Cleft Lip & Cleft Palate

It is a congenital deformity affecting both males and females. A baby may have a cleft lip, cleft palate or both cleft lip and palate.  A cleft is a birth defect that prevents fusion of lip and or palate segments causing a visible defect in the lip, gums and or palate with difficulty in feeding in the beginning and speech defect later in the life.

Cleft lips are classified as:

1. microform cleft- it presents as a small notch in the vermillion of the upper lip.
2. unilateral incomplete cleft- presents as partial cleft of the lip extending through the white roll to the skin of the upper lip
3. Unilateral complete- complete cleft lip involves the upper lip completely and extends to the gum and alveolus of the upper jaw.
4. Bilateral complete- this is a complete cleft lip on both sides.

Cleft palates are classified as:

1. sub mucous cleft palate- it is presented as bifid uvula with underlying muscle abnormality
2. Unilateral Incomplete cleft palate- the cleft involves soft and hard palate on one side without involving the alveolus
3. Bilateral incomplete or horseshoe shape cleft- it is a “U” shaped defect of the soft and hard palate without the alveolus
4. Unilateral complete cleft palate- it is complete cleft of soft and hard palate extending to the alveolus and associated with cleft Cleo
5. Bilateral complete cleft palate- complete cleft of lip and palate on both the sides

Management of cleft lip and palate

Treatment of a child born with cleft lip and palate involves a multidisciplinary team approach with following key team members

1. Plastic and craniofacial surgeon
2. ENT
3. Orthodontist
4. Dentist and oral surgeon
5. Speech therapist

The international protocol for management of Cleft lip and palate, for a successful outcome, is as follows-

At Birth–

• Counseling by Plastic surgeon
• Feeding advice

3 months of age–

• Cleft Lip repair
• Grommet Insertion in the Ear drums

8-12 months of age–

• Cleft Palate repair depending upon the type of cleft palate and health of child

2 years of age–

• Speech assessment by Speech therapist

5 years of age–

• Surgery for Lip and Nose touch up if necessary
• Speech assessment including nasoendoscopy

6 years of age–

• Initial Dental and Orthodontist consultation

7-11 years of age–

• Orthodontics/ braces
• Alveolar bone grafting for the cleft in Gums

18 years + of age–

• Septorhinoplasty
• Jaw Surgery if required