Cleft lip and cleft palate

The first three months of a pregnancy are a critical time for a growing fetus: In addition to many other developments taking place throughout the body, the structure of the mouth and face also begins to take shape.

Normally, at around the fifth or sixth week, the two sides of a baby’s upper lip begin to fuse together. Sometimes, though, the fusing doesn’t happen the right way and the upper lip is split, or cleft.

A child with a cleft lip has a visible separation in the skin of her top lip. This space can be a small hole, or it can be a significant opening that extends from the base of the baby’s nose all the way down to her top jaw and gums.

Between the eighth and twelfth weeks of pregnancy, the roof of a baby’s mouth begins to form. The roof of the mouth is made up of two parts:

• the hard palate, the firm and bony plate hugging the horseshoe-shaped curve of the top teeth
• the soft palate, the flexible, fleshier tissue that spans the back of the mouth

When the development of one or both of these parts is incomplete, the baby has what is known as a cleft palate.

A child can be born with a cleft lip, a cleft palate or both. Cleft lip/cleft palate:

• when combined, affect one in every 700 babies born in the U.S., making them the fourth most common birth defect nationwide
• can be unilateral—involving only one side of the mouth and face—or bilateral, involving both
• are more common in boys than girls 
• affect more children of Asian, Latino and Native American descent—and fewer of African-American descent—than children of other ethnicities

The good news is that cleft lip/cleft palate are very treatable. Although children with more advanced cases may require assistance in several areas, and may need multiple procedures over time, there are several minimally invasive treatment options available to help them regain a normal appearance and range of functions.

How Boston Children's Hospital approaches cleft lip and cleft palate

Boston Children's Hospital treats children with cleft lip, cleft palate and the combination of both defects through our dedicated Cleft Lip and Palate Program.

Our program:

• is one of the largest in the U.S.
• cares for more than 575 babies, children and adolescents every year
• uses a multidisciplinary approach that combines expertise in plastic and oral surgery, nutrition, dentistry and orthodontics, otolaryngology and audiology
• conducts groundbreaking scientific research to better understand the causes of cleft lip/cleft palate, identify new therapies and work toward finding a cure

Here at Children’s, our compassionate clinicians also understand the emotional and psychosocial toll cleft lip/cleft palate can cause. We recognize your child as an individual—never “just a patient”—and provide vital resources and support to meet the needs of your entire family.

Cleft lip/cleft palate: Reviewed by John G. Meara, MD, DMD, MBA, and John B. Mulliken, MD
© Children’s Hospital Boston; posted in 2011