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Cleft lip and cleft palate

Cleft lip and cleft palate are openings or splits in the upper lip, the roof of the mouth (palate) or both. Cleft lip and cleft palate result when developing facial structures in an unborn baby don't close completely.

Cleft lip and cleft palate are among the most common birth defects. Cleft lip and cleft palate most commonly occur as isolated birth defects but are also associated with many inherited genetic conditions or syndromes.

Having a baby born with a cleft can be upsetting, but cleft lip and cleft palate can be corrected. In most babies, a series of surgeries can restore normal function and achieve a more normal appearance with minimal scarring.

Symptoms Causes Risk factors Complications Prevention

Usually, a cleft — or split — in the lip or palate is immediately identifiable at birth. Cleft lip and cleft palate may appear as:

  • A split in the lip and roof of the mouth (palate) that can affect one or both sides of the face
  • A split in the lip that can appear as only a small notch in the lip or can extend from the lip through the upper gum and palate into the bottom of the nose
  • A split in the roof of the mouth (palate) that doesn't affect the appearance of the face

Less commonly, a cleft occurs only in the muscles of the soft palate (submucous cleft palate), which are at the back of the mouth and covered by the mouth's lining. This type of cleft often goes unnoticed at birth and may not be diagnosed until later when signs develop. Signs and symptoms of submucous cleft palate may include:

  • Difficulty swallowing
  • Nasal speaking voice
  • Recurring ear infections

When to see a doctor

A cleft lip and cleft palate are usually apparent at birth, and your doctor may start coordinating care at that time. If your baby has signs and symptoms of a submucous cleft palate, such as difficulty with feedings, make an appointment with your child's doctor.

Cleft lip and cleft palate occur when tissues in the baby's face and mouth don't form properly. Normally, the tissues that make up the lip and palate fuse together in the second and third months of pregnancy. But in babies with cleft lip and cleft palate, the fusion never takes place or occurs only partially, leaving an opening (cleft).

Researchers believe that most cases of cleft lip and cleft palate are caused by an interaction of genetic and environmental factors. In many babies, a definite cause isn't discovered.

  • Genes inherited from the parents. Either the mother or the father can pass on genes that cause clefting, either as an isolated defect or as part of a syndrome that includes clefting as one of its signs. In some cases, babies inherit a gene that makes them more likely to develop a cleft, and then an environmental trigger actually causes the cleft to occur.
  • Exposure to certain substances during pregnancy. Cleft lip and cleft palate may be more likely to occur in pregnant women who smoke cigarettes, drink alcohol and take certain medications.

Several factors may increase the likelihood of a baby developing a cleft lip and cleft palate, including:

  • Family history. Parents with a family history of cleft lip or cleft palate face a higher risk of having a baby with a cleft.
  • Race. Cleft lip and palate are most common in American Indian and Asian children. Black children are least likely to have a cleft.
  • Sex. Males are twice as likely to have a cleft lip with or without cleft palate. Cleft palate without cleft lip is more common in females.
  • Exposure to certain substances during pregnancy. Babies born to women who smoked or drank alcohol during pregnancy are more likely to develop cleft lip and cleft palate.
  • Being obese during pregnancy. There is some evidence that babies born to obese women may have increased risk of cleft lip and palate.

Children with cleft lip with or without cleft palate face a variety of challenges, depending on the type and severity of the cleft.

  • Difficulty feeding your baby. One of the most immediate concerns after birth is feeding. While most babies with cleft lip can breast-feed, a cleft palate can make sucking difficult or cause gagging or breast milk to come out through the nose. Your health care team will discuss feeding strategies with you, such as using a special bottle nipple.
  • Ear infections and hearing loss. Babies with cleft palate are especially susceptible to middle ear infections. Over time, repeated ear infections increase the risk of hearing loss. Your doctor may refer you to an audiologist or an ear, nose and throat doctor who may suggest regular visits to evaluate your child's hearing. Most children with clefts have tubes surgically inserted in their ears to drain fluids and help prevent infections.
  • Dental problems. If the cleft extends through the upper gum, tooth development will likely be affected. Ask your doctor whether your child should see a pediatric dentist who can monitor tooth development and oral health from an early age.
  • Speech difficulties. Because the palate is used in forming sounds, the development of normal speech can be affected by a cleft palate. Your doctor may refer you to a speech pathologist who can evaluate your child and provide speech therapy.
  • Challenges of coping with a medical condition. Children with clefts may face social, emotional and behavioral problems due to differences in appearance and the stress of intensive medical care. A psychologist and a social worker can help you and your child find ways to cope with the stresses your family encounters.

After a baby is born with a cleft, parents are understandably concerned about the possibility of having another child with the same condition. While many cases of cleft lip and cleft palate can't be prevented, consider these steps to increase your understanding or lower your risk:

  • Consider genetic counseling. If you have a family history of cleft lip and cleft palate, tell your doctor before you become pregnant. Your doctor may refer you to a genetic counselor who can help determine your risk of having children with cleft lip and cleft palate.
  • Take prenatal vitamins. Taking a multivitamin before conceiving and during pregnancy may help reduce the risk of birth defects, such as cleft lip and cleft palate. If you're planning to get pregnant soon, begin taking a prenatal multivitamin now.
  • Don't use tobacco or alcohol. Use of alcohol or tobacco during pregnancy increases the risk of having a baby with a cleft defect.
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