​Cleft Lip and Cleft Palate 

Cleft lip and cleft palate (the roof of the mouth) are amongst the most common birth defects which occur when a baby’s facial structures do not develop fully during pregnancy, causing your child’s lip or mouth not to not fuse together properly. Together these are known as “orofacial clefts”, and your child may have either or both of these.

Your child’s lips will normally form between the fourth and seventh week of your pregnancy. A cleft lip results when the tissue that makes up your child’s lip does not join together entirely before birth. The opening may either be a small or large enough to extend from the lips through to the nasal cavity. It can appear on either or both sides of the lip and in some rare cases may appear in the middle of the lip.

The palate is usually formed between the sixth and ninth week of your pregnancy. A cleft palate may develop if the tissue that makes up the roof of your child’s mouth does not develop fully and fails to join completely. Your baby may have a partially open palate or a case where both the front and back of their palate is open. 

Orofacial clefts are thought to be the result of a combination of genetic, environmental or other factors, including certain medicines the mother may have taken during pregnancy. Usually, orofacial clefts occur as isolated birth defects. 


 

In most cases, a cleft lip or palate are easy to identify at birth. Orofacial clefts may appear as:

  • A spilt in either or both of your child’s lip and palate, which can affect either one or both sides of their face

  • A split that could appear as either a small notch in your child’s lip, or as a split that extends from the lip through to their nasal cavity

  • A split in your child’s palate (the roof of their mouth) that does not affect their facial appearance 

Although less frequent, your child may have a cleft in only the muscles on the soft palate (sub mucous cleft palate), which are located at the back of the mouth and is covered by the mouth’s lining. It is common for this form of cleft to go unnoticed after birth, and be noticed once symptoms develop. Symptoms and indications of a sub mucous cleft include: 

  • Trouble with nursing, such as your child not being able to suck properly

  • Difficulty swallowing, with the possibility of liquid or food to come of their nose 

  • A nasally sounding speaking voice 

  • Speech and language delay caused by decreased muscle function due to an opening on the palate or on the lip

  • Dental problems, such as the improper development of teeth

  • Chronic ear infections due to a dysfunction of the tube which connects the middle of the ear to the throat  

A cleft lip or palate is usually detected at birth, and your doctor may suggest a course of treatment or care at that time. However, if your child develops symptoms and indicators of a sub mucous cleft at a later stage, you should schedule an appointment with your doctor to discuss your options.  ​​
Your time with your doctor may be limited, so make sure to prepare for your visit beforehand. Here​ are some tips to help get you started.​

Orofacial clefts, particularly cleft lips, may be detected and diagnosed by a routine prenatal ultrasound taken during