Cleft palate (cleft lip): what it is, causes, surgery

According to the Hospital for Rehabilitation of Craniofacial Anomalies (HRAC), of the University of São Paulo, in about 650 births performed a child is diagnosed with cleft palate.

This condition is due to malformation, when the baby is still in the womb. Through ultrasonography it is possible to see a crack in the baby’s lip, it is common to appear more in boys than in girls and its causes are multifactorial.

As much as the cleft palate causes concern in future mothers, this condition has treatment. Learn more about the cleft palate:

What is cleft palate?

The cleft palate consists of a facial malformation, which appears before the baby is born. One in 650 children is born with the change.

In these cases, the baby is born with the roof of the mouth open, with a kind of slit, and a little bit is missing in the child’s lips.

It occurs when there is not enough tissue in the development of the face region, which can make feeding the baby difficult and requires care.

There are different types of cleft palate, such as bilateral cleft palate, unilateral, lip and palate, which can be:

  • A division that reaches the roof of the mouth (palate) and the lip, in which it can affect one or both sides of the baby’s face;
  • A small division in the lip, but which can extend to the gum, passing through the palate (roof of the mouth) and also reaches the base of the nose;
  • A division only in the roof of the mouth, which does not reach the lips and does not affect the appearance of the face.

It may happen that the cleft palate does not reach the lip, gums or nose, passing unnoticed by the mother and the doctor. In which the muscles of the mouth are able to hide the cleft, not being diagnosed immediately during the ultrasound or birth procedure.

Its cause intrigues specialists, as there is still no exact reason, but factors that add up to the malformation. Among them are: genetic issue, use of alcohol and cigarettes during pregnancy, history of diabetes , use of certain medications, lack of folic acid or contact with radiation.

If left untreated, the cleft palate, regardless of type, can make the child’s life difficult during growth, causing difficulty in feeding and swallowing, both solid and liquid, constant ear infection, nasal voice, among others.

For this reason, in addition to the aesthetic issue, there is also the nutritional, respiratory, dental and emotional issues, requiring multidisciplinary treatment, which involves performing correction surgery.

After the procedure is performed, care is needed to readjust the patient.

It is possible to find the cleft palate in the International Statistical Classification of Diseases and Health-Related Problems (ICD 10), by the codes:

  • Q37 – Cleft lip with cleft palate;
  • Q37.0 – Cleft palate with bilateral cleft lip;
  • Q37.1 – Cleft palate with unilateral cleft lip;
  • Q37.2 – Cleft palate with bilateral cleft lip;
  • Q37.3 – Cleft palate with unilateral cleft lip;
  • Q37.4 – Cleft hard and soft palate with bilateral cleft lip;
  • Q37.5 – Cleft palate hard and soft with unilateral cleft lip;
  • Q37.8 – Cleft palate with bilateral cleft lip, unspecified;
  • Q37.9 – Cleft palate with unilateral cleft, unspecified.

What are the types of cleft palate?

The cleft palate appears in the roof of the child’s mouth, as a kind of opening. It can appear alone or in conjunction with another facial malformation, such as a fissure in the lips on the right or left side, and has lighter to more serious types. Depending on the location and size, it receives a rating:

Bilateral cleft lip and palate

In this type of case, the cleft occurs on both sides of the lip and also on the palate (roof of the mouth). In general, each opening can occur just below the nostril openings.

Unilateral cleft lip and palate

The fissure arises from only one side of the lip and reaches the palate (roof of the mouth). That is, there is a single opening in the lip.

Cleft lip

It affects only the lip, regardless of which side, left or right and does not reach the palate (roof of the mouth)

Fissura palatal

In this case, it reaches only the roof of the mouth, known as the palate. The lip or outer structure forms properly.

What is the difference between cleft lip and cleft palate?

The difference is that the cleft lip is an opening that reaches the lips and, in some cases, can reach the nose. The cleft palate consists of the malformation of the palate (palate), in which a kind of cleft develops at that location. This cleft can vary in degree, being larger or smaller, as well as the cleft lip.

Is cleft lip like a cleft palate?

More or less, the cleft lip and palate are terms that specify the cleft lip and palate. Although they are often used equally to describe the condition, some people call lip cleft only in cases where the lip, externally, presents the malformation.

Thus, the cleft palate can be used to name the pictures in which the malformation occurs in the roof of the mouth.

