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What is a Cleft Lip and Cleft Palate?

By November 26, 2021February 16th, 2022Blog
what is a cleft lip

What is a cleft lip and why is it a concern for parents?

A cleft palate or cleft lip is something that, understandably, can cause great concern for parents at first. However, whether a cleft lip is seen on an ultrasound during pregnancy or in real life at birth, efforts to treat it can begin as soon as the baby is born. On your medical team? Doctors, surgeons, and nurses are a given. But you might be surprised to know that an orthodontist like Dr. Buddy Davis, a fellowship-trained craniofacial orthodontist, also plays a key role in cleft lip or palate treatment.

In this post, we want to cover everything you need to know about cleft lips and cleft palates. We’ll answer the questions:

What is a cleft lip or cleft palate?

Statistics show that each year in the United States, about 2,650 babies are born with a cleft palate and 4,440 babies are born with a cleft lip, with or without a cleft palate. Although it’s a condition that many people have heard of, you might not know how it comes to be. Cleft lips and cleft palates — also called orofacial clefts — happen when the tissue on a baby’s face doesn’t fuse together in the middle during pregnancy. During weeks 4-7 of pregnancy, body tissue and special cells from each side of the baby’s face grow towards each other and join, forming facial features like the lips and mouth.

A cleft lip means the lip tissue doesn’t completely join together, leaving an opening in the upper lip. This gap can vary in size, from a narrow slit to a large opening that goes from the lip up to the nose. A cleft lip is typically either to the left or right of center, or on both sides. Only in rare cases is the opening exactly in the middle. Children with a cleft lip can also have a cleft palate.

Now, a cleft palate is different. The palate — or roof of your mouth — normally forms between weeks 6-8 of pregnancy. If this doesn’t happen, then either both the front and back parts of the palate are open or only part of the palate. Babies who have a cleft palate don’t necessarily have a cleft lip too.

A typical cleft palate is diagnosed easily enough because a doctor can see it. But there are two types of cleft palate that aren’t always diagnosed right away because they’re harder to see. A  submucous cleft palate is a cleft that is under mucous membrane tissue – the tissue that covers the palate. It’s often not found until the child who has it starts showing signs of difficulty with feeding or eating, difficulty speaking, has chronic ear infections, speaks with a nasally-sounding tone, or you can hear air leaking out of their nose when they speak.

Another type of cleft palate that is sometimes not identified at birth is a bifid uvula, also called a cleft uvula. You’re most likely familiar with the uvula; it’s the hanging tissue at the back of your throat. When formed normally, it looks like a teardrop shape, but a cleft uvula is split in two.

What causes a cleft lip or cleft palate?

There isn’t one direct and conclusive reason for what causes a cleft lip or what causes a cleft palate, but you might be asking, “Is a cleft lip or cleft palate genetic?” Yes and no. A cleft lip or cleft palate can be hereditary, either on its own or as part of a genetic issue that includes a cleft as one of its signs. Some babies inherit a gene that makes them more likely to develop a cleft but don’t develop one in the end, while others who have the gene might be exposed to external factors that trigger it. 

On the flip side, researchers believe that a cleft lip or cleft palate can also happen without a genetic predisposition — when genes are affected by environmental factors. Certain lifestyle habits, things that a pregnant woman eats, drinks, or comes in contact with can contribute to an orofacial cleft. The CDC lists several factors that can increase the chances of a baby having a cleft lip or cleft palate:

  • Smoking or exposure to air pollutants: Women who smoke during pregnancy are more likely to have a baby with a cleft than women who don’t smoke.
  • Diabetes: Having diabetes before pregnancy can introduce an increased risk of having a child with a cleft lip compared to women who didn’t have diabetes. Women who have gestational diabetes aren’t part of this group. 
  • Some medications: Certain medications that treat epilepsy, like topiramate or valproic acid, can increase the risk of a cleft lip if the mother is taking it during her first trimester.
  • Obesity: Some evidence suggests that babies born to obese mothers have a higher risk of developing an orofacial cleft.

Complications of a cleft lip or palate

Children with a cleft lip face a variety of challenges, whether they also have a cleft palate or not: 

Nursing – One of the first concerns with a newborn that has an orofacial cleft is feeding. Nursing is challenging enough those first few days of infancy, and although most babies with a cleft lip can breastfeed, a cleft palate may make a proper latch and sucking more difficult for the baby and mother.

