Clearing Up Confusion On Cleft Lip and Palate

There’s a common misconception that cleft lip and cleft palate is a third-world disease. The truth is: it’s very common in the United States. In fact, it’s the most common birth defect after congenital heart disease, occurring in one in 700 births. That’s around 5,000 births per year.

On a recent episode, PediaCast host Mike Patrick, MD sat down with Richard Kirschner, MD, chief of plastic and reconstructive surgery and director of the cleft lip and palate center at Nationwide Children’s, to discuss the condition.

What is cleft palate?

The palate is the roof of the mouth and separates it from the nose. It has an important job during speech and while swallowing – that way, food and fluid don’t come through our nose when we eat or drink.

Normally, the lip and the palate develop during the first three months of pregnancy. As an embryo, the baby’s right and left halves of the lip and palate form separately before they gradually fuse together. So, a cleft lip or a cleft palate occurs when that fusion process is somehow disrupted.

What causes cleft palate?

We don’t fully know what causes cleft palate. There is a genetic piece, but its exact cause hasn’t been identified. Some clefts are associated with other abnormalities as part of a larger syndrome. Certain medications and smoking cigarettes can also lead to an increased risk of clefting.

What kinds of problems does a cleft palate create for a baby?

The main problems we see in infancy are difficulty with feeding, since the mouth and nose don’t have that separation. It’s also common for the eustachian tube to malfunction, leading to a buildup of fluid in their eardrums that can interfere with hearing or lead to infection. Later on, the clefting may influence the sound of the child’s speech or lead to social issues.

How do you treat cleft palate surgically and holistically?

We can generally repair a clefted lip or palate within the first several months of life with one or two surgeries. We like to get those surgeries done early to minimize appearance-related issues and restore the palate before the child develops a whole lot of speech. If patients have a cleft that involves both the lip and the palate, we will typically place additional bone in the gum area around seven to nine years old. And, because a cleft is more than an appearance-related issue, there are a number of medical professionals that are needed for holistic care. Oral surgeons, ENT (ear-nose-throat) surgeons, speech and language pathologists, and audiologists are just a few team members that can help resolve speech and hearing challenges.

What are some resources for parents of children with cleft palate?

The most important tool for families to achieve best outcomes is information. The Cleft Palate Foundation is a national organization working to get parents the information they need to work as part of their child’s health care team. Additionally, if you don’t have a specialist or multi-team approach in your area, you don’t need a referral to make an appointment through the Nationwide Children’s Welcome Center.