What causes cleft palate?

Cleft palate is caused when the tissues on the baby’s face and mouth do not develop properly during the gestation period. Generally, facial tissues are formed in the 2nd and 3rd month of pregnancy .

In the case of children diagnosed with cleft palate, this development does not occur properly, leaving an opening that reaches the roof of the mouth.

In some cases it is still not possible to define the exact cause of this condition, but researchers believe that it can occur due to several factors, both genetic and environmental:

Genetic causes

It has not yet been discovered which genetic factors determine or predispose to cleft palate, but research notes that having a family history of the condition is a risk factor.

Environmental causes

Alcohol intake during pregnancy, smoking, consuming drugs, such as anticonvulsants, and environmental factors still unknown to the medical community can facilitate or trigger malformation in predisposed people.

What are the risk factors for cleft palate?

The cleft palate appears during the woman’s pregnancy, the following factors can influence the appearance of this problem:

  • Having affairs in the family;
  • Pregnant women in old age;
  • Infections during pregnancy;
  • Use of alcohol and cigarettes during pregnancy;
  • Mothers with a history of diabetes;
  • Obese women;
  • Use of certain medications, such as corticosteroids and anticonvulsants;
  • Lack of folic acid during pregnancy;
  • Contact with radiation.

Symptoms and aspects

The opening in the lip or roof of the mouth (palate) can cause some situations and cause changes in the life and health of children, such as:

Difficulty feeding

The opening of the palate or lip, even if small, can cause difficulty in the child when it is time to breastfeed, eat solids or drink fluids.

Due to the mouth not being able to close completely, it can happen that the milk “leaks”, making feeding difficult or impeding.

Ear infection constantly

When there is a cleft lip and palate, it causes a problem in the roof of the mouth (palate) that reflects in the tube, part of the structure of the ear.

The tube ends up not being able to function properly, changing the amount of air that passes through the ear and the pressure, causing the accumulation of liquid and causing an inflammation. Babies and children with cleft palate often complain of earache .

Read more: Infections in childhood may increase the risk of mental disorders

Change in voice and speech

Babies and children who have a cleft palate tend to have a “nasal” or fanny voice. This is due to the crack causing weak intraoral pressure, which loses air through the nose. This mismatch makes, when speaking, the sound comes out through the nose, changing the timbre.

In addition to altering the sound, the cleft palate can influence speech by causing the child to pronounce words in the wrong way. In these cases, the accompaniment of a speech therapist can help to solve the problem.

Breathing problems

Cleft lip and palate can cause respiratory problems due to the proximity to the nasal route, which can influence respiratory activities.

Hearing problems

The cleft palate can influence the functioning of the auditory tube, as it is connected to the jaw and nose. What can happen is that there is insufficient ventilation to the ear, which makes the child unable to hear properly, causing hearing problems.

Social difficulties

As the child grows and acquires age, cleft lip and palate can affect social life. This can lead to shame, low self-esteem and damage to the patient’s emotional.

Diagnosis

Cases of cleft palate can be diagnosed at birth and do not need a specific examination, as the case is quite characteristic.

But, even before birth, it is already possible to detect the malformation by means of an ultrasound.

Ultrasound

Ultrasonography consists of the examination in which a gel is passed in the region to be performed, then a device is passed over the region with the gel in which sound waves are emitted and transmitted to a computer, which transforms them into images .

This type of ultrasound is performed to check that the baby is developing correctly in the mother’s womb. With it, it is possible to know if there is a case of cleft palate before the birth of the child.

She can be identified, by examination, from the 14th week of pregnancy and also at the time of delivery. It usually appears as:

Is cleft palate severe?

Yes , the cleft palate is serious because it causes difficulties since the child’s feeding, breathing and speech.

Therefore, as soon as it is discovered, either before delivery, by ultrasound, or at the time of delivery, it is necessary to talk to the obstetrician who can indicate the next procedure.

Baby care with cleft palate

Some care needs to be taken in relation to the baby, when there is a diagnosis of cleft lip and palate.

There may be episodes of difficulty in sucking (in the case of breastfeeding), nasal escape, excessive vomiting, choking and insufficient food intake.

The cleft palate involves more than aesthetic factors, but also functional and social factors, so some of the precautions to be taken are:

food

When breastfeeding, always try to be in a position that helps the baby to suck the milk. The ideal is to be semi-seated, so that the breast fills the baby’s entire mouth, in addition to the slit.

