If some parts do not join properly, the result is a cleft, the type and severity of which can vary.

• A cleft lip is a condition that creates an opening in the upper lip between the mouth and nose. It looks as though there is a split in the lip. It can range from a slight notch in the colored portion of the lip to complete separation in one or both sides of the lip extending up and into the nose. A cleft on one side is called a unilateral cleft. If a cleft occurs on both sides, it is called a bilateral cleft.
  
  
• A cleft in the gum may occur in association with a cleft lip. This may range from a small notch in the gum to a complete division of the gum into separate parts. A cleft palate occurs when the roof of the mouth has not joined completely. The back of the palate (towards the throat) us called the soft palate and the front (towards the mouth) is known as the hard palate. If you feel the inside of your mouth with your tongue, you will be able to notice the difference between the soft and the hard palate. A cleft palate can range from just an opening at the back of the soft palate to a nearly complete separation of the roof of the mouth (soft and hard palate).
  
  
• Sometimes a baby with a cleft palate may have a small lower jaw (or mandible) and a few babies with this combination may have difficulties with breathing easily. This condition may be called Pierre Robin Sequence.
  

How does it happen?

The cause of clefts is not understood very well. We certainly know what happens, we do not know why. Sometimes clefts run in families and sometimes a baby is born with a cleft without anyone else in the family having one.

Does a cleft cause feeding problems for a baby?

• Babies with a cleft lip do not usually have any feeding difficulties. Breast or bottle-feeding is possible.
  
  
• A newborn with a cleft palate may need extra help. A cleft palate can make it hard for a baby to form a vacuum in its mouth. The most common problems are:
  • Feeding slowly
  • Taking in too much air during feeding
    
  • Bringing milk up through the nose
    
    
• A baby born with Pierre Robin Sequence must learn how to manage feeding and breathing at the same time.
  
  
• Breastfeeding a child with a cleft palate is sometimes possible. When it proves very difficult to breastfeed, mothers often express breast milk for bottle-feeding. Bottle-feeding is usually most successful for babies with cleft palates.

Who treats cleft lip and palate patients?

• Treatment will be provided be a Cleft Lip and Palate Team. This will be made up of specialists working together to make sure that the best possible treatment is given. The specialists making up a team may include the following:
  
  • Surgeon
    
  • Cleft Nurse
    
  • Orthodontist
    
  • Pediatrician
    
  • Speech and Language Therapist
    
  • Psychologist
    
  • Geneticist
    
    
• A baby born with a cleft should be contacted by someone on their Cleft Team within 24 hours of diagnosis.

When is a cleft lip repaired?

• A cleft lip is usually surgically repaired by the time a baby is 2-3 months old. It requires a general anesthetic and takes roughly on and a half hours. The surgeon re-arranges the skin and muscles of the lip so no skin grafting from other parts of the body are needed.
  
  
• Most babies recover very quickly and will not experience much pain after this operation. Medication is give for any discomfort. The hospital stay for this operation is between 3-5 days. A parent is usually welcome to stay in the hospital with the child.
  
  
• Feeding after the lip operation is not usually a problem. The nurse or the speech and language therapist on the cleft team will be able to answer any questions about feeding.

When is a cleft palate repaired?

• The palate is usually repaired by the time a baby is a year old. The tissues of the palate are re-arranged but no extra tissue from other parts of the body is used. The operation is, like the lip repair, carried out under general anesthetic and takes approximately one and a half hours.
  
  
• In infancy, the child’s hearing is monitored carefully by an ENT surgeon and regular checks are provided, as good hearing is needed for speech and language development.
  
  
• If a child has frequent middle ear problems, surgery to the ear may be recommended. This may involve placing a grommet tube into the eat drum to allow air into the middle ear. This operation can significantly improve the child’s hearing.

Do a cleft child’s teeth develop normally?

• As a child’s teeth are growing in the jaw at the time the cleft occurs, the normal development of some of them may be affected. This will depend on the type of cleft the child has. The teeth of children with clefts often come through a little later than those of children who do not have clefts.
  
  
• If the gum is affected by cleft, teeth near the position of the cleft may be missing, twisted or not the right shape. Sometimes extra teeth develop. The teeth in the top and bottom jaws may not meet together properly.
  
  
• It is rare for any orthodontic treatment to be carried out on a child’s milk teeth. When the permanent teeth come through, a brace is usually needed to correct irregularities. It is important that cleft children, just and others, should see a local dentist from an early age for regular check-ups. He or she will need to be happy about dental examinations. It is important that the teeth are well cared for with special attention to cleaning and avoidance of too many sweets and sugary or fizzy drinks.

What other operations may be necessary?

• Minor improvements to the lip or nose may sometimes be required. It is recommended that any such surgery takes place just before the child starts school. Some such operations are best performed in the teenage years.
  
  
• A few children may require an extra operation to improve speech by reducing the amount of air going into the nose.
  
  
• An operation to put some extra bone into the gum is often necessary to help teeth move into the best position. This happens at about the age of 10 years.
  
  
• Other surgery to help the top and bottom jaw meet in the best position may occasionally be necessary. This is carried out when a child has reached his or her full growth at about 18 years of age.