CleftSMALLBy David Fisher, MD, Levine Children’s Hospital

Cleft lip and palate remain one of the most common birth defects, affecting up to one in 700 live births. I meet with parents during pregnancy and newborns with cleft lip and palate all the time.  One of the most important things to explain and show with pictures and individual stories is that the diagnosis of cleft lip and palate does not have to define the children or families. We have excellent treatments and a great team of specialists who work together on all aspects of care.

What is a cleft lip and palate?

A cleft lip occurs when the normal process of the joining of the lip does not occur. Sometimes this can be linked to a specific genetic change, but most of the time this occurs spontaneously for no known reason. Sometimes there is just a small “notch” in the lip, and sometimes the cleft carries through the full height of the lip into the nose. The lip is usually seen on ultrasound during pregnancy. If there is a cleft, it is often picked up by your obstetrician.

The palate forms the roof of the mouth and is “hard” in the front (formed by some of the bones of the mid-face) and “soft” in the back (formed by muscles that help with speech and swallowing). A cleft palate occurs when the two halves of the palate do not join properly during pregnancy. It may occur along with a cleft lip, as an isolated cleft palate, or with another difference in development.

What is the soft palate?

The soft palate is the back part of the palate that contains important muscles to help with speech and swallowing. Normally the soft palate moves toward the back of the nasal passage and helps form certain sounds. When there is a cleft of the soft palate, these muscles do not connect, and the normal movement of the palate is disrupted. Children have difficulty making certain sounds (e.g. b, d, k).

What is the hard palate?

The hard palate forms the front part of the palate containing bone that supports the upper teeth and the midface. This separates the mouth from the nose and also helps with feeding and the formation of certain sounds (e.g. d, s, t).

How is a cleft lip and palate diagnosed?

A cleft lip can usually be seen on ultrasound during pregnancy, and when there is a cleft palate it may sometimes be seen. When a palate occurs on its own, it is usually seen when your child is born. Often times one of our pediatric genetics doctors will also evaluate your child after birth.

How does a cleft lip and palate impact speech?

One of the most important functions of the palate lies in the development of speech as children grow. There are physical factors (the anatomy of the palate and nerve function of the muscles) as well as cognitive factors (the brain’s ability to learn language) that work together to help children learn how to talk. The speech and language therapist plays a critical role in helping children and families develop normal speech. The plastic surgeon helps to restore normal anatomy of both the soft and hard palate.

When is a cleft palate treated?

A cleft lip is usually closed by six months of age. A cleft palate is usually closed by 18 months of age before the child begins to develop the core sounds for speech.

What does this mean for my child?

Most children can and will achieve normal speech. Some children may require additional surgery on the jaws or palate as they grow. Your cleft surgeon will follow your child to ensure they are developing normally and will coordinate care as a team with other specialists as indicated.

David Fisher, MD, is a plastic surgery specialist in Charlotte, North Carolina and practices at Levine Children’s Hospital. Dr. Fisher delivers advanced, compassionate care for children with complex conditions affecting the head and neck and performs major reconstructive procedures to correct abnormalities and improve children’s health.

This blog was produced in partnership with Charlotte ParentClick here for the original post and other parenting resources.