If it is not possible to breastfeed, you can use special bottles and even nipples that can be placed on the breast or adapted in the bottle to facilitate breastfeeding.

Read more: Food in childhood: what to know

Oral hygiene

It is necessary to perform daily oral cleaning to remove food debris on the gums, cheeks and tongue.

For this it is possible to use flexible cotton swabs, special fingers for cleaning, gauze soaked in boiled water or in saline, always according to the doctor.

This care avoids problems and keeps the oral region healthy.

Is there a cure?

Yes , the cure for cleft palate consists of performing corrective surgery. As the malformation can cause different changes in the patient, the treatment needs to be carried out in a multidisciplinary approach, that is, with the participation of specialists from different areas.

Among them, plastic surgery to correct the cleft, otorhinolaryngology to assess whether breathing works normally, dentistry for the correct formation of the dental arch and speech therapy for speech processes.

What is the treatment?

Treatment requires a multidisciplinary approach, focusing on the objective of rehabilitating the patient in a morphological, functional and psychosocial way. The treatments are:

Pre-surgical orthopedics

Surgery to correct the cleft palate depends on the age of the patient to be performed and, while it cannot be performed, other alternatives are adopted, such as pre-surgical orthopedics.

In this case, molded plates are used, which mobilize the palatal bones in a better position, according to the child’s development. This alignment promoted by the plates ends up facilitating the child’s suction and feeding.

Surgery

Lip cleft surgeries can be performed on average at 3 months of age, while cleft palate only at 12 months.

They can be done by the Unified Health System (SUS) or by private hospitals.

Firstly, the so-called “primary corrections” are performed, in which the soft tissues are manipulated together with the muscle and skin, not directly affecting the bones.

As the patient grows, secondary surgeries are indicated for lip retouching and nasal corrections to be performed.

The surgical process can start at 3 months and last until adulthood, until there is a stabilization of the problem, in which the facial and oral functions are working in harmony and healthy.

Every patient with cleft lip and palate needs to be aware that sometimes more than one surgery is necessary to close the malformation.

The treatment can be completed when the patient reaches the age of 18 (18 years), due to the formation and development of the face to stabilize. But that does not mean that even if you are an adult, no other type of treatment will be done, even surgical, as everything depends on each case.

Frequent visits to the dentist

The cleft palate can cause problems in the teeth during the growth phase of children, which ends up influencing their size, shape and positioning.

Some teeth may not be able to develop in the best way and cause dental problems, so the follow-up with the dentist is essential for the professional to be able to monitor the child’s dental evolution and can help in the quality of life.

In some malformations, the patient may need to use the orthodontic appliance, so that the facial cranial region and occlusion of the teeth function naturally.

Speech Therapy

Speech therapy treatment helps from the breastfeeding period, in which the specialist can teach the correct way to breastfeed the baby even as it develops, guiding on other techniques.

Among them, moving the facial muscles, stimulating language correctly, introducing blowing and breathing exercises, all with the aim of avoiding muscle problems and developing a good speech pattern in the child.

Therapy with a speech therapist should take place after surgery, more or less after one month, until the healing of the palate is good.

If the child has speech problems after surgery, this is the time for exercises to stimulate mouth pressure.

Thus, the correct articulation of the sound removes the nasal or fanous voice and aids in the speech in a correct way.

Psychological therapy

As the child grows and the organism develops, some problems may arise, such as acceptance of appearance depending on the type of surgery (if it left marks, for example).

Speech problems can result in attitudes associated with bullying by classmates, and this can affect the child’s self-esteem.

Therefore, it is important that patients are accompanied by psychologists from childhood.

Surgeries for cleft palate

Among the possibilities of surgery there are:

Reconstruction of the muscle band of the soft palate

In this type of surgery, a replacement of the musculature is performed, closing the palate (roof of the mouth), so that there is a good development in the child’s speech.

The nasal floor and mucosa are also reconstructed, so that the development between the mouth and nose does not suffer any trauma and occurs normally after surgery.

Re-palatoplasty and sphincteroplastia

These two surgeries aim to reposition the cleft palate.

The re-palatoplasty aims to correct and perform the re-joining of the palate, in the roof of the mouth. In sphincteroplasty, the pharynx muscles are altered, which are cut laterally and brought together to solve the problem.

