Craniofacial Clefts

A cleft is a fissure or opening - a gap. Facial cleft is a malformation, opening or gap in the face. Complete facial clefts, that involve more than the lip and palate, are extremely rare congenital (present from birth) irregularities, and occur due to non-fusion of the body's natural structures before birth. All structures like bone, soft tissue, skin, etc., can be affected.

The most common facial clefts are oral clefts, and occur on the lip, palate (roof of mouth), or both. Approximately 1 in 700 children are affected.

Cleft lip is a birth defect in which a baby's upper lip doesn’t form completely and has an opening in it. A cleft palate is a similar birth defect in which a baby’s palate doesn’t form completely and has an opening in it. It can be left, right or bilateral.

Patients can be seen by Texas Children's experts in Cleft Lip and Palate and Craniofacial and Craniosynostosis Clinic.

Causes & Risk Factors

Formation of clefts happens early during pregnancy (about 6 weeks). An exact cause for facial clefts is unknown. Some possible causes and risk factors are:

  • Genetic mutations during pregnancy.
  • Mutated genes passed from parents to the child.
  • Not getting enough folic acid before pregnancy. Folic acid is a vitamin that can help protect your baby from birth defects of the brain and spine called neural tube defects. It also may reduce the risk of oral clefts by about 25%.
  • Using certain medicines, during pregnancy (ask your medical provider).
  • Smoking during pregnancy. Smoking causes 1 in 5 (20 %) oral clefts.
  • Having certain infections during pregnancy 

Symptoms & Types

The major symptom of an oral cleft is a visible opening in the lip or palate. Sometimes a cleft can be seen before birth on an ultrasound. If the face is not easy to see on ultrasound, it may not be noticed until birth.

Diagnosis & Tests

Sometimes a cleft can be seen before birth on an ultrasound. Usually, but not always, the doctor will see the cleft right after the baby is born. However, minor clefts of the palate might not be diagnosed until later in life. These types of clefts do not have a gap in the palate, but the muscles underneath and within the palate are not arranged in the right way, just like children with a palatal cleft with a gap.

Treatment & Care

Because the cause of facial clefts still is unclear, it is difficult to say what may prevent children being born with facial clefts. It seems that folic acid contributes to a lower risk of a child being born with a facial cleft, but more research is needed.

Proper management is best performed by a multidisciplinary team that is made of: a pediatrician, plastic surgeon, ear, nose, and throat physician (otolaryngologist), speech pathologist, orthodontist and others. This is a standard of care at Texas Children’s Hospital that begins soon after the child's birth and continues to adulthood.

An oral cleft can be successfully treated with surgery. The best aesthetic result is achieved if conducted soon after birth or in early childhood, and when the incisions can be positioned in areas that attract the least attention. If, however, the function of a part of the face isn’t damaged, the operation depends on psychological factors and the facial area of reconstruction.

A cleft lip is usually repaired between the ages of 3 to 6 months, and a cleft palate is usually repaired between 9 and 12 months of age. As kids grow older, they might need additional surgeries. The treatment plan is made with the entire team and the family. This plan includes every operation needed in the first 18 years of the patient’s life until full reconstruction. 

Living & Managing

Children with oral clefts they might encounter social, psychological, and educational challenges. If your baby has only a cleft lip, speech problems are not likely. However, many children with cleft palate need the help of a speech-language pathologist.

Children with cleft palate often have a lot of middle ear problems. These may cause hearing loss if not treated. Your child should see an ear, nose and throat doctor and an audiologist to determine if ear tubes are necessary.

Related Topics

References & Sources