Cleft Palate

A cleft palate (pronounced PAL-et) or cleft lip is the most common facial birth defect and the second most common birth defect overall. The word “cleft” literally means a split or separation, while the word “palate” means roof of the mouth. So, a cleft palate is a split in the roof of the mouth, and a cleft lip is a split in the lip.

The cleft in the lip can be a tiny notch in the upper lip or it can be a large gap that extends from the upper lip into the nose.

Some may refer to a cleft lip as a harelip, meaning that the lip is split like the lip of a hare or rabbit. This ancient reference also has ties to witchcraft, and therefore is not a term that is well liked by those who have a cleft or those who have children with a cleft. The term should be avoided.

A cleft palate may range from a small hole in the roof of the mouth to a large gap that can cause eating, speaking, or breathing problems for the patient.

The birth defect most commonly affects Native Americans, then Asians, Caucasians, and least of all, African-Americans.

The palate consists of two parts:

• Hard Palate
  The hard palate is the plate that divides your oral and nasal cavities. It is the roof of your mouth.

• Soft Palate
  The soft palate makes up the back of your mouth. It facilitates swallowing, and it provides a passage for your speech and airway.

Before we were born, each of us had a cleft palate and a cleft lip. During fetal development, the parts of your lip pulled together and fused approximately five weeks after you were conceived. At approximately 10 weeks during your development, the pieces of your palate, one on the right side of your face and the other on the left, grew together. You can actually still feel the seam where the palate fused by running your tongue along the center of the roof of your mouth. The ridge that you feel is where the palates joined together to form the roof of your mouth.

In some, the tissues don't grow together properly, leaving a gap in the lip or a hole in the hard palate or the soft palate.

Individuals with clefts may have a unilateral cleft (split on one side) or bilateral cleft (split on both sides), and most have one of three primary types of clefts:

• Cleft lip and palate
  This is the most common type of cleft affecting both the palate and the lip. It occurs most often in males.

• Isolated cleft palate
  This type of cleft means that only the palate is affected. It occurs more often in females.

• Isolated cleft lip
  This is the least common type of cleft.

A cleft palate can affect:

• Breathing
  A cleft palate may cause a baby to have a small lower jaw. This can lead to breathing problems, a condition called Pierre Robin Sequence.

• Feeding
  Because of the hole in the palate, food and liquids can pass from the mouth back through the nose, and the baby can experience problems swallowing. It can also be difficult for the baby to form a vacuum in the mouth and not be able to suck properly. This may cause the baby to eat too slowly and take in too much air. Special feeding devices, such as baby bottles and nipples, are available.

• Chronic ear infections
  Babies with a cleft palate are more prone to a build up of fluid in the middle ear, and they may need ear tubes to help fluid drain.

• Hearing loss
  Experts theorize that because the palate hasn’t formed properly, certain muscles in the ear shift, and abnormally attach to the Eustachian tube, the tube that equalizes air pressure on both sides of the eardrum.This can cause chronic ear infections, leading to hearing loss.

• Speech problems
  It is difficult for a child with a cleft palate to be able to articulate words properly. So, in most cases, the cleft is surgically closed.

• Speech and language development delays

• Dental problems
  Because the palate has not properly developed, the teeth and the alignment of the jaw may also be affected. Those with a cleft palate are prone to a greater number of cavities, and they often have missing, extra, malformed, or displaced teeth.

• Facial growth and development
  The face of a person born with a cleft palate gets flatter in the middle of the face and the flattening is most obviously seen in those aged 10-20.

In most cases, a cleft can be repaired. The repaired lip may leave a small scar that runs from the nose through upper lip, and the repaired cleft palate may cause the patient's voice to have a nasal quality to it.