Cleft Lip and Palate

What is cleft lip and palate?

Cleft lip and palate are birth differences that occur when parts of a baby’s upper lip or the roof of the mouth (the palate) do not join together completely during early pregnancy. A cleft lip is a gap or split in the upper lip, which can range from a small notch to a wide opening that extends up into the nose. A cleft palate is an opening in the roof of the mouth, which may involve the soft palate at the back of the mouth, the hard palate toward the front, or both. Some children are born with only a cleft lip, some with only a cleft palate, and others with both together. The medical classification code Q37.9 refers to an unspecified cleft palate with cleft lip.

To answer the common question “what is cleft lip and palate” in the simplest terms: it is a gap in the lip, the roof of the mouth, or both, that is present at birth because the tissues did not fuse fully while the baby was developing in the womb. The lip normally closes early in pregnancy, and the palate closes a few weeks later, which is why a baby can have one, the other, or both.

Cleft lip and palate is one of the most common birth differences worldwide. It affects babies of all backgrounds, although it occurs somewhat more often in some populations than others. A cleft can appear on one side of the lip (unilateral) or on both sides (bilateral). In many cases it occurs on its own; in some children it is part of a broader genetic condition or syndrome. With modern care, most children born with a cleft can eat, speak, hear, and live full lives, although treatment usually involves several stages over childhood.

Symptoms

Unlike many medical conditions, cleft lip and palate is usually visible or detectable at birth, so “symptoms” here mainly means the physical signs of the cleft and the practical difficulties it can cause. Cleft lip and palate symptoms vary depending on whether the lip, the palate, or both are affected, and on how wide the cleft is.

Common signs and symptoms include:

• A visible split or gap in the upper lip — this may be a small notch or a wider opening that reaches the base of the nose, on one or both sides.
• An opening in the roof of the mouth — visible when looking inside the baby’s mouth, affecting the soft palate, hard palate, or both.
• Feeding difficulties — babies with a cleft palate often struggle to create the suction needed for breastfeeding or standard bottle-feeding, and milk may come out of the nose during feeds.
• Nasal-sounding speech — as the child grows, an unrepaired or incompletely repaired palate can allow air to escape through the nose during speech.
• Frequent ear infections and fluid in the middle ear — the muscles of the palate help the ear tubes (Eustachian tubes) work properly, so children with cleft palate are prone to ear problems and, in some cases, hearing loss if these are not managed.
• Dental differences — teeth near the cleft may be missing, extra, small, or out of position, and the gum line (alveolar ridge) may be affected.

The picture differs by type. A cleft lip alone mainly affects appearance and, to a lesser degree, feeding and later lip and nose shape. A cleft palate alone may not be obvious from the outside at all, but it typically causes more significant feeding, speech, and ear problems. A rarer form called a submucous cleft palate is hidden under the lining of the mouth; it may only be suspected later, when a child develops nasal speech or repeated ear infections. Cleft lip and palate together combine features of both, and the challenges change with age: feeding is the main concern in infancy, speech and hearing become more important in the toddler and preschool years, and dental alignment and facial growth matter through later childhood and adolescence.

Causes and risk factors

Cleft lip and palate causes are not fully understood, and in most individual cases no single cause can be identified. Doctors generally consider clefts to be multifactorial, meaning they result from a combination of genetic factors (the genes a baby inherits) and environmental factors (conditions during pregnancy) acting together during the first weeks of development.

Recognized risk factors include:

• Family history — a parent, sibling, or other close relative with a cleft increases the chance that a baby will be born with one, although most babies with a family history are still born without a cleft.
• Genetic syndromes — some clefts occur as part of a wider genetic condition; this is more common with cleft palate alone than with cleft lip.
• Smoking during pregnancy — maternal smoking is associated with a higher risk of clefts.
• Alcohol use during pregnancy — has been linked to a higher risk of birth differences, including clefts.
• Certain medications — some anti-seizure medicines and other drugs taken in early pregnancy have been associated with clefts; pregnant women should review all medications with their doctor rather than stopping them on their own.
• Diabetes — women with diabetes diagnosed before pregnancy may have a somewhat higher risk of having a baby with a cleft.
• Nutritional factors — inadequate folic acid intake before and during early pregnancy may play a role, which is one reason folic acid supplements are widely recommended.
• Maternal obesity — has been associated in some studies with a higher risk of clefts.

It is important for parents to understand that in most cases a cleft is not the result of anything a mother or father did or failed to do. The lip and palate form very early in pregnancy, often before a woman knows she is pregnant, and many clefts occur even when all recommended precautions were followed.

