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Cleft Lip and Palate - an overview

A cleft lip is an opening in the upper lip. Normally the lip is formed by the union of two tabs of tissue that grow in from the sides of the face with a central tab that grows down from the tip of the nose. This fusion should take place in the fourth to sixth week of pregnancy. If the union is not complete, the baby is born with a cleft lip. If the cleft extends up into the nostril it is called a ‘complete cleft lip’. If the nose is not affected it is called an ‘incomplete cleft lip’.

What is a cleft palate?

A cleft palate is an opening in the roof of the mouth. In the first eight weeks of pregnancy, bone and tissue normally grow in from the sides of the upper jaw to join in the middle and form the roof of the mouth (called the ‘palate’). This is also the floor of the nose. When the tissue from the two sides of the jaw does not join properly in the middle, there is an opening between the mouth and the nose. This is called a ‘cleft palate’.

What causes clefts of either the lip or the palate?

We do not know what causes cleft lip and palate. Sometimes there is no family history and no known cause of the condition (called ‘sporadic’). Sometimes, another relative or several relatives also have a cleft condition (called ‘familial’).

Cleft lip and cleft palate can occur by themselves or in some cases with other problems.

Treatment

The amount of treatment required for a child with a cleft lip or palate depends on how severe the condition is at birth.

A small cleft lip may need only one surgical procedure in the first months of life. A child with a large cleft involving the lip and palate will need several surgical procedures and ongoing care from the ‘cleft team’. The cleft team at RCH has a Clinical Nurse Specialist who coordinates care from birth through to adult hood. Our RCH team includes:

• audiologists
• dental specialists
• ear, nose and throat surgeons
• oral and maxillofacial surgeons
• paediatricians 
• plastic surgeons
• speech pathologists.

Children with clefts see the cleft team from birth until their face has finished growing (usually in their late teens). There have been many improvements in surgery for children with cleft conditions over the past ten to twenty years. Today, children usually only need to stay in hospital for one to three days for surgical procedures.

Key points to remember

• There have been excellent improvements in the treatment of cleft lip and palate in the past ten to twenty years.
• Many children now achieve excellent results with their appearance, speech and teeth.
• The Royal Children’s Hospital has a large and experienced Cleft Palate Team with expertise in all areas of treatment. We work together with parents to provide the most up-to-date management from birth through to adulthood.

For more information

• CleftPaLS (the Cleft Palate and Lip Society) - www.cleftpalsvic.com
  CleftPaLS is a parent group that offers support and information to families. Members of this group are happy to visit new parents in hospital, they provide telephone contact, and are available at any time. There is a branch of CleftPaLS in each state the Victorian contact telephone number can be found in the White Pages under CleftPaLS. CleftPaLS provide information packs for expecting and new parents and also supply a range of bottles and teats for babies who are unable to breast feed or bottle feed using conventional teats and bottles. (Refer to our feeding information for advice regarding feeding your child with a cleft palate).
• Series of factsheets on 'Feeding your child with a cleft palate' (under 'c')
• RCH Department of Plastic & Maxillofacial Surgery
• Email The Royal Children's Hospital Cleft Cranio-facial Service: cleftcraniofacial.service@rch.org.au

Individual information