Overview
Cleft lip and/or palate (CLP) is a relatively common craniofacial deformity characterised by the failure of the normal fusion of the palate and lip during development. CLP is not only a cosmetic deformity but can affect the infant’s ability to feed, swallow, speak, and can affect maternal bonding.
Around 70% of cases occur in isolation and the remaining 30% are thought to be associated with a syndrome (such as a chromosomal disorder).
Epidemiology
- Cleft lip and palate can affect around 1 in 1000 live births
- Asian and Native American people are more commonly affected
- Male children are more commonly affected
- Combined CLP is the most common variant
Risk Factors
- Maternal drug use:
- Antiepileptics
- Isotretinoin
- Corticosteroids
- Benzodiazepines
- Maternal smoking
- Maternal alcohol use
- Family history
Presentation
Overview
Cleft lip and palate result in a gap or opening between the mouth and nasal cavity:
- Cleft lip – where the cleft (gap) affects the lip only and not the palate
- Cleft palate – where the cleft affects the palate only and not the lip
- Cleft lip and palate – where the cleft affects both the lip and palate
Management
Referral
Patients with CLP should be referred to secondary care and are managed by a multidisciplinary team consisting of plastic, ENT, and maxillofacial surgeons, speech and language therapists, dentists etc.
An examination to exclude associated syndromes should be performed by the paediatrician.
Management
Initial management involves ensuring the baby can feed. This may involve the use of orthodontic devices such as specially-shaped bottles and teats. Definitive management involves surgery:
- Cleft lip is generally repaired at 3 months of age
- Cleft palate is generally repaired at 6-12 months of age
Complications
- Feeding, swallowing, and speech problems
- Impaired maternal bonding
- Increased risk of ear problems including ear infections, otitis media with effusion (glue ear), and hearing loss
- Cosmetic complications such as lip and nose deformities and poor self-esteem
Prognosis
- With early management and regular follow-up, the prognosis is very good. Treatment generally takes place over several years as the child grows and the palate and teeth develop.
