Cleft Palate and Cleft Lip: Everything to Know

Medically Reviewed By Karen Gill, M.D.
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Collectively called orofacial clefts, cleft palate and cleft lip are types of congenital disabilities. They occur when a fetus’s mouth or lip does not form correctly during pregnancy. A baby can be born with either a cleft lip or a cleft palate. They may also be born with both. The cause of most clefts is unknown.

Read on to find out more about cleft palate and cleft lip. This guide includes information about possible causes, risk factors, and treatments.

What is the difference between a cleft palate and cleft lip?

There is a baby with a cleft lip.
Margaret Vincent/Stocksy United

Both cleft palate and cleft lip are orofacial clefts. A cleft lip affects either or both sides of the lip. A cleft palate, however, refers to an opening in the roof of the mouth.

Cleft lip

A cleft lip occurs due to lip tissue not joining up completely before birth. The opening in the upper lip can appear as a slit or notch, or it may be a larger opening. In some cases, it can extend to the nose.

A cleft lip can affect one or both sides of the lip. In rare cases, it can also affect the middle of the lip.

Types of cleft lip include:

  • Forme-fruste cleft lip: This is a much more subtle type of cleft lip, which appears as a slight indentation
  • Incomplete unilateral cleft lip: In this type, the cleft lip is on one side of the lip and does not extend to the nose.
  • Complete unilateral cleft lip: In this type, the cleft lip is on one side of the lip and extends to the nose.
  • Incomplete bilateral cleft lip: In this type, there are openings on either side of the lip. However, they do not extend to the nose.
  • Complete bilateral cleft lip: In this type, there are openings on either side of the lip, and they extend to the nose.

Cleft palate

A cleft palate occurs when the tissue of the palate, or roof of the mouth, does not completely join together during pregnancy. A cleft palate can affect only part of the palate, or both the front and back parts of the palate may be open.

Types of cleft palates include:

  • Incomplete cleft palate: With this type, the opening occurs at the soft palate at the back of the mouth.
  • Complete cleft palate: With this type, the openings occur at the soft palate at the back of the mouth and the hard palate at the front of the mouth.
  • Submucous cleft palate: With this type, the soft palate muscles are separate, but the skin or mucous membrane remains closed. The uvula may appear split in two, called a bifid uvula or cleft uvula.

What do a cleft palate and cleft lip look like?

View the slideshow below for pictures of cleft palate and cleft lip.

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This shows a cleft lip.

Bronwynn Wessels/EyeEm/Getty Images

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This shows a complete unilateral cleft lip.

Angela Meier/Shutterstock

Baby with cleft before and after surgery

This shows a complete unilateral cleft lip before and after surgery.

Maos/Getty Images

Can a cleft lip and cleft palate occur at the same time?

A baby can be born with both a cleft palate and a cleft lip. Around 1 in every 1,600 babies in the United States is born with both a cleft lip and a cleft palate.

This compares with 1 in every 2,800 babies born with a cleft lip without a cleft palate.

Around 1 in 1,700 babies are born with a cleft palate.

What causes cleft lips and cleft palates?

The cause of cleft lips and cleft palates is typically unknown.

Some babies may be born with an orofacial cleft due to changes in their genes.

A cleft palate or lip may happen if the baby has a condition that causes other congenital disabilities. This includes Pierre Robin sequence and 22q11 deletion syndrome, also known as DiGeorge or velocardiofacial syndrome.

Research into the causes of orofacial clefts is ongoing.

Can a doctor diagnose cleft palate or lip during pregnancy?

A doctor can usually diagnose a cleft lip with an ultrasound during pregnancy. This includes cleft lips with and without cleft palate.

They can also diagnose cleft lip and cleft palate once the baby is born. However, diagnosing submucous cleft palate may not be possible until later in life.

The doctor may also carry out an amniocentesis during pregnancy to see if the orofacial cleft results from a genetic condition. During this procedure, they will insert a long needle through your abdomen and into the amniotic sac. They will then be able to draw out some amniotic fluid for laboratory testing.

Contact your doctor if they have diagnosed a cleft palate or lip and you wish to discuss an amniocentesis.

How are cleft palates and lips treated?

