Cleft Lip and Cleft Palate

Medically Reviewed by Jabeen Begum, MD on February 28, 2024
10 min read

Cleft lip and cleft palate are facial and oral differences that occur very early in pregnancy, while the fetus is developing inside the uterus. When the tissues in the mouth or lip area are not enough and fail to join together properly, it results in clefting.

A cleft lip is a physical split or separation of the two sides of the upper lip and appears as a narrow opening or gap in the skin of the upper lip. This separation often extends beyond the base of the nose and includes the bones of the upper jaw and/or upper gum.

A cleft palate is a split or opening in the roof of the mouth. A cleft palate can involve the hard palate (the bony front portion of the roof of the mouth) and/or the soft palate (the soft back portion of the roof of the mouth).

Cleft lip and cleft palate can occur on one or both sides of the mouth. Because the lip and the palate develop separately, it is possible to have a cleft lip without a cleft palate, a cleft palate without a cleft lip, or both conditions together.

Who gets cleft lip and cleft palate?

About 1 out of every 2,800 babies in the U.S. are born with a cleft lip. Around 1 in 1,600 have both cleft lip and palate. Clefts affect more children of Asian/Pacific, Latinx, or Native American descent than children of other races. 

Cleft lip, with or without cleft palate, affects twice as many babies assigned male at birth as those assigned female. But cleft palate is more common in females.

Is cleft lip genetic?

Scientists say that a combination of genes and environment causes cleft lip and palate. A newborn is more likely to have these facial changes if one of their parents or a brother or sister has it. But most children with cleft lip and palate don't have any relatives with this condition. 

Cleft lip and palate can be part of genetic conditions such as Stickler syndrome and 22q11.2 deletion syndrome (or DiGeorge syndrome). Children with these conditions may have other facial and body differences, too. Some babies inherit a gene that makes them more likely to get cleft lip and palate. Triggers in the environment, such as exposure to certain chemicals in the womb, can also cause the condition.

In most cases, the cause of cleft lip and cleft palate is unknown. These conditions can't be prevented. Most scientists believe clefts are due to a combination of genetic and environmental factors. There appears to be a greater chance of clefting in a newborn if a sibling, parent, or relative has had the problem.

Another potential cause may be related to a medication a mother may have taken during pregnancy. Some drugs that may cause cleft lip and cleft palate include anti-seizure/anticonvulsant drugs, acne drugs containing Accutane, and methotrexate, a drug commonly used for treating cancer, arthritis, and psoriasis.

Cleft lip and cleft palate may also occur as a result of exposure to viruses or chemicals while the fetus is developing in the womb.

In other situations, cleft lip and cleft palate may be part of another medical condition.

Babies with a cleft palate may have more trouble eating from the bottle or breast because the roof of their mouth isn't fully formed. Food or liquid may come out of their nose when they try to eat.

Other symptoms include:

  • Delayed speech or trouble speaking
  • Ear infections
  • Hearing loss
  • Missing, crooked, or small teeth
  • Teeth and jaws that don't line up evenly

An ultrasound during pregnancy can sometimes show a cleft lip, with or without cleft palate. The doctor can confirm the diagnosis with an exam after the baby is born. But a small cleft lip or palate may not be noticeable until your baby has trouble feeding, or later in life.

Prenatal ultrasound

An ultrasound is a test that uses sound waves to make pictures of your unborn baby. Doctors usually perform ultrasounds twice during pregnancy, once in the first trimester and again around 18-20 weeks into pregnancy.

The doctor should be able to see differences in the structure of your baby's face on an ultrasound between 11 and 13 weeks. Cleft lip and palate are easier to see as the fetus develops. An ultrasound can often show a cleft lip alone or a cleft lip and palate at about 16 weeks into pregnancy. A cleft palate alone or a partial cleft lip may not show up on this imaging test.

If your baby has signs of a cleft lip or palate on ultrasound, the doctor may take a sample of your amniotic fluid to test for other inherited genetic disorders. It's not easy to diagnose cleft lip and palate while the fetus is growing in the womb. It's easier to diagnose by looking at a newborn's mouth, nose, and palate. Your newborn may also have tests to find other physical changes.

  • Eating problems. With a separation or opening in the palate, food and liquids can pass from the mouth back into the nose. Fortunately, specially designed baby bottles and nipples that help keep fluids flowing downward toward the stomach are available. Children with a cleft palate may need to wear a man-made palate to help them eat properly and ensure that they are receiving adequate nutrition until surgical treatment is provided.
  • Ear infections/hearing loss. Children with cleft palate are at increased risk of ear infections since they are more prone to fluid buildup in the middle ear. If left untreated, ear infections can cause hearing loss. To prevent this from happening, children with cleft palate usually need special tubes placed in the eardrums to aid fluid drainage, and their hearing needs to be checked once a year.
  • Speech problems. Children with cleft lip or cleft palate may also have trouble speaking. These children's voices don't carry well, as their voice may take on a nasal sound and their speech may be difficult to understand. Not all children have these problems, and surgery may fix these issues entirely for some. For others, a special doctor called a speech pathologist will work with the child to resolve speech difficulties.
  • Dental problems. Children with clefts are more prone to cavities and often have missing, extra, malformed, or displaced teeth requiring dental and orthodontic treatments. In addition, children with cleft palate often have an alveolar ridge defect. The alveolus is the bony upper gum that contains teeth. A defect in the alveolus can (1) displace, tip, or rotate permanent teeth, (2) prevent permanent teeth from appearing, and (3) prevent the alveolar ridge from forming. These problems can usually be repaired through oral surgery.

