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Oral & Maxillofacial Surgery
Cleft Lip and Cleft Palate

Cleft lip and cleft palate are two common but markedly different birth defects that affect about one in every 700 newborns. These developmental deformities occur in the first trimester of a woman’s pregnancy; cleft lip in week seven, and cleft palate in week nine. Cleft lip and cleft palate occur simultaneously in about half of all cases, and separately in approximately a quarter of all cases.

A cleft lip is essentially a separation of the two sides of the lip. In many cases, this separation will include the bone and gum of the upper jaw. A cleft palate occurs when the sides of the palate fail to “fuse” as the fetus is developing, which results in an opening in the roof of the mouth.

The cleft deformities are categorized according to their location in the mouth and the size of the defect.

Unilateral Incomplete: A cleft on only one side of the mouth that does not extend as far as the nostril.

Unilateral Complete: A cleft on only one side of the mouth that extends into the corresponding nostril.

Bilateral Complete: Larger clefts affecting both sides of the mouth which each extend as far as the nostril.

Microform Cleft: A mild case of cleft lip which may simply form a bump on the lip, or a small scar line extending toward the nostril.

Reasons for cleft lip and cleft palate correction

Cleft lip and cleft palate are highly treatable deformities, though it may take a whole team of different specialists to fully treat the condition. The prognosis for sufferers who receive corrective treatment is excellent; medically, physically, dentally, and emotionally. There are however, a series of risks for those who do not receive corrective treatment:

  • Speech – Children born with either cleft deformity are likely to experience speech problems unless treatment is sought. Speech problems are detrimental to a child’s social and emotional development.
  • Feeding – Babies with a cleft palate or a complete cleft lip have problems drinking milk. The gap means that liquids can pass from the mouth to the nasal cavity. This can be dangerous unless the child is fed sitting upright.
  • Hearing Loss & Frequent Ear Infections – A cleft palate can cause the eustachian tubes (connecting the throat to the ear) to be incorrectly positioned. The fluid build up which results from this poor positioning can lead to painful middle ear infections. Severe and prolonged ear infections can lead to complete hearing loss.
  • Dental Issues – Abnormalities in the upper jaw, gum, or arch can cause teeth to become impacted (unable to erupt) or absent completely. The shape of the mouth might not permit proper brushing which can lead to periodontal disease and tooth decay.

What does cleft lip and cleft palate treatment involve?

Initially, surgeons will work to close the cleft openings in the first six months of the child’s life. Unfortunately, this does not cure the dental problems that occur as a result of cleft lip and cleft palate defects. Often there is a gap in the child's upper jaw form that if left untreated can lead to loss of his/her canines and other teeth resulting in malocclusion and very poor dentition. Additionally, cleft patient can have a poor mismatch of their upper jaw and lower jaw resulting in a malocclusion that cannot be corrected by orthodontics alone which may require corrective jaw surgery. A thorough examination of the teeth surrounding the deformity is often needed with radiographic imaging to allow the surgeon to time the surgery for grafting these sites to be performed at the most optimal time. 

Often dental implants  may be needed to replace missing teeth or other treatment modalities to improve function of the jaws and improve the aesthetic appearance of the smile. These procedures can be accomplished under a variety of types of ansethesia and can often be done as an outpatient. 

If your child was born with any cleft deformity, we strongly encourage you to contact our office to schedule a consultation.