Ear Infections – As any parent knows, babies and young children are sometimes more susceptible to getting ear infections than older kids. Babies with a cleft palate are especially at risk of developing middle ear fluid and experiencing hearing loss.

Speech Difficulties – The palate and lips are integral when it comes to forming sounds and words. So if a child has an orofacial cleft, especially a cleft palate, development of normal, clear speech can be difficult or sound nasally.

Dental Issues – A cleft lip and cleft palate can affect a child’s dental development. It can impact the alignment, size, shape, and number of teeth that grow in. Specifically, a child born with an orofacial cleft is more likely to have fewer or too many teeth, a narrow upper jaw that can lead to a misalignment bite, crowding, or crooked teeth.

If the cleft extends through the upper gum, problems with chewing can occur. And with a cleft lip, increased openness to the air can dry up saliva, encouraging a drier oral environment where bacteria thrives. Studies have also shown that those with orofacial clefts may have abnormal salivary glands. This can impact their oral health and, as a result, they may have a higher rate of tooth decay. In these cases, it’s super important to have an excellent oral hygiene routine.

Difficulties Coping With Their Condition – It goes without saying that children with cleft lips or palates come up against many challenges, many of which we’ve talked about above. But in addition to those physical issues, it’s not surprising that social, emotional, and behavioral problems can arise from dealing with those complications, with looking different, and from the stress of medical care.

What does treatment look like for cleft lips and palates?

Treatment for cleft lips and palates varies depending on the severity of the condition, the child’s age and needs, and if other conditions or birth defects exist at the same time. Surgery to repair a cleft lip typically happens in a baby’s first few months and is recommended before the child is a year old. For a cleft palate, initial surgery is typically within a child’s first 18 months. For both, additional surgeries are needed as the child grows which helps normalize the child’s appearance and improves their breathing, hearing, and speaking.

In this series of surgeries from birth to around age 20, a team approach works best and is standard practice today. Hand-in-hand, a collaborative effort amongst your child’s dental, medical, surgical, and therapy teams means everything from facial aesthetics, dental aesthetics, and oral functioning are covered. The expertise of a trained craniofacial orthodontist like Dr. Buddy contributes greatly in this kind of holistic treatment. Dr. Buddy knows which orthodontic treatments will help a child with a cleft issue at every stage of oral development: from infant presurgical orthopedics to comprehensive orthodontic treatments throughout childhood and adolescence. 

But… hold on a minute. We’ve tossed the words “craniofacial orthodontist” around a few times so at this point, you might be wondering, “What exactly is craniofacial orthodontics?” 

Simply put, craniofacial orthodontics is a subspecialty of orthodontics that focuses on multidisciplinary treatment for those with birth defects like cleft lip and cleft palate. Current practice calls for a coordinated care plan between a trained craniofacial orthodontist and the plastic-craniofacial surgeon, in addition to other specialists like dentists and speech therapists. For parents, it’s heartening to know that all aspects of their child’s cleft lip or palate are being taken care of by experts in each field!  

How is a cleft lip or palate managed in orthodontics?

Dr. Buddy and the team at Davis Orthodontics are all about compassionate care and expert, experienced service. So when it comes to patients with a cleft lip or palate, we absolutely want to help you get the happy and confident smile you deserve! It’s actually something that’s extra close to Dr. Buddy’s heart; he volunteers with the SC Children’s Rehabilitative Services Program, treating children with craniofacial anomalies who need orthodontics.

So what types of treatment are typically needed with a cleft lip or cleft palate? An orthodontic expander might be recommended in the elementary school years to widen a narrow jaw. And braces for a cleft lip or palate is often the answer once all the adult teeth have erupted — in the tween or teen years. We should also mention that your Upstate SC orthodontist also treats adults with a cleft lip or palate who are looking to improve their smile.

Part of your Craniofacial Orthodontics Team

There’s no doubt that Davis Orthodontics is your choice for craniofacial orthodontics in Simpsonville, Greer, and our five other convenient Upstate SC locations. Dr. Buddy’s craniofacial and surgical orthodontic fellowship training, paired with his experience treating orofacial clefts means you can rest assured your results will be amazing. Contact us today!