What Is a Cleft?
A cleft is when a baby is born with an opening in the lip and/or roof of the mouth (palate).
A baby with a cleft might have:
These birth defects are treatable. Most kids can have surgery to repair them early in life.
What Is a Cleft Palate?
A cleft palate (PAL-it) is when a baby is born with a cleft in the roof of the mouth. This leaves a hole between the nose and the mouth. It can be:
- a complete cleft palate: going from behind the front teeth to the back of the palate
- an incomplete cleft palate: affecting just the back of the palate, near the back of the throat.
Complete Cleft Palate
Complete cleft palate is when a baby is born with a cleft (gap) of the hard and soft palate. This means there's a gap in the roof of the mouth from behind the front teeth to the back of the palate.
Incomplete Cleft Palate
Incomplete cleft palate is when a baby is born with a gap that usually affects only the back part of the palate.
An untreated cleft palate will create problems with feeding, growth and development, ear infections, hearing, and speech development. It is important to correct a cleft with surgery while a child is young.
How Is a Cleft Palate Diagnosed?
A cleft palate is harder to see than a cleft lip. Doctors find them when they examine the inside of a baby's mouth after birth.
While twice as many boys have a cleft lip, with or without a cleft palate, cleft palate without a cleft lip affects girls more often.
How Is a Cleft Palate Treated?
A cleft palate usually can be repaired with surgery called palatoplasty (PAL-eh-tuh-plass-tee) when the baby is 6–12 months old. The goals of palatoplasty are to:
- Close the opening between the nose and mouth.
- Help create a palate that works well for speech.
- Improve swallowing and breathing.
In this palate reconstruction surgery, a plastic surgeon will:
- close the cleft down the middle in layers, connecting the muscles of the soft palate and rearranging them to close the cleft
- make two incisions (cuts) behind the teeth to help ease tension on the palate closure
This surgery requires general anesthesia and takes about 2–3 hours. Your child will stay in the hospital for several days for recovery. The stitches will dissolve on their own.
Your child will need a liquid diet for a week or two, then will eat soft foods for several more weeks before going back to his or her regular diet.
More surgeries may be needed as children grow older and their facial structure changes. This can include surgeries like:
- pharyngoplasty (fuh-RING-oh-plas-tee), which helps improve speech. This operation changes the shape and function of the soft palate and the pharynx. This sometimes can help with a nasal voice tone.
- alveolar (al-VEE-eh-lur) bone grafts, which can support permanent teeth and stabilize the upper jaw. A bone graft fills in the gaps in the bone or gums near the front teeth. It's usually done when kids are 6–10 years old.
Throughout childhood, kids who were born with a cleft palate will need:
As children become teens, they will likely want to (and should) be more involved in their care. They may want to:
- have their scars made less noticeable
- improve the appearance of their nose and upper lip
- improve their bite with orthognathic (or-thog-NATH-ik) surgery, which realigns the jaws and teeth
These operations may improve speech and breathing, overbites/underbites, and appearance.
What Else Should I Know?
A child with a cleft palate can sometimes have other health problems, such as:
- trouble feeding
- fluid buildup in the middle ear
- hearing loss
- dental problems
- speech difficulties
It's important to work with a care team to help manage any problems. Besides the pediatrician, a child's treatment team will include:
- plastic surgeon
- ear, nose, and throat (ENT) physician (otolaryngologist)
- oral surgeon
- speech-language pathologist
You might also work with a:
- social worker
- psychologist or therapist
- team coordinator
When Should I Call the Doctor?
Palatoplasty and the other procedures done to help kids born with a cleft palate have seen major improvements in recent years. Most kids who undergo them have very good results. There are risks with any surgery, though, so call the doctor if your child:
- has a fever above 101.4˚F
- has lasting pain or discomfort
- has heavy bleeding from the mouth
- can't drink fluids
Most kids with cleft palate are treated successfully with no lasting problems.
The psychologists and social workers on the treatment team are there for you and your child. So turn to them to help guide you through any hard times. You also can find more information and support online:
- American Cleft Palate-Craniofacial Association (ACPA)
- Cleft Lip & Palate Association
- FACES: The National Craniofacial Association
- Smile Train