Plastic Surgery :: Cleft Lip and Cleft Palate
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Cleft lip is a birth abnormality of the nose and lip. Cleft palate is a birth abnormality of the roof of the mouth (palate). A child can have cleft lip, cleft palate or both. They occur early in pregnancy when the sides of the lip and/or the roof of the mouth do not fuse together as they should.  Most babies born with a cleft are otherwise healthy with no other birth abnormalities. In some cases, other family members have also had a cleft lip/palate.

Cleft lip is an abnormality in which the lip does not completely form during development. It often affects the nose, as well. The degree of the cleft lip can vary greatly, from mild (notching of the lip) to severe (opening from the lip up through the nose). It can affect one side of the lip or both sides.

Cleft palate occurs when the roof of the mouth does not completely close, leaving an opening that can extend into the nasal cavity. The cleft may involve either or both sides of the palate. It can extend from the front of the mouth (hard palate) to the throat (soft palate). Often the cleft will also include the lip. Cleft palate is not as noticeable as cleft lip because it is inside the mouth, but it affects the baby’s ability to nurse.

What other complications can occur?

Beyond the cosmetic abnormality, there are other possible complications that may be associated with cleft lip and cleft palate, including:

Feeding difficulties: Most babies with only a cleft lip are able to nurse. Babies with a cleft palate, however, are unable to suck properly because the roof of the mouth is open.

Ear infections and hearing loss: Ear infections are often due to a dysfunction of the tube that connects the middle ear and the throat. Recurrent infections can then lead to hearing loss. This is treated by placing tubes in the ear, which is a very straightforward and effective treatment.

Speech and language delay: Due to the opening of the roof of the mouth, muscle function may be affected, which can lead to a delay in speech or abnormal speech. Talk to your child’s doctor about a referral to our speech therapy program.

Dental problems: As a result of the abnormalities, teeth may not develop normally and orthodontic treatment is usually required. Sometimes surgery is required, as well.

How is cleft lip or cleft palate treated?

Parents can take comfort in the sophisticated surgical techniques that help restore the balance and function of this area. With treatment, your child’s cleft lip or cleft palate can be repaired. Your child can look, eat and speak just like other children. This will all be possible through our craniofacial multidisciplinary team that will work with you and your child to develop and carry out a treatment plan.

Treatment requires the skills of many different specialists. We offer a multidisciplinary team to meet your child’s needs including ENT specialists, plastic surgeons, speech pathologists and audiologists.

For most infants with cleft lip alone, the abnormality can be surgically repaired within the first several months of life (usually when the baby is 3 to 6 months old). This will be decided by your child’s surgeon. The goal of this surgery is to fix the separation of the lip.

Cleft palate repairs are usually done between the ages of 9 to 12 months. The exact timing of the surgery will be decided by your child’s doctor. The goal of this surgery is to fix the roof of the mouth so that your child can eat and learn to talk normally.

Feeding Your Baby with Cleft Palate

The most immediate concern for a baby with cleft palate is good nutrition. Sucking for children with a cleft palate is difficult because of the poorly formed roof of the mouth. Children with just a cleft lip (without a cleft palate) do not routinely have feeding difficulties. The following are suggestions to help aid in the feeding of your infant:

  • It is rare that a baby with a cleft palate will be able to attain adequate nutrition through breastfeeding alone. Breast pumping and then using a bottle with a special nipple is the recommended technique.
  • Hold your infant in an upright position to help keep the food from coming out of the nose. Burp your baby frequently since babies with a cleft palate tend to swallow a lot of air.
  • Small, frequent feedings are recommended. This can be a frustrating and slow process; however, your infant will receive more calories, and therefore, gain weight.
  • There are many types of bottles and nipples that can assist with feeding an infant with cleft palate. In some cases, supplements may need to be added to breast milk or formula to help your infant meet his or her calorie needs. We can assist you in deciding which nipple and supplement is most appropriate for your child.

Jason Toranto and Sharon VargasSharon Vargas, a case manager and nurse specialist, and Dr. Jason Toranto, a CHOC plastic surgeon and craniofacial specialist, recently stopped by Seacrest Studios to discuss the challenges of feeding infants with cleft palates in this CHOC Radio Podcast episode.








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