Cleft palate is a gap in the roof of the mouth that forms when two pieces of tissue do not fuse together during fetal development. It is the most common facial deformity in the U.S., affecting approximately one of every 1,700 babies.
The majority of children born with a cleft palate also have a cleft lip, or a visible gap in the middle of the upper lip. Having a child with a cleft palate or lip is not out of the ordinary and often happens with no apparent cause. That said, some factors play at least a minor role in increasing the risk, including:
- Race – Caucasian children are more prone to developing cleft palate and cleft lip than children of Asian and African descent
- Family history of either condition
- Maternal alcohol use
- Maternal smoking
- Poor maternal nutrition during pregnancy
Though the condition is common, it’s rare to see a child with a cleft lip or palate go untreated in the U.S. because prompt treatment is the standard of care. Let’s discuss why this is so and what parents can expect.
Why cleft palate and lip should be treated right away
Cleft palate can make it difficult for a baby to take a bottle or breastfeed. To suckle, babies compress the nipple of the bottle or breast against the roof of the mouth to create suction and draw out formula or milk. If they have a cleft palate or lip, they can’t do either efficiently because air and liquid will leak into the nose. In the time between birth and treatment, we can use special feeding devices designed with a valve system that serves as the palate.
Children who don’t receive treatment for cleft palate or cleft lip as infants often have difficulty speaking or being understood by peers, teachers, and social groups. One of the main functions of the palate is to act as a valve system to stop air from leaking out of the nose while speaking. In English, the only consonant sounds we make through the nose are “m,” “n,” and “ing.” All other consonant sounds require some sort of pressure in the mouth, which is nearly impossible with a cleft palate.
Psychological and social problems
Psychological and social dilemmas can arise from palpable differences in facial appearance and speech problems, which can be the result of an improperly treated cleft palate or lip. These issues can attract unwanted attention at school or in the community, which could hurt the child’s self-confidence.
What does cleft palate surgery entail?
Surgery is an important part of treatment for a child born with a cleft palate or lip. A cleft lip repair typically occurs when children are 3 to 4 months old, and a cleft palate typically is repaired at 9 to 12 months.
UT Southwestern plastic surgeons partner with Children’s Medical Center to repair these conditions in babies. Physically, the goal is to remedy and prevent feeding and speech issues. Aesthetically, the goal is to reduce the appearance of scarring in children with cleft lips. We typically approach the aesthetic component by mirroring the appearance of the patient’s non-cleft side of the face. As such, we can:
- Lengthen the lip
- Even up the red part of the lip
- Even up any nose deformity and try to hide the scar in between the nostril and the center of the upper lip
Surgery for a cleft palate aims to repair the mouth’s valve system, which controls the flow of air within the mouth and nose by opening, closing, or partially obstructing various passageways; in a cleft palate, these usually don’t function properly due to the gap in the palate as well as the position of the muscles in the soft palate. As a result, we must identify the muscles that move the palate, reposition these muscles to the right place, and move the tissues of the palate to close the gap. We perform cleft palate surgery under the operating microscope to move the muscles more precisely and efficiently.
Our cleft clinic team is accredited by the American Cleft Palate-Craniofacial Association (ACPA), which is dedicated to enhancing treatment for kids with craniofacial conditions. Our team includes plastic surgeons who specialize in cleft palate and lip repair; ear, nose, and throat doctors; oral surgeons; pediatric dentists and orthodontists; speech pathologists; psychologists; social workers; cleft team coordinators; and physician assistants. With all these aspects of care being assessed in one place and discussed between providers, parents can feel assured of great communication and a coordinated plan of care for their children.
Ongoing research to enhance treatment
One of my main research projects is the creation of an automated cleft speech evaluator. This technology would use a computer learning system to evaluate speech patterns of children born with cleft palate. The primary goal is to help facilitate care coordination between medical centers in the United States; on the global level, it could help inform parents about whether surgery or speech therapy are necessary if assessment facilities are not readily available.
The automated cleft speech evaluator is in the training and testing phase as of June 2018. As with any computer learning system, we need ample data to “train” it in what to look for in patients, as well as to determine its effectiveness. Thus far, it’s been extremely efficient.
Parents want what’s best for their babies, and it can be scary to think about a baby undergoing facial surgery. However, children with cleft palate or lip tend to do very well after surgery, particularly in the hands of experienced plastic surgeons who specialize in the procedure.