What is a Cleft Lip or Palate?

Cleft Lip and Cleft Palate are openings or splits that occur in the upper lip and palate (roof of the mouth). They appear from birth and can appear as standalone concerns or together, due to developmental issues during pregnancy.

A Cleft Lip may affect one side of the lip, known as unilateral Cleft Lip, or both sides, resulting in two splits, known as bilateral Cleft Lip. The openings can range from a small notch to a wider gap which extends up to the nose.

Similarly, a Cleft Palate may be a small opening in the back of the roof of the mouth, or it may run to the front of the mouth.

Cleft Lip and Cleft Palate may result in several issues, especially in a baby’s very early life:

• Feeding difficulties: Cleft Lip and Palate may result in problems with swallowing and discomfort while eating which could further hamper growth and physical development
• Ear concerns: Babies with a Cleft Palate may be more vulnerable to ear infections or fluid build-up in the ears (Glue Ear), which can impact hearing
• Dental concerns: Cleft Lip and Palate may impact the development of the teeth, and can heighten their risk of tooth decay
• Speech concerns: Untreated Cleft Palate can result in unclear or nasal-sounding speech when a child is older

Having a baby with Cleft Lip and Cleft Palate can be upsetting for parents, but fortunately, treatment outcomes are highly positive. Early treatment of Cleft Lip and Palate is crucial to optimise outcomes and reduce the risk of further damage or developmental issues.

Can Adults Have a Cleft Lip or Cleft Palate?

Although Cleft Upper Lip and Palate are usually repaired in early childhood, Cleft Lip in adults may continue to require ongoing treatment to address aesthetic and functional concerns. As the tissue around the lips and nose grows, dental and speech issues may arise. Treatments for Cleft Lip in adults may include revision surgery to improve the alignment and appearance of the lips or Rhinoplasty for Cleft Lip to straighten the base of the nose.

Cadogan Clinic’s team of expert facial and ENT Consultant Surgeons has extensive experience of performing surgery to address ongoing concerns arising from Cleft Palate and Cleft Lip in adults.

How Common is Cleft Lip and Palate?

Cleft Lip and Cleft Palate are among the most common birth development irregularities globally.

Roughly 1 in every 700 babies born in the UK each year have a Cleft Lip and/or Palate. This is comparable to the global figures, but this can vary across different populations.

• Cleft Palate only: Around 45% of all cases
• Cleft Lip only: Around 24% of all cases
• Cleft Lip and Palate: Around 31% of cases

A Cleft Lip is often diagnosed during a scan between 18 and 21 weeks of pregnancy. However, it is not always evident during this scan, and it is very difficult to detect a Cleft Palate during an ultrasound.

If a Cleft Lip or Palate is not diagnosed during pregnancy, it is usually observed immediately after birth or within the first few days, during a routine health check.

As soon as a Cleft Lip or Palate has been diagnosed, you will be referred to a specialist surgeon who will discuss the condition and the available treatments.

What are the Different Types of Cleft Palate and Lip?

Cleft Lip and Palate are categorised by the areas involved, whether they are unilateral or bilateral, and whether they are complete or incomplete.

The type of Cleft Lip or Palate will determine the possible treatments

Types of Cleft Lip

• Unilateral Cleft Lip – An opening (cleft) on one side of the lip
• Bilateral Cleft Lip – Clefts on both sides of the lip
• Microform Cleft – An incomplete cleft which typically appears as a small indentation in the lip
• Incomplete Cleft Lip – Partial separation, such as a notch in the lip
• Complete Cleft Lip – A full opening in the lip, extending up to the nose

Types of Cleft Palate

• Isolated Cleft Palate – An opening in the roof of the mouth, that doesn’t affect the lip
• Submucous Cleft Palate (SMCP) – The muscles and bone of the palate are separated, but the overlying skin remains complete, making it challenging to detect.

What are the Symptoms of Cleft Lip and Palate?

Signs and symptoms of a Cleft Lip and Palate can be very obvious or more subtle and may require further investigation.

Cleft Lip and Palate symptoms typically include:

• A visible split in the lip and palate that affects one or both sides of the face
• A split in the upper lip that either appears as a small notch or extends from the lip through the palate and also up to the bottom of the nose
• An opening in the palate that doesn’t affect the appearance of the face
• In adults who have had Cleft Lip or Cleft Palate repair in childhood, they may be left with a vertical scar over the lip and extending up to the nose

In cases of Submucous Cleft Palate, where the muscle and bone in the roof of the mouth are affected, but the overlying tissue appears normal, other symptoms are important to consider:

• Difficulty feeding and swallowing, including liquids or foods coming out of the nose
• Recurrent ear infections
• Glue ear
• Nasal speaking voice

What Causes a Cleft Lip and Palate?

Typically, the tissues that make up the lip and roof of the mouth develop within the first few weeks of pregnancy. However, in some cases, these tissues either fail to develop or only develop partially, resulting in Cleft Lip and Palate.

In many instances, the reason for this is not fully understood; however, there are risk factors which may increase the chances of Cleft Lip and Palate occurring:

• Family history – Parents born with Cleft Lip or Palate, or who have relatives who were born with a cleft, may have a higher chance of having a baby with a Cleft Lip or Palate
• Smoking and drinking during pregnancy – Cleft Lip and Palate may be more likely to occur when a woman smokes or drinks alcohol during pregnancy
• Folate deficiency – Women who are deficient in folate during the first three months of their pregnancy may have a higher risk of having a baby with a Cleft Lip or Palate
• Medication – Taking certain medications in early pregnancy, including some anti-seizure medicines, may increase the risk of a Cleft Lip or Palate developing
• Related conditions – Cleft Lip and Cleft Palate can occur as part of other conditions, such as 22q11 deletion syndrome, or Pierre Robi sequence – both genetic conditions which are connected with a number of birth defect

If you are concerned that you may be at a higher risk of having a baby with a Cleft Lip or Palate, you should discuss this with your doctor. They may advise lifestyle changes or changes in medication while you are trying to conceive, and during your pregnancy, to reduce the risk.

Treatment for Cleft Lip and Palate

Cleft Lip and Cleft Palate are treated by specialist surgeons and clinicians. Your child will typically be given a long-term care plan, outlining the treatment, assessment and support they need as they grow up.

Although the treatment plan will be tailored to your child’s needs, a typical treatment plan will include:

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