unclear exactly what triggers this malformation during pregnancy. Medical experts suspect a genetic cause: if one parent has a cleft, the likelihood of cleft formation in their children is slightly increased.

If both parents are affected, the child has a 35% risk, as the condition is inherited through multiple genes.

Other factors that may contribute to the developmental abnormality include:

• Oxygen deprivation in the expectant mother (hypoxemia)
• Excessive alcohol consumption
• Heavy tobacco use
• Ionizing radiation (e.g., during radiation therapy)
• Environmental toxins (dioxin)
• Excessive intake of vitamins A and E
• A deficiency of folic acid
• Rubella infection in pregnant women
• Fever
• Uterine bleeding
• Use of antiepileptic medications (hydantoin)

If several of these factors are present, the risk that the child will be born with a cleft lip and palate is significantly increased.

The malformation can already be clearly seen on an ultrasound image as early as the 20th week of pregnancy. After birth, it is evident that the child has a deviated nasal septum. One nostril is also flatter than the other. This impairs breathing.

The cleft palate causes problems with sucking: food repeatedly enters the nasal cavity. Breastfeeding is also more difficult than for children without this malformation. It is virtually impossible without special aids such as a Haberman Feeder or a palatal plate.

When the affected child begins to speak, the cleft lip and palate cause a nasal tone and a “throaty” pronunciation of certain sounds. It also leads to ear, nose, and throat conditions such as middle ear infections and hearing loss, which in turn can impair speech development.

Other symptoms include:

• Missing teeth
• Misaligned teeth
• Increased plaque buildup and tooth decay

Treatment of the malformation usually begins within the first few days of the child’s life. By the time the child starts school, treatment should be far enough along to ensure normal development thereafter. Further treatment may also be necessary in early adulthood.

Immediately after birth, babies with a unilateral cleft lip and palate are fitted with a removable palatal plate. It separates the mouth from the nasal cavity and promotes the fusion of the jawbones. It also ensures that the child’s tongue becomes accustomed to its anatomically correct position.

The palatal plate enables nasal breathing and facilitates breastfeeding and bottle-feeding. If ENT specialists fear that a middle ear infection may develop, they insert ventilation tubes to ensure adequate ventilation of the ear.

After 3 days, but no later than 6 months, doctors close the cleft through facial surgery. This is done either in several operations or in a single surgical procedure.

Doctors perform these primary surgeries before the child begins to speak. At the very latest, they do so once they are certain that the surgery will not inhibit jaw growth.

For babies with a bilateral cleft lip and palate, doctors must also surgically lengthen the nose (columelloplasty). If the cleft compromises the stability of the jawbone, they perform a secondary surgery.

For cleft jaw osteoplasty, they graft bone tissue from the pelvic bone into the jawbone. This ensures that the adult dentition will be more durable later in life.

A successful treatment of a cleft lip and palate @ jorgecachoh /AdobeStock

Once the nose has finished growing, surgeons straighten the bony part of the nose. They reshape the lips and correct the nose to improve the patient’s appearance.

To enable the child to speak normally, doctors reshape the soft palate using a velopharyngoplasty. Subsequent treatment by a speech therapist is then necessary. The therapist works with the patient to practice the correct pronunciation of certain sounds that were previously mispronounced.

The orthodontist corrects any misalignments of the teeth that have developed as a result. Regular hearing tests are conducted to prevent hearing loss.

Since children with cleft lip and palate are often teased, they may develop psychological problems. It is therefore advisable to take advantage of psychological support services. Alternatively, a support group is a good option. It can provide affected parents with advice and practical support.