Oral-Facial Clefts

An oral-facial cleft is a birth defect. A cleft lip is an opening in the upper lip, usually just below the nose. A cleft palate is an opening in the roof of the mouth (hard palate) or in the soft tissue at the back of the mouth (soft palate). In the majority of cases, a cleft lip and cleft palate occur together.

Infant With Cleft Lip

© 2011 Nucleus Medical Media, Inc.

All fetuses have an opening in the lip and palate during early pregnancy. In normal fetal development, these openings close during pregnancy. Failure of one or both of these openings to close results in an oral-facial cleft. The exact cause is not known. Cleft lip occurs alone or in combination with cleft palate in approximately 1 in 750 white births, and cleft palate occurs in approximately 1 in 2,500 white births.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors for oral-facial clefts include:

• For the infant:
  • Having other birth defects
  • Sex: males
  • Having a sibling, parent, or other close relative born with an oral-facial cleft
    • A geneticist can best define the actual risk, which can vary greatly among families.
    • In general, if one child in a family has a cleft palate, the next child has about a 4% chance of also having a cleft palate. If only the lip has a cleft, the risk of this occurring in a second child is about 2%.
• For the mother during pregnancy:
  • Taking certain drugs, such as antiseizure drugs (especially phenytoin), thalidomide, or retinoic acid (used for dermatologic conditions, such as acne)
  • Smoking
  • Consuming alcohol (especially in the development of a cleft lip)
  • Having an illness or infection
  • Having folic acid deficiency at conception or during early pregnancy

Symptoms

The major symptom of a cleft lip and/or cleft palate is a visible opening in the lip or palate. Other symptoms can occur as a result of an oral-facial cleft include:

• Feeding problems (especially with cleft palate)
• Problems with speech development
• Dental problems, including missing teeth, especially when cleft lip extends to the upper gum area
• Recurrent middle ear infections
• Hearing problems

Diagnosis

A doctor can diagnose cleft lip or cleft palate by examining the newborn baby. A newborn with an oral-facial cleft may be referred to a team of medical specialists soon after birth. Rarely, a partial or “submucous” cleft palate may not be diagnosed for several months or even years.

Cleft lip and palate are sometimes associated with other medical conditions. Your doctor should be able to tell you whether or not your child’s clefting is part of a “syndrome.” Some syndromes may require treatment in addition to taking care of a cleft lip or palate.

Prenatal diagnosis (diagnosis prior to birth) can also be accomplished using ultrasound examination. Cleft lip is more easily diagnosed via prenatal ultrasound than cleft palate is. Diagnosis can be made as early as 18 weeks of pregnancy. Prenatal diagnosis gives the parents and the medical team the advantage of advanced planning for the baby’s care.

Treatment

Treatments may include:

Surgery

The main treatment is surgery to close the opening in a lip and/or palate. Additional surgical treatment for oral-facial clefts may include:

• Bite alignment surgery if the jaw is not aligned properly
• Plastic and/or nasal surgery to improve facial appearance and function

Other Treatments

Other treatments may include:

• For cleft palate:
  • Prior to surgery, temporary placement of a dental plate in the roof of the mouth to make eating and drinking easier
• For middle ear infections and fluid build-up:
  • Medications to treat infection or prevent fluid build-up
  • Surgery to drain built-up fluid and prevent future infections
• Most children with cleft palate are at risk for hearing loss which may interfere with learning language.
  • Hearing testing should be done regularly.
  • Rarely, children with cleft palate may benefit from hearing aids.

Prevention

Pregnant women and women who are likely to become pregnant can do the following to help prevent oral-facial clefts in their unborn children:

• Consume 400 micrograms of folic acid daily by taking a multivitamin or eating foods containing folic acid, such as:
  • Fruits and orange juice
  • Green leafy vegetables
  • Dried beans and peas
  • Pasta, rice, bread, flour, and cereals
• Do not smoke or drink alcohol during pregnancy.
• Take medications during pregnancy only as directed by your doctor.
• Get early and regular prenatal care.
• If you are thinking about having a child and have risk factors for oral-facial cleft:
  • Seek medical advice on additional ways to prevent the disorder.
  • Consider genetic counseling.