Common Congenital Disorders-Cleft Lip

The cleft lip deformity is the most common congenital deformity seen in the United States. The overall occurrence is one in seven hundred live births. Some ethnic groups (eskimos, asians) have a higher number of babies with cleft lip. Sometimes the cleft lip is associated with a cleft in the roof of the mouth (cleft palate). The cleft lip maybe unilateral (one side) or bilateral (on either side of the nose). The cleft lip maybe complete (no bridging tissue across the cleft) of incomplete.

The deformity seen in your baby with a cleft lip includes the lip, muscles around the lip, and the nose. All these deformities should be addressed at the initial surgery. The alveolus (the bone where the teeth come out) may also have a cleft, which may be address early if the deformity is

not too severe, often the alveolus cleft is corrected at seven or eight years old. The repair of the lip is usually completed around three months of age. In preparation for the repair, early manipulation of the skin and nose is started at two to three weeks of age either by special taping across the cleft or with a small device within the mouth. It is very important that a craniofacial team is available for taking care of any baby with a cleft lip.

The first step is to make sure that no other problems with your baby exists. This is usually done at the time of birth by your pediatrician and also during your first visit to our office. During that visit you will also be provided with information pamphlets and meet members of the craniofacial team.

Very often, the cleft lip will have a cleft or opening of the roof (palate). The cleft may include all or part of the roof. Sometimes the cleft palate is related to a small lower jaw (Pierre Robin Sequence). The most important concern if your baby has a cleft palate will be to make sure that he/she is feeding well. It is difficult for some babies to create suction to breast feed or feed from a normal bottle. There are several different bottles that maybe used. If the baby takes a long time to feed (over thirty minutes) then an appliance for the roof of the mouth can be made to help with the feedings. The parents should be well educated on feeding requirements for a baby with a cleft palate through a feeding specialist from our craniofacial team.

The repair of the cleft palate is usually completed around 6-7 months of age. For the same reason that your baby may have difficulty creating suction during feeding, some sounds that require air through the mouth (B, P, T,etc) may be difficult to perform. It is important to close the roof of the mouth before the baby is allowed to form incorrect speech patterns.

Many babies with a cleft palate often have difficulties clearing fluid from the inner ear. Because of this problem, the babies are suceptible to ear infections and may require drainage tubes in the ear drum. A visit with pediatric otolaryngologists (ENT) is coordinated through the craniofacial clinic to evaluate this condition. Baseline audiology examination may also be obtained.

Some babies are born with a very small lower jaw. Because the tongue does not have room in the mouth, the roof of the mouth does not form together creating a cleft palate. Therapies range from careful monitoring and "sleep studies" (to determine if breathing is OK when the baby is asleep) in the hospital, to finding out if the baby requires belly down position to keep the tongue out of the way. Some babies may require various types of surgery to move the tongue forward, or enlarge the mandible through a new technique called distraction. Occasionally, these babies will require a surgical opening in the neck (tracheotomy) to help them breathe. If a baby is suspected of having Pierre Robin sequence, it is very important that he/she be evaluate at Scottish Rite Children's Hospital and seen by the pediatric craniofacial surgeon shortly after birth.

Cleft Lip and Palate