Surgery to repair a cleft lip typically occurs within the first few months of an infant’s life. Medical professionals recommend repairing a cleft lip within the first 12 months of the baby’s life. For a cleft palate, experts recommend repairing it within the first 18 months.

Additional surgery may also be necessary once the child gets older.

In addition to repairing the appearance of the congenital disability, surgery for orofacial clefts can also improve:

  • breathing
  • hearing
  • speech and language development

Specially designed baby bottles can help with feeding before surgery.

Depending on the cleft’s severity and the surgery’s effectiveness, a child may benefit from speech and language therapy as they grow up. Therapy can also help with self-esteem issues arising from any visible signs of the condition.

Learn more about:

Will I have another child with an orofacial cleft?

If you have a baby with a cleft lip or cleft palate, you may have concerns about any other children you carry developing a similar condition.

However, the likelihood of having another child with an orofacial cleft only slightly increases, unless the condition occurs due to genetics.

If one of the baby’s parents has a genetic condition such as 22q11 deletion syndrome, there is a 50% chance that this will also affect the baby.

What are the complications of a cleft palate and lip?

Various complications can occur due to a cleft palate or cleft lip, particularly before surgery.

Possible complications include:

  • Feeding difficulties: A cleft lip and palate can make breastfeeding and bottle feeding difficult, particularly if the baby cannot form a seal with their mouth.
  • Breathing difficulties: A cleft lip can cause breathing difficulties, particularly if it results in a deviated septum. A septoplasty can help to rectify this by straightening the septum.
  • Ear infections: Having a cleft palate may make a baby more susceptible to ear infections. Fluid buildup may also lead to conditions such as glue ear, which can impact their ability to hear clearly.
  • Dental problems: Teeth may not develop properly if a baby has an orofacial cleft. This can also increase their risk of tooth decay.
  • Speech problems: A child may experience problems with speech if they do not receive treatment or surgery for a cleft palate.
  • Jaw discrepancy: A child’s upper and lower jaw may grow at different rates if they have an orofacial cleft. This discrepancy can cause complications with chewing food, early jaw-joint arthritis, and incorrect teeth alignment.

What are the risk factors for cleft palate and lip?

The causes of orofacial clefts are usually unknown. However, certain risk factors make a baby more likely to develop a cleft lip or cleft palate.

Possible risk factors for orofacial clefts include:

  • smoking during pregnancy
  • having diabetes
  • taking certain epilepsy medications during the first trimester, including:
    • topiramate
    • valproic acid

Contact your doctor if you have concerns about the risk factors for cleft palate and lip.

What is the outlook for a baby born with a cleft lip or palate?

Following surgery, most children born with a cleft lip or cleft palate will lead ordinary lives without experiencing any serious related medical conditions.

Surgery will help to improve the child’s ability to feed. Problems with speech will usually go away, though some children may benefit from speech therapy.

Surgery may leave a small scar above the lips. This is not a permanent scar. It should fade with time, though it may not always completely disappear.

Is it possible to prevent a cleft palate and lip?

Medical professionals often do not know the cause of lip and cleft palates. Therefore, it may not be possible to prevent orofacial clefts.

However, there are steps you can take to help to reduce the likelihood. These steps include:

  • taking a folic acid supplement at the advice of your doctor
  • quitting smoking during pregnancy
  • avoiding drinking alcohol during pregnancy
  • having a health checkup if you are thinking about starting a family
  • maintaining a healthy weight as determined between you and your doctor

Smoking and drinking alcohol during pregnancy can also harm a baby in other ways. Contact your doctor for advice about making changes to your diet and lifestyle. Your doctor will also be able to provide information about any medications you are taking and the effects they may have on a fetus.

Summary

Cleft lip and cleft palate are both types of orofacial clefts. These conditions occur when the tissues in the lip or mouth do not form properly during pregnancy. Surgery can help correct a cleft, usually occurring within the first few months of an infant’s life.

Cleft palate and lip can cause feeding, breathing, and speech development difficulties. Surgery, special bottles, and language therapy can all help a child with a cleft palate or lip.

Contact your doctor if you are pregnant and have concerns about orofacial clefts. It is possible to diagnose a cleft during an ultrasound.

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Medical Reviewer: Karen Gill, M.D.
Last Review Date: 2022 Jun 24
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