We had a worried mother calling in, her newborn baby had been born with a cleft lip, so we reached out to The Portland Hospital who are pros on the subject. Professor Piet J.J Haers, Consultant Oral, Maxillofacial and Cleft Surgeon at The Portland Hospital.

What’s the definition of a cleft lip and palate?

A cleft lip and/or palate occursin the womb when the parts that form the lip and the palate do not join together.  This can occur either only in the lip when the three parts do not join together or in the palate separately.  In the lip this happens most often on one side only, but it can occur on both sides.

What’s the cause of a cleft lip and palate, how common is it, and is there anything that can be done during pregnancy to prevent it?

Today, more than sixty genetic links have been identified that can in complex interaction with environmental factors lead to the expression of cleft lip and/or palate.  In the UK, 1 in 750 are born with a cleft.

A healthy lifestyle is important for all pregnancies.  There is some evidence that high doses of folic acid at the time of conception may reduce the risk of cleft lip and palates.

Besides cosmetic reasons, does a cleft lip and palate pose any danger to health and are there any implications on speech or taste?

Cleft lip and palate is not a cosmetic condition but a facial deformity with aesthetic and functional consequences.  It is important that a cleft palate is repaired in a timely manner to allow normal speech to develop, provided that the child’s hearing and learning development is normal.

The cleft lip involves not only the lip but also the nose.  It is important to achieve good lip competence for pronunciation of some sounds, but equally it is important to have a good repair of the upper lip to allow, in particular, normal drinking.  In some cases, nasal breathing can be impaired and that may require additional correction of the nose later on in life.  A cleft palate has no implications for taste, but is obviously unpleasant as food and drink go via the open roof of the mouth and enter the nose.

How easy is it to rectify the problem, and what is the procedure?

Modern techniques of surgical repair of cleft lip and palate lead to good results.

The cleft lip repair aims to achieve good reconstruction of the upper lip muscle as well as creating the best possible symmetry of the lip itself.  I personally always try to achieve maximal symmetry of the nose at the same time, as this may improve nasal breathing and the overall result of the repair.  It is important to achieve the best possible repair during this first procedure, as this leads to significantly less additional surgeries later on in life.  A unilateral cleft lip, which is a cleft lip on one side only, is usually repaired at the age of about three to four months.  A bilateral cleft lip, which means a cleft lip on either side of the upper lip, can be repaired in a single procedure but I prefer to repair it in two stages.  The first stage is a so-called ‘lip adhesion’ which allows for moulding of the central bony part of the upper jaw and stretching of the soft tissues.  This then allows for a good definitive second stage primary repair four or five months later. A good age for cleft palate repair is between nine and twelve months old.

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