Pharyngeal flap

First, a cut is made in the posterior pharynx (part of the throat), as a way to obtain tissue. Then, this tissue is cut and then sutured (sewn) in the posterior region of the palate (roof of the mouth).

Where to do the surgery?

For those who do not have the resources to finance a surgery, but want to make the correction of the cleft palate happily can count on the assistance and surgery in the Unified Health System (SUS) or in NGOs that help to carry out the surgical intervention.

In order to offer a better quality of life and health, NGOs such as Smile Train and   Operation Smile offer corrective surgery free of charge to those who need it.

Living together

With some care, it is possible to maintain a good quality of life. For this, the following are recommended:

Use of special nipples and bottles

As soon as the child is born and receives the diagnosis, it may be necessary to use special nipples and bottles so that he can feed correctly.

Frequent dentist appointments

As the baby grows, teeth begin to grow. As the cleft palate can cause deviations and problems in the size of the teeth, it is recommended to consult the professional frequently.

Thus, it is possible to monitor the development of the dental arch, prevent problems and other diseases of the oral region.

Emotional support

The cleft palate involves not only dental, respiratory and nutritional factors, but can generate emotional, sociability and aesthetic problems.

Therefore, having an emotional support is necessary, it can be from family, friends or from a professional, such as the psychologist. It is important to work on trust, depending on the case so that the patient lives well and with self-esteem.

Prognosis

Cleft palate is a disease that can be cured, but it requires long-term treatment. From birth to 18 years of age, which is when the bones of the face region solidify.

Until reaching that age, it is necessary to carry out an approach that takes into account food, frequency of visits to the dentist, exercises with a speech therapist and routine consultation to assess the patient’s condition.

The support of the family is also an important factor, to assist and give strength during the treatment until the end of it.

Complications

The patient who has a cleft lip and palate, and who is not treated, may develop not only the aesthetic alteration, but also complications that will harm the child’s nutrition, development and growth. If left untreated, the cleft lip and palate can generate:

Speech and hearing problems

The cleft lip and palate, if left untreated, can affect hearing causing constant earaches and impairing the activities of this organ. In addition to being able to impair speech, due to the child being unable to pronounce the words correctly because of the fissure.

Malnutrition

The cleft palate can impact the correct feeding of the baby or child. If proper precautions and care are not taken, malnutrition, anemia and impaired development can occur .

Emotional problems, socialization and low self-esteem

Psychological damage due to malformation has a high impact on the child’s development.

Even when the condition is treated surgically, childhood can often be marked by isolation or learning and socialization difficulties, which tend to reflect throughout life.

How to prevent cleft palate?

As this malformation has genetic influence, there is not always a way to prevent it. But one possibility is to avoid risk factors, which can facilitate malformation:

  • Do not consume alcohol and cigarettes during pregnancy;
  • Perform the prenatal care indicated by the obstetrician;
  • Frequent consultations with the doctor for health assessments;
  • Performing ultrasound.

Use of folic acid

If the obstetrician deems it necessary, it may be important to use folic acid for the pregnant woman.

This medication works to reduce the risk of injury to the fetus and the development of diseases such as cleft palate and cleft lip. In addition, it also helps in the formation of the placenta and in the development of the child’s DNA.

  • Folic acid ( Femme Folic , Afolic , Acfol )

Attention!

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

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Common questions

How long after I am born can I operate on my child?

It is advisable to perform lip surgery, with intervention in the nose deformity, between 3 to 6 months of life. The surgery to correct the palate can be done before 2 years of age – around 1 ½ years can already be performed.

My son has a cleft palate. Can he suck at the breast?

Yea! The baby can and should breastfeed normally, what can happen is a little difficulty at first.

For this, the mother must put herself in a more vertical or semi-seated position, so that she can cover the cleft lip with the breast. In this way, the child is able to carry out the pressure that facilitates the outflow of milk.

When there is a malformation of the lip or palate, some precautions must be taken when feeding – whether solid or liquid, including breastfeeding.

If the child is still unable to breastfeed, the milk should be removed and given to the baby in a bottle with a special nipple or syringe. But the ideal is to insist on the mother’s breast.


Cleft palate is a condition of concern, but it can be cured by surgery.

Do you know someone who has a cleft palate? Share this article, it can be useful for the patient and for mothers who were diagnosed with their babies.

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