Cleft Lip and Cleft Palate Information

Dr. Daggett is proud to be an integral part of the ETCH cleft lip and palate team where children born with cleft lip and palate can receive comprehensive and individualized care.

Care Teams


What is cleft lip and cleft palate?

A cleft lip and cleft palate is an opening in the upper lip or the top of the mouth (palate). These are present when the child is born and can occur individually or in conjunction.

Before and After

Cleft Palate Child 1
Cleft Palate Child 2

Cleft Palate Child 3

Cleft Palate Child 4

Cleft Palate Child 5


What causes cleft lip and palate?

Cleft lip and palate are one of the most common birth defects seen in children, occurring in roughly 1 in 2000 children. Many people are unaware that each person actually starts their life with both a cleft lip and palate which close during the course of normal development. In some children one or both of these fail to close resulting in the presence of a cleft lip and/or cleft palate at birth.

What causes this failure to close is each individual child is often poorly understood and for the majority of children no clear single cause is found. We do however know that both genetics and environmental factors can contribute to cleft lip and palate.

Genetic causes are derived from changes in a child's DNA and can take the form of unique mutations or well known patterns of mutations known as syndromes. These can be evaluated with the help of a genetic counselor or geneticist.

Some common syndromes associated with cleft lip and /or palate include:

  • Van der Woode Syndrome
  • Stickler syndrome
  • Pierre Robin Sequence
  • Hemifacial microsomia/ Goldenhar syndrome
  • Down's Syndrome
  • CHARGE syndrome
  • 22q / velocardiofacial syndrome
  • DiGeorge Syndrome
  • Oro- mandibular limb hypoplasia syndrome

Will I have another child with a cleft lip?

While the exact risk of having another child with a cleft varies depending on family history, genetics and other associated factors, for most families this risk is low, between 2-8%. The same is true when these children grow up and have their own children. In the majority of cases their children are unlikely to be born with a cleft.

What problems can cleft lip and palate cause?

Children born with a cleft lip and palate (and their parents) face some unique challenges. However, at ETCH our dedicated cleft team is there to help you manage and overcome these.

Feeding

The first and most common challenge for children born with a cleft lip or cleft palate is difficulty eating. Children with a cleft palate are unable to create the suction needed for normal nursing and bottle feeding. This can cause them to have to work harder during feeds and can lead to poor weight gain. For this reason children with a cleft often require special bottles and modifications to their feeding. Parents of a new child with a cleft will receive individualized teaching on cleft feeding from our speech and language pathologists as a part of their care with the ETCH cleft team.

Ear infections/Hearing loss

Ear infections are much more common in children with a cleft palate due to a buildup of fluid in the middle ear. Repeated infections can lead to hearing loss if un-treated. Luckily this buildup is easily treated with ear tubes which can be placed by an Otolaryngologist (Ear, Nose and Throat doctor). These are often placed at the time of lip or palate repair.

Poor speech/language delay

The palate plays an important part in normal speech and this can be disrupted in children with a cleft. For this reasons the cleft palate is repaired before children begin speaking to allow for the normal development of speech. In some children, palate dysfunction (often called velopharyngeal dysfunction or VPI), can persist even after the palate is repaired. These children may require an additional operation to allow normal speech.

Dental and jaw problems

Children with a cleft often develop dental issues as they grow. This most commonly takes the form of crowded or poorly positioned teeth but can also include missing or even extra teeth. Clefts can also cause poor growth of the upper jaw leading to poor alignment of the teeth, difficulty chewing and changes in face shape. These problems can be treated by our specialists through jaw surgery.

Nasal obstruction

It is common for children with a cleft lip to have a deviated septum, a twist or bend in the middle wall of the nose leading to difficulty breathing through one or both nostrils. This can be straightened through a septoplasty to relieve this difficulty.


Overview

What is the difference between cleft lips and cleft palates?

A cleft lip is an opening in the upper lip; a cleft palate is an opening in the roof of the mouth. In both cases, an opening forms because the facial structure doesn't close completely during development. A child can be born with one or both of these conditions.

Cleft lips

A cleft lip is a split in the upper lip. A baby can have a cleft on one side or both sides of their lip. A cleft lip can also extend up into the nose. Nearly 4,500 children are born each year with the condition, making it one of the most common congenital abnormalities.

Types of cleft lip

There are five types of cleft lip. These are:

  • Forme fruste or microform cleft lip: A small indentation on one or both sides of the lip
  • Incomplete unilateral cleft lip: An opening on one side of the lip that does not extend into the nose
  • Complete unilateral cleft lip: An opening on one side of the lip that extends up into the nose and typically involves the gum ridge and palate
  • Incomplete bilateral cleft lip: Openings on both sides of the lip that do not extend into the nose
  • Complete bilateral cleft lip: Openings on both sides of the lip that extend up into the nose and typically involve the gum ridge and palate

Cleft palates

A cleft palate is a split in the roof of the mouth. Each year, about 2,500 babies are born with this condition.

Types of cleft palate

There are three types of cleft palate. These are:

  • Incomplete cleft palate: Opening in the back of the mouth, called the soft palate
  • Complete cleft palate: Opening in the front and back of the mouth, or the soft and hard palates
  • Submucous cleft palate: Muscles within the soft palate are separated or cleft but the skin or mucous membrane is closed. At times the uvula may be bifid

What causes cleft lips and cleft palates?

Both of these conditions form during early pregnancy. Experts aren't sure what causes them, but the conditions could develop if:

  • There are changes in the baby's genes
  • The mother has a disease, such as diabetes
  • The mother uses certain drugs for epilepsy in early pregnancy
  • The mother smokes or drinks alcohol in early pregnancy

Who is at risk for cleft lips and cleft palates?

Risk Factors

Both non-preventable factors, such as family history, and lifestyle risks, such as smoking, can increase your chance of having a child with cleft lip or cleft palate. You may be more likely to have a baby with one or both of these conditions if:

  • A family member has one of these conditions
  • The mother is diabetic
  • The mother smoked or drank alcohol in early pregnancy
  • The mother used certain medicines in early pregnancy

Complications

Babies with cleft lips or cleft palates may struggle to feed because they can't suck or swallow properly. As the child grows, they may have problems with:

  • Hearing
  • Teeth development
  • Speech
  • Social development

Can you prevent cleft lips and cleft palates?

If you're planning to become pregnant, you may be able to reduce the chance of having a child with these conditions by:

  • Taking prenatal vitamins
  • Avoiding alcohol
  • Avoiding smoking
  • Talking to your doctor about medicines you're taking
  • Making sure you're as healthy as possible before becoming pregnant

Where do I start getting care for my child with cleft lip and palate?

The 1st and most important step in getting care for your child with cleft lip and palate is to find a certified cleft team. This helps to ensure your child can get access to all of the help and services needed to allow him or her to develop into the wonderful person they were meant to be. The ETCH cleft team is the longest running actively accredited team in Tennessee and is dedicated to providing top quality care to every child we see.


American Cleft Palate-Craniofacial Association (ACPA)Parents can also look of other accredited teams near them using the ACPA Find a Team Page

East Tennessee Children's Hospital
Pediatric Plastic and Reconstructive Surgery

865-824-4939
Medical Office Building, Suite 510
2100 Clinch Ave.
Knoxville TN 37916
(Directions)

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  • Tuesday: 8 A.M. to 4:30 P.M.
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