Cleft Palate and Cleft Lip

A gap or a split in the upper lip and/or the roof of the mouth (palate) is called a cleft. Cleft palate and cleft lip are birth defects in an infant’s mouth or lip because parts of the mouth are fused incompletely during early pregnancy. A cleft lip, palate, or both (orofacial clefts) can happen to a baby. Children born with these conditions may require a tailored approach to care.

What is cleft palate?

A cleft palate happens when the tissue that forms the roof of the mouth (palate) does not fuse wholly during pregnancy, which can cause an opening in the hard palate (the front bony part of the roof of the mouth) and/or the soft palate (the soft back part of the roof of the mouth). In some cases, a submucous cleft palate might be present, where the surface of the palate appears normal but the underlying muscles or bone are affected.

What is cleft lip?

A cleft lip occurs when the lip does not develop completely during foetal growth. It can span from mild (notching of the lip) to serious (big opening from the lip up to the nose). A cleft lip can be either unilateral cleft lip (one side of the lip) or bilateral cleft lip (both sides of the lip).

What are the causes and risk factors?

The causes of cleft palate and cleft lip are not completely known, but it is suspected that they result from genetic and environmental factors. The potential risk factors include:

1. You have a family background of cleft palate/lip.
2. A deficiency in folic acid.
3. Smoking when you are pregnant.
4. Substance abuse when you are pregnant (alcohol, illicit drugs).
5. Specific types of medications taken when you are pregnant (anti-seizure medications, cancer drugs).
6. You are diagnosed with diabetes before you get pregnant.
7. Obesity when you are pregnant.

How are cleft lip and palate diagnosed?

A cleft lip can usually be detected during a standard prenatal ultrasound. It is normally apparent during a newborn’s first examination. However, specific types of cleft palate (isolated cleft palate, with no cleft lip present) may be harder to detect and might go undiagnosed until the later stages of life.

What are the potential complications?

If the following conditions are left unaddressed, the complications will negatively affect the growth and development of the affected children.

• Feeding challenges: Infants may find breastfeeding challenging because they are unable to form a good seal surrounding the nipple. Solid food and liquids may travel from the mouth back up through the nose.
• Ear infections: Children with cleft palates tend to have fluid buildup in the middle ear, which can cause ear infections and hearing loss if left unaddressed or it happens constantly.
• Speech and language challenges: Children with a cleft palate/lip may sound nasally and face challenges in articulating words, and mainly, difficulties in being understood. Specialised support for cleft palate speech can make a significant difference in these children's communication skills.
• Dental issues: They are susceptible to missing, misshapen, or misaligned teeth and cavities. These children may have defects of the alveolar ridge (the bony upper gum surrounding the teeth) which could hinder permanent teeth from appearing and lead to the early loss of canine/incisor teeth.

What are the treatment options?

Children with orofacial clefts go through different types of services and treatments based on the seriousness of their clefts, ages and specific needs, and the presence of other existing birth defects and associated syndromes. Throughout their care journey, they are supported by a multidisciplinary cleft team that includes surgeons, speech therapists, orthodontists, and other specialists.

Surgical treatment

• Cleft lip repair is normally done when the infant is between 3 and 6 months old.
• Cleft palate repair is usually performed between the ages of 9 and 18 months old.

Non-surgical treatment

• Babies with cleft lip or palate can be helped through special feeding bottles and nipples to feed more effectively. Guidance and support can be provided by a feeding specialist or lactation consultant.
• Speech therapy can help many children with cleft palates to aid them in developing normal speech patterns. The child can seek assistance from a speech-language therapist to address any speech and language problems. 
• Frequent hearing evaluations are crucial, as children with cleft palates are at elevated risk for ear infections and loss of hearing. Fluid buildup and infections can be prevented by inserting ear tubes. 
• Orthodontic treatment may be required to fix misaligned teeth and bite problems. This treatment option can include braces and other dental appliances.
• The child and family can benefit from psychological support and counselling to address any emotional and social issues concerning the cleft condition.

Book an appointment at Pantai Hospitals

Parents may first feel overwhelmed by a cleft palate / cleft lip diagnosis, and this is to be expected. However, a consultation with an experienced healthcare professional can provide you with some reassurance, assist with treatment planning, and help make sure the child leads a normal childhood.

If you have any concerns regarding a cleft palate or cleft lip, get in touch with us to find out more about our Paediatric services at your nearest Pantai Hospital.

Pantai Hospitals has been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.