A crack is a space or partition in the upper lip and / or roof of the mouth (palate). It is present from birth.
The gap is there because parts of the baby’s face did not come together properly during development in the womb.
A cleft lip and palate is the most common congenital facial defect in the UK, affecting about 1 in 700 babies.
What do the lips and the cleft palate look like?
Babies can be born with a cleft lip, a cleft palate or both.
A split lip can affect only part of the lip or there can be 2 cracks.
It can range from a small notch to a large space that reaches the nose.
A split palate can be just an opening in the back of the mouth or it can be a parting of the palate that goes to the front of the mouth.
Sometimes it can be hidden by the lining of the roof of the mouth.
Problems with splitting the lip and palate
A cleft lip and a cleft palate can cause a number of problems, especially in the first few months after birth, before surgery.
Issues may include:
- feeding difficulties – a baby with a split lip and palate may be unable to breastfeed or feed on a normal bottle because they cannot form a good mouth seal
- hearing problems – some babies with split palate are more vulnerable to ear infections and fluid buildup in the ears (ear glue), which can affect their hearing
- dental problems – lips and cleft palate can mean that a child’s teeth are not developing properly and may be at higher risk for dental care
- Speech problems – if a cleft palate is not repaired, it can lead to speech problems such as blurred speech or nasal sound when a child is older
Most of these problems will improve after surgery and with treatments such as speech and language therapy.
Causes of the lips and palate
A cleft lip or palate occurs when the structures that form the upper lip or palate fail to unite when a baby develops in the womb.
The exact reason why this happens to some babies is often unclear. It is very unlikely that it was caused by something you did or did not do during your pregnancy.
In some cases, the cleft lip and palate are associated with:
- smoking during pregnancy or drinking alcohol during pregnancy
- obesity during pregnancy
- lack of folic acid during pregnancy
- taking certain medicines at the beginning of pregnancy, such as some anticonvulsants and steroid tablets
- genes that a child inherits from parents
In some cases, a cleft lip or palate may appear as part of a condition that causes a wider range of birth defects, such as 22q11 deletion syndrome (sometimes called DiGeorge or velocardiofacial syndrome) and the Pierre Robin sequence.
Diagnosis of the lip and palate
A cleft lip is usually raised during a mid-pregnancy abnormality scan, done when you are 18 to 21 weeks pregnant. Not all split lips will be evident in this scan and it is very difficult to detect a split blade on an ultrasound scan.
If a cleft lip or palate does not appear on the scan, it is usually diagnosed immediately after birth or during the physical examination of the newborn within 72 hours of birth.
When a cleft lip or palate is diagnosed, you will be directed to a special NHS splitting team who will explain the child’s condition, discuss the treatments they need and answer any questions you may have.
It may also be helpful to contact a support group, such as the Cleft Lip and Palace Association, which can provide advice and put you in touch with parents in a similar situation.
Treatments for split lips and palate
The cleft lip and cleft palate are treated at NHS specialist cleft centers.
Your child will usually have a long-term care plan that outlines the treatments and assessments they will need as they grow up.
The main treatments are:
- surgery – a split lip correction operation is usually done when the baby is 3 to 6 months old and a split palate repair operation is usually done at 6 to 12 months
- feeding support – you may need advice on positioning your baby to help him or her feed, or you may need to feed him or her using a special type of bottle
- hearing monitoring – a baby born with a split palate has a higher chance of sticking to the ear, which can affect hearing. Careful monitoring of their hearing is important and if the sticky ear significantly affects their hearing, a hearing aid can be fitted or small tubes called gaskets can be placed in the ears to drain the fluid.
- speech therapy – a speech therapist will monitor your child’s speech and language development throughout childhood and help you with any speech and language problems
- good dental hygiene and orthodontic treatment – you will be given advice on caring for your child’s teeth and they may need braces if their adult teeth do not pass properly
Perspectives for split lips and palate
Most children treated for cleft lip or palate grow up to a completely normal life.
Most affected children will not have other serious medical problems, and treatment can usually improve their appearance and feeding and speech problems.
The operation to repair a split lip can leave a small pink scar over the lips. This will fade over time and become less visible as your child gets older.
Some adults who have had a cleft lip or repair the palate may be self-aware or dissatisfied with their appearance. Your family doctor can refer you back to an NHS splitting center for further treatment and assistance if there are ongoing problems.
Will split lips and palates happen again?
Most cases of a cleft lip or palate are unique and it is unlikely that you will have another child with this condition.
The risk of having a child with a split lip or palate is slightly increased if you have had another child with the condition, but the chances of this happening are considered to be between 2 and 8%.
If you and your partner were born with a cleft lip or palate, the chance of having a cleft baby is also about 2 to 8%.
The chances of another child being born with a cleft or a parent passing on their child’s condition may be higher in cases related to a genetic condition.
For example, a parent with wiping syndrome 22q11 (DiGeorge syndrome) has a 1 in 2 chance of passing on their child’s condition.
SOURCE: NHS