In early pregnancy, different parts of a baby’s face develop separately and then join together. If some parts do not join properly, the baby is born with a cleft.
Cleft lip and palate can occur separately or together.
The causes of cleft are complicated, and they are usually the result of different factors coming together in a way that couldn’t be predicted or prevented. It is very unlikely that your baby’s cleft is because of anything you did or didn’t do during pregnancy.
This article provides information on cleft palate symptoms and what causes cleft lip.
How Often Is Cleft Lip Misdiagnosed
Sometimes a cleft lip is not picked up at any scans before birth and can be a big surprise to parents. This is especially likely to happen (30% of cases) if the baby has a cleft lip without a cleft palate.
A cleft palate by itself (called an ‘isolated cleft palate’) is almost impossible to pick up before birth through regular scans, and can be easily missed when a baby is born if it is not looked for. Midwives and other health professionals should visually examine the baby’s mouth with a torch by pressing down on the baby’s tongue so the whole of the mouth can be seen.
What are cleft lip and cleft palate?
A cleft lip and cleft palate are openings in a baby’s upper lip or roof of the mouth (palate). They’re congenital abnormalities (birth defects) that form while a fetus develops in the uterus. Cleft lips and cleft palates happen when tissues of the upper lip and roof of the mouth don’t join together properly during fetal development. Surgery is required to repair cleft lip and cleft palate.
What is cleft lip?
Our lips form between four and seven weeks of pregnancy. Tissues from each side of our head join together at the center of the face to make our lips and mouth. A cleft lip happens when the tissues that make the lips don’t join completely. As a result, an opening or gap forms between the two sides of the upper lip. The cleft can range from a small indentation to a large gap that reaches the nose. This separation can include the gums or the palate (roof of the mouth).
What is cleft palate?
The roof of your mouth (palate) forms between six and nine weeks of pregnancy. A cleft palate is a split or opening in the roof of your mouth that forms during fetal development. A cleft palate can include the hard palate (the bony front portion of the roof of the mouth) or the soft palate (the soft back portion of the roof of the mouth).
Cleft lip and cleft palate can occur on one or both sides of the mouth. Because the lip and the palate develop separately, it’s possible to have a:
- Cleft lip without a cleft palate.
- Cleft palate without a cleft lip.
- Both a cleft lip and cleft palate (the most frequently occurring disorder).
How will a cleft lip or cleft palate affect my baby?
Babies born with a cleft lip or cleft palate may have difficulties eating (both from the breast and a bottle). They may also have trouble speaking, and they often have fluid behind their eardrum that can affect hearing. Depending on the case, some also have issues with their teeth.
What Causes Cleft Lip
What causes a cleft lip and cleft palate?
In most cases, there is no cause of cleft lip or cleft palate, and parents can’t prevent it. Most scientists believe clefts are caused by a combination of genetic (inherited) and environmental (related to the natural world) factors. There seems to be a greater chance of a newborn having a cleft if a sibling, parent or other relative has one.
Another cause of a cleft lip or cleft palate may be related to medication the birthing parent took during pregnancy. This includes antiseizure medications, acne treatment medications containing Accutane®, or methotrexate, a drug commonly used for treating cancer, arthritis and psoriasis.
Other factors that can contribute to the development of a cleft include:
- Vitamin deficiency (folic acid).
- Having obesity.
- Smoking or tobacco use during pregnancy.
- Substance abuse.
- Birth disorders like DiGeorge syndrome or Pierre Robin syndrome.
The condition may also occur due to exposure to viruses or chemicals while the fetus develops in the uterus.
Cleft Palate Symptoms
Symptoms of cleft lip and palate may include:
Crooked, poorly shaped or missing teeth
Misalignment of teeth and jaw
Deformities of the upper jaw (maxilla)
Speech problems
Unrepaired oronasal fistulae, which is a hole between the mouth and nose cavity
Alveolar clefts, which are defects in the bone that supports the teeth
DIAGNOSIS AND TESTS
How are cleft lip and cleft palate diagnosed?
Prenatal ultrasound can diagnose most clefts of the lip because clefts cause physical changes in the fetus’s face. Isolated cleft palate (no cleft lip present) is detected in only 7% of fetuses with the condition during the prenatal ultrasound because it’s difficult to see.
If a cleft has not been detected in an ultrasound before birth, a physical exam of the mouth, nose and palate can diagnose cleft lip or cleft palate after birth.
In some cases, your provider may recommend amniocentesis to check for other genetic conditions. Amniocentesis is a procedure to remove amniotic fluid from the amniotic sac. It helps diagnose other congenital disorders.