Diagnosis

Cleft lip and palate diagnosis often begins before birth. During routine pregnancy ultrasound scans, usually performed around the middle of pregnancy, a cleft lip can frequently be seen on the images of the baby’s face. A cleft palate on its own is harder to detect on ultrasound because the roof of the mouth is difficult to see clearly, so it is often not identified until after birth. When a cleft is suspected on ultrasound, the doctor may recommend a more detailed scan and, in some cases, additional testing such as amniocentesis (sampling the fluid around the baby) to check for associated genetic conditions, particularly if other differences are seen.

After birth, diagnosis is usually straightforward. A cleft lip is visible on physical examination, and a cleft palate is found when the doctor or midwife examines the inside of the newborn’s mouth, which is part of the standard newborn check. No blood test or imaging is needed to confirm the cleft itself; the diagnosis is made by direct examination.

Further assessments are commonly arranged to build a full picture and plan care:

• Feeding assessment — a nurse or feeding specialist evaluates how the baby sucks and swallows and advises on special bottles or feeding positions if needed.
• Hearing tests — newborn hearing screening and follow-up tests, because middle-ear problems are common with cleft palate.
• Genetic evaluation — if the cleft occurs alongside other physical differences, a genetics specialist may examine the baby and suggest tests to look for an underlying syndrome.
• Dental and orthodontic assessment — as the child grows, dental X-rays and examinations help track how the teeth and jaws are developing.

A submucous cleft palate may be diagnosed later in childhood, when nasal speech, feeding difficulty, or repeated ear infections prompt a closer look at the palate. In these cases, the doctor examines the palate carefully and may use special assessments of speech and palate movement to confirm the diagnosis.

Treatment options

Cleft lip and palate treatment is delivered in stages over many years and typically involves a coordinated team, often including a pediatric or plastic surgeon, a pediatrician, a speech and language therapist, an ear, nose, and throat (ENT) specialist, a dentist and orthodontist, an audiologist (hearing specialist), and sometimes a geneticist and a psychologist. In hospital settings such as Acibadem, this coordinated care is generally organized through pediatric surgery together with the pediatrics department.

Feeding support before surgery

Before any operation, the first priority is helping the baby feed and grow well. Babies with a cleft palate usually cannot create normal suction, so specially designed bottles and nipples that allow milk to flow more easily are often used. Some mothers can breastfeed a baby with a cleft lip alone; with a cleft palate, expressed breast milk given by special bottle is a common approach. A feeding specialist typically guides parents through this. In some centers, a removable plate or molding device may be fitted before surgery to help shape the lip, gum, and nose, an approach sometimes called presurgical orthopedics.

Surgical repair

Surgery is the core of cleft lip and palate treatment. There is no medication that can close a cleft, and a true cleft does not heal on its own, so watchful waiting is not a treatment for the cleft itself — although timing matters, and surgeons deliberately wait until the baby is strong enough and the tissues are ready.

• Cleft lip repair — usually performed in the first several months of life, often around three to six months of age, depending on the baby’s health and the surgical team’s protocol. The surgeon closes the gap and reshapes the lip and often the nostril.
• Cleft palate repair — usually performed later in the first year or early in the second year of life, commonly between about six and eighteen months. Closing the palate before speech develops helps the child form sounds normally.
• Ear tube placement — small drainage tubes are often inserted into the eardrums, sometimes during the same anesthetic as another operation, to prevent fluid buildup and protect hearing.
• Alveolar bone grafting — if the cleft involves the gum line, a small piece of bone (often taken from the hip) may be placed into the gap, usually between about eight and twelve years of age, to support the adult teeth.
• Further speech surgery — some children continue to have air escaping through the nose during speech after palate repair and may benefit from an additional operation to improve palate function.
• Revision and refinement procedures — as the child grows, additional operations may improve the appearance of the lip and nose or, in adolescence, correct jaw alignment (orthognathic surgery) once facial growth is largely complete.

Nonsurgical treatment

Alongside surgery, several ongoing therapies are usually needed:

• Speech and language therapy — regular assessment and therapy help children develop clear speech, especially after palate repair.
• Hearing care — repeated hearing checks and treatment of ear infections; hearing aids are considered if hearing loss persists.
• Dental and orthodontic care — braces and other orthodontic treatment are commonly needed to align teeth and guide jaw growth.
• Psychological support — counseling can help children and families manage the emotional aspects of visible differences and repeated hospital visits.

Medications play only a supporting role, for example antibiotics for ear infections and standard pain relief after operations, as directed by the treating team.

Living with cleft lip and palate / outlook

The outlook for children born with cleft lip and palate is generally good when treatment is delivered by an experienced, coordinated team. Most children who undergo timely repair can eat normally, develop understandable speech, hear adequately, and attend regular school. Surgical scars usually fade considerably over time, although some visible difference often remains, and some children choose further refinement surgery in adolescence.

It is honest to say that cleft care is a long-term process rather than a single fix. Families should expect regular follow-up visits through childhood to monitor speech, hearing, dental development, and facial growth. Some children need additional operations; others do not. Speech therapy may continue for years, and orthodontic treatment often extends into the teenage years. Outcomes vary from child to child depending on the width and type of the cleft, whether a syndrome is present, and how the individual child grows and heals — no team can guarantee a specific result.

Emotionally, many families find the diagnosis distressing at first, particularly when it is made during pregnancy. Support groups, psychologists, and the care team can help parents prepare and can support children as they grow, especially around school age and adolescence when appearance and speech can affect confidence. With appropriate care and support, the great majority of people born with a cleft lead healthy, independent adult lives.

Frequently asked questions

What is cleft lip and palate in simple terms?

It is a gap in the upper lip, the roof of the mouth, or both, that is present at birth. It happens because the tissues that form the lip and palate did not fully join together during the first weeks of pregnancy. It can range from a small notch in the lip to a wide opening involving both the lip and the entire palate.

Can cleft lip and palate heal on its own?

No. A true cleft is a structural gap in tissue and bone, and it does not close by itself as the child grows. Surgery is needed to repair it. However, the timing of surgery is planned carefully, and with staged operations and supportive therapy, most clefts can be repaired effectively during childhood.

How serious is cleft lip and palate?

It is a significant condition that affects feeding, speech, hearing, and dental development, but it is very treatable. It is not usually life-threatening on its own, although newborn feeding difficulties need prompt support. When a cleft occurs as part of a genetic syndrome, the overall outlook depends on the associated condition, which is why doctors may recommend genetic evaluation.

What causes cleft lip and palate, and did I do something wrong?

In most cases, no single cause can be found, and parents should not blame themselves. Clefts result from a mix of genetic and environmental influences during very early pregnancy. Known risk factors include family history, smoking or alcohol use in pregnancy, certain medications, and diabetes, but many clefts occur even when none of these factors is present.

When is cleft lip and palate surgery done, and what is recovery like?

Cleft lip repair is often performed in the first several months of life, and cleft palate repair usually within the first year or two, though exact timing varies by child and by surgical team. After surgery, babies typically stay in the hospital briefly, need adjusted feeding for a period, and are monitored for pain and healing. Most recover well within a few weeks, and follow-up visits check the results as the child grows.

Will my child speak normally after cleft palate repair?

Many children develop clear, understandable speech after palate repair, especially with speech therapy support. Some children continue to have nasal-sounding speech or difficulty with certain sounds and may need ongoing therapy or, in some cases, a further operation to improve palate function. Regular speech assessments help identify and address problems early.

Can cleft lip and palate be detected before birth?

A cleft lip can often be seen on routine ultrasound scans around the middle of pregnancy. A cleft palate alone is much harder to see on ultrasound and is frequently found only after birth during the newborn examination. If a cleft is suspected before birth, doctors may offer more detailed scans and discuss whether additional tests are appropriate.

When to see a doctor

All babies born with a cleft lip or palate should be evaluated promptly by a pediatric care team so that feeding support and treatment planning can begin early. Beyond routine follow-up, seek medical attention urgently if any of the following occurs:

• Feeding problems in a newborn — the baby cannot feed effectively, tires quickly during feeds, chokes or coughs repeatedly, or has milk consistently coming out of the nose.
• Signs of dehydration or poor growth — very few wet diapers, unusual sleepiness, a sunken soft spot on the head, or failure to gain weight.
• Breathing difficulty — noisy, labored, or pausing breathing, or a bluish color around the lips, which requires emergency care.
• Problems after surgery — fever, increasing redness or swelling at the repair site, bleeding that does not stop, wound opening, or a baby who refuses all feeds after an operation.
• Repeated ear infections or concerns about hearing — a child who pulls at the ears, has discharge from the ear, or does not respond normally to sounds or voices.
• Speech concerns — very nasal speech, little understandable speech by the expected age, or a sudden change in speech quality.

If you are pregnant and a cleft has been seen on ultrasound, ask your obstetric team about referral to a cleft care team before delivery, so that a feeding and treatment plan is ready when your baby is born. For any sudden or severe symptom in a baby, such as difficulty breathing or signs of serious dehydration, seek emergency medical care immediately.