Understanding Cleft Lip and Palate: Diagnosis, Treatment, and Support

Highlights

• A cleft lip or palate happens when parts of the lip, upper jaw, or roof of the mouth don’t properly join during fetal development.
• It can cause difficulties with breastfeeding or bottle feeding and later with speech development.
• Surgical intervention can address these issues and aid in the child’s appearance and speech development.

In This Article

• Understanding Cleft Lip or Palate
• Signs and Symptoms
• Diagnosing Cleft Lip or Palate
• Treatment Options
• Who Will Support My Baby’s Care?
• Possible Complications
• Support and Resources

Understanding Cleft Lip or Palate

A cleft lip or palate occurs when parts of the lip, upper jaw, or roof of the mouth do not properly form during early fetal development, resulting in an opening or gap. This is a congenital condition, present from birth.

Signs and Symptoms

The specific symptoms depend on which areas of the mouth or lip fail to join properly:

• Cleft Lip and Palate: A gap can form when the upper lip, gums, and roof of the mouth do not merge properly, either unilaterally (on one side) or bilaterally (on both sides).
• Cleft Lip: Occurs when the upper lip doesn’t fuse properly, typically between the 7th and 9th week of pregnancy. This may appear as a notch in the gum.
• Cleft Palate: The roof of the mouth may have a gap when the bones and soft tissues don’t merge correctly, forming a hole in the palate.

Diagnosing Cleft Lip or Palate

Cleft lip or palate is typically diagnosed right after birth, but it may be detected earlier with an ultrasound around the 18th week of pregnancy. If the condition is suspected, further diagnostic tests, such as amniocentesis, may be advised.

Treatment Options

There are various treatments available for babies born with a cleft lip or palate:

• Surgical repair of the cleft lip and palate
• Speech therapy to address developmental speech difficulties
• Feeding assistance to help with breastfeeding or bottle feeding

Who Will Support My Baby’s Care?

Babies with a cleft lip or palate will be cared for by a specialized team of healthcare professionals, including:

• Cleft coordinator
• Pediatrician
• Speech pathologist
• Lactation consultant
• Dietitian
• Audiologist
• ENT surgeon
• Social worker
• Dentist
• Orthodontist

Regular check-ups at a cleft clinic are important throughout childhood, with visits typically at:

• 18-24 months
• 3 years
• 5 years
• 8 years
• 12 years
• 16-18 years

Surgical Intervention for Cleft Lip or Palate

Surgical procedures can improve both appearance and speech development:

• Cleft Lip Repair: Typically performed between 3 and 6 months of age.
• Cleft Palate Repair: Usually performed between 9 and 18 months, though additional procedures may be needed.

Surgery is conducted by a specialist plastic surgeon in a hospital.

Feeding Assistance

Babies with cleft lip or palate often face challenges with feeding. Special techniques may include:

• Specialized bottles with unique nipples
• Nasogastric tube feeding if required

Healthcare professionals, such as midwives, will guide parents on proper feeding strategies.

Possible Complications

As children with cleft lip or palate grow, they may face challenges such as:

• Hearing problems
• Speech difficulties
• Dental issues

Additional concerns may include:

• Frequent ear infections
• Tooth decay
• Jaw development problems
• Speech that sounds nasal

The cleft repair surgery may leave visible scars, and some children may experience changes to the appearance of their nose, gums, and teeth, potentially affecting self-esteem.

Tools and Assistance

1. Feeding Assistance Tools
   Babies with a cleft lip or palate may require specialized feeding bottles with unique nipples designed for easier sucking. Additionally, a nasogastric tube can be used in certain cases to assist with feeding.
2. Speech Therapy Tools
   Speech pathologists work closely with children with clefts to help develop normal speech. Techniques such as oral motor exercises, articulation practice, and other specialized therapies can support speech development.
3. Surgical Planning
   For cleft lip and palate surgery, planning tools like 3D imaging can be used by surgeons to determine the most effective approach for repair. Tools for pre-surgical assessment help healthcare providers plan surgeries according to the child’s specific needs.
4. Hearing Screening Tools
   Regular hearing tests are essential for children with cleft lip or palate as they are at higher risk for hearing issues. Audiology tools help assess the child’s hearing ability and detect any early hearing problems that could affect speech development.
5. Orthodontic Tools
   Orthodontic assessments are crucial as children with clefts may require braces or other dental interventions to correct teeth alignment and jaw development. Specific orthodontic tools help in shaping and guiding proper dental development.
6. Cleft Lip/Palate Repair Surgical Tools
   During surgery, specialized tools are used to close the gap in the lip or palate. Surgeons utilize precise instruments for tissue repair, stitching, and creating a smooth, functional appearance and structure.
7. Psychological and Emotional Support
   Psychological tools, such as therapy sessions and counseling, provide emotional support for families and children. This is important for addressing issues of self-esteem or anxiety that may arise from physical appearance changes after surgery.
8. Follow-up Care and Monitoring
   After surgery, follow-up care tools, including growth charts and developmental milestones, are used to track the child’s progress and ensure that the lip and palate continue to develop normally.