Cleft Palate

Cleft palate signs and symptoms include speech problems, ear infections, and psychological and social problems.

Cleft palate is an opening in the roof of the mouth (called the palate) that goes into the nose. It is a common type of birth defect that occurs in approximately one in 700 births and is a result of facial tissues not completely joining during pregnancy. A cleft palate may occur in the front or back of the roof of the mouth, on one side (unilateral) or both sides (bilateral).

A cleft palate may be hereditary but most researchers suggest it is caused by an interaction of genetic and environmental factors. Parents who had a cleft palate are more likely to have children with the condition. However, a defined cause has not been found.

Cleft palate may be accompanied by cleft lip (also called a harelip and incorrectly referred to as a hair lip), which is an opening or split in the lip that runs up to the nose.

A cleft palate is usually visible at birth and may appear as a split in the lip and roof of the mouth (hard palate). It may affect one or both sides of a baby’s face, or not affect the appearance of the face at all. It may also be incomplete with some portion of the bone left intact.

Less frequently, a cleft palate may affect only the soft palate (submucous cleft palate), which is at the back of the mouth. This type of cleft palate may not be noticed at birth and is diagnosed when the child is older and develops signs and symptoms.

Signs and symptoms of submucous cleft palate include:

1. Trouble nursing or drinking from a bottle in newborns and babies
2. Problems swallowing
3. Ear infections/temporary hearing loss
4. Nasal speaking voice
5. Problems with tooth development (small teeth, missing or extra teeth, and crooked teeth)
6. Speech difficulties

Psychological and Social Problems

Cleft palate defects may also result in psychological and social problems for an affected child. The appearance of the cleft palate and associated problems such as speech difficulties may lead to a poor self-image, low self-confidence, depression, anxiety, and difficulty making friends.

The 3 types of cleft palates are:

1. Incomplete cleft palate: This type starts in the back of the mouth in the soft palate and extends forward, but may not reach the front of the mouth.
2. Complete cleft palate: This type involves the entire length of the palate and affects both the hard and soft parts of the palate. The mouth and nose cavities are exposed to each other. A complete cleft palate may be present on one side (unilateral) or both sides (bilateral).
3. Submucous cleft palate: This type is located under the mucosa that lines the roof of the back of the mouth and often cannot be seen from the surface. It is often diagnosed when a child has problems with speech development.

A cleft palate is typically repaired in stages and treatment begins at about 10 to 12 months of age. Treatment requires several surgeries to repair the defects and can take years to complete. Treatment aims to close the gap between the mouth and nose and restore the muscular function of the soft palate. Dental, orthodontic, and/or speech therapy may also be needed.

There are 3 stages of cleft palate treatment:

1. Infancy: In this stage, the cleft palate is repaired by 12 months of age, before a child begins to speak.
2. Childhood: Surgery at this stage is usually done before a child begins school to resolve and residual palate deformities and improve the child’s appearance as well as help with speech development. Treatment with a speech and language pathologist may also be needed.
3. Adolescence: Most children with clefts with need braces and orthodontic care. In some cases, the upper jaw and the lower jaw grow unevenly and the face develops a sunken appearance as the child grows into adolescence, and jaw surgery (orthognathic surgery) is needed.