Due to the number of oral health and medical problems associated with a cleft lip or cleft palate, a team of doctors and other specialists is usually involved in the care of these children. Members of a cleft lip and palate team typically include:

  • A plastic surgeon to evaluate and perform necessary surgeries on the lip and/or palate
  • An otolaryngologist (an ear, nose, and throat doctor) to evaluate hearing problems and consider treatment options for hearing problems
  • An oral surgeon to reposition segments of the upper jaw to improve function and appearance, if needed, and to repair the cleft of the gum
  • An orthodontist to straighten and reposition teeth
  • A dentist to perform routine dental care
  • A prosthodontist to make artificial teeth and dental appliances to improve the appearance and to meet functional requirements for eating and speaking
  • A speech pathologist to assess speech and feeding problems
  • A speech therapist to work with the child to improve speech
  • An audiologist (a specialist in communication disorders stemming from a hearing impairment) to assess and monitor hearing
  • A nurse coordinator to provide ongoing supervision of the child's health
  • A social worker/psychologist to support the family and assess any adjustment problems
  • A geneticist to help parents and adult patients understand the chances of having more children with these conditions

The health care team works together to develop a plan of care to meet the individual needs of each patient. Treatment usually begins in infancy and often continues through early adulthood.

Treatments for cleft lip and palate help your child eat and speak better. Doctors treat cleft lip and palate with surgery. Other treatments help with problems such as eating and speech that cleft lip and palate can cause.

Cleft lip surgery

Cleft lip repair involves one or two surgeries, depending on the size of the cleft. The first surgery happens when the baby is 3-6 months old. While your baby is asleep and pain-free, the surgeon closes the opening in their lip.

Cleft palate surgery

Surgery to close a cleft palate happens during the baby's first year. The surgeon closes the opening in the palate and rebuilds the roof of the baby's mouth. Special tubes may go into the child's ears to drain fluid and prevent hearing loss. 

Many children with a cleft palate will need a few procedures as they grow. Some may need a bone graft between ages 6 and 10 to support their teeth and jaw.

Other surgeries improve the look of the lip and nose, close openings between the mouth and nose, help with breathing, and straighten the jaws and teeth. Some children will not have their last surgery until the teen years once their face has grown.

Other treatments

Your child's doctor may suggest one or more of these treatments to fix complications from a cleft lip and palate:

  • Braces to straighten the teeth
  • Ear tubes and other treatments for ear infections
  • Feeding therapy
  • Hearing aids
  • Speech therapy
  • Talk therapy to manage the stress of living with cleft lip and palate

Treatment for a cleft lip and cleft palate can take many years and involve several surgeries. But most children with this condition can have a normal childhood and life.

A team of doctors and other health care providers will manage your child's care. Some children may feel stressed by the surgeries or get self-conscious about the way they look. A psychologist, therapist, or other mental health care provider can help your child deal with the emotional impact of their condition. You can also find resources and support from organizations such as the American Cleft Palate Craniofacial Association (ACPA).

Generally, the preventive and restorative dental care needs of children with clefts are same as those of other children. However, children with cleft lip and cleft palate may have special problems related to missing, malformed, or malpositioned teeth that require close monitoring.

  • Early dental care. Like other children, children born with cleft lip and cleft palate require proper cleaning, good nutrition, and fluoride treatment to have healthy teeth. Appropriate cleaning with a small, soft-bristled toothbrush should begin as soon as teeth erupt. If a soft children's toothbrush will not adequately clean the teeth because of the modified shape of the mouth and teeth, your dentist may recommend a toothette. It is a soft, mouthwash-containing sponge on a handle that's used to swab teeth. Many dentists recommend that the first dental visit be scheduled at about 1 year of age or even earlier if there are special dental problems. Routine dental care can begin around 1 year of age.
  • Orthodontic care. A first orthodontic appointment may be scheduled before a child has any teeth. The purpose of this appointment is to assess facial growth, especially jaw development. After teeth erupt, an orthodontist can further assess a child's short and long-term dental needs. After the permanent teeth erupt, orthodontic treatment can be applied to align the teeth.
  • Prosthodontic care. A prosthodontist is a member of the cleft palate team. They may make a dental bridge to replace missing teeth or make special appliances called "speech bulbs" or "palatal lifts" to help close the passage between the nose and the mouth so that speech sounds more normal. The prosthodontist coordinates treatment with the oral or plastic surgeon and speech pathologist.

Cleft lip and cleft palate are facial differences that sometimes happen as a fetus develops in the womb. Your doctor can diagnose these changes during an ultrasound or with an exam after your baby is born. Surgery is the main way to treat cleft lip and palate, and most children will need many surgeries as they grow.

How common is cleft lip?

About 1 out of every 2,800 babies in the U.S. are born with cleft lip. Around 1 in 1,600 babies have both cleft lip and cleft palate.

What foods cause cleft lip?

No foods directly cause cleft lip. If your child has these facial differences, it's probably not from anything in your diet. But this condition is slightly more likely to affect babies whose mothers drink alcohol, don't get enough folic acid, or are obese during their pregnancy.

How can you prevent cleft lip and palate during pregnancy?

You can't always prevent cleft lip and palate, but you can lower your risk. Take a multivitamin that contains 400 micrograms (mcg) of folic acid every day in the months before your pregnancy. During pregnancy, increase folic acid to 600 mcg a day. Don't drink alcohol or smoke while you're pregnant.

When is cleft palate detected?

A prenatal ultrasound can detect cleft lip and palate by around week 16 of pregnancy. A cleft palate alone may not show up on an ultrasound. A doctor can diagnose it with an exam after your child is born.