Cleft palate is an abnormality of the upper part of the mouth that is present at birth in about one out of 700-1,000 infants. This condition occurs when the palate forms during fetal development without enough tissue to fully cover the palate or when the sections of the palate simply don’t join up properly. The cleft or gap may affect only the soft palate, or it may extend into the hard palate near the front of the mouth. There may be one cleft, or two. A child who has a cleft palate may or may not have a cleft lip as well.
There appears to be a genetic component to this common birth defect. There are some medications that a mother may take that can increase the risk of cleft palate. These include isotretinoin (a powerful acne medication) and certain drugs for treating seizures and immune system disorders. However, there is no way to completely prevent cleft palate and the underlying cause is usually not identifiable.
What Cleft Palate Means for Your Child
This condition can cause problems from birth onward. The palate normally separates the interior of the mouth from the nasal passageways. When there’s a gap in the palate, breast milk or formula can enter the nose and sinuses during feeding, causing choking. Eating solid food can also be difficult as the child gets older.
Hearing and speech can both be affected in children with a cleft palate. They are more likely to have ear infections which may lead to permanent hearing loss. Since the front teeth, lips and palate may all be affected by the cleft, speech can be difficult. If the cleft extends into the hard palate, the part of the upper jaw that holds baby and adult teeth may be deformed. This can cause teeth to come in out of proper alignment or prevent teeth from emerging at all.
Treatment Options for Cleft Palate
There are a number of temporary options to help children cope with cleft palate during their early development:
- Babies with a cleft palate require specially designed bottles with a nipple that directs fluid down away from the nose.
- Older children may need to wear a prosthetic palate to help them eat and speak normally.
- Kids with a cleft palate may need drainage tubes in their ears to keep fluid from building up.
- Those with speech delays or difficulties can generally benefit from speech therapy.
- Children who have oral or dental defects as a result of cleft palate may be helped with dental prosthetics to restore teeth and/or the missing part of the palate.
- They may also benefit from braces to straighten crooked front teeth later in life.
The most effective and permanent solutions for cleft palate involve surgery. Fixing a cleft lip is usually a simple procedure that takes just a couple of operations to complete. Unfortunately, repairing the palate requires much more extensive treatment.
What Does Surgery for Cleft Palate Involve?
This varies a great deal depending on the extent of the cleft. A repair for the upper lip may be recommended by three months. The first major surgery to repair the palate itself is usually done before a child’s first birthday. It may be performed as early as six months in some cases. The goal of surgery is to connect the two separate sides of the palate to close the gap and allow the upper part of the mouth to function normally. Successful reconstructive surgery for cleft palate:
- Reduces the risk of inner ear infection
- Aids good nutrition
- Promotes clear speech
- Helps your child look more like his or her peers
- Encourages normal development of the rest of the face
As the child grows, an additional surgery to further reconstruct the palate may be needed a few years later. Generally, by the time the child starts school, they will have a functioning upper palate. Repair to the upper jaw so it can support permanent teeth is done later, after development is further along. This usually involves a bone graft of the alveolar ridge (the bone just under the gums) at about age 8. This procedure closes the gap in the bone and makes the area strong enough to support adult teeth.
Additional surgeries may be needed during childhood and teen years to:
- Improve speech
- Create a more symmetrical and aesthetic appearance
- Minimize scarring
- Install dental implants in the place of missing teeth
- Properly align the upper and lower jaws
Both parents and children may benefit from counseling throughout the years of treatment to help them cope with the emotional and physical challenges presented by cleft palate. Fortunately, most kids who are born with a cleft palate can have their condition successfully treated before they reach adulthood. Once the cleft is fully repaired, it is often no longer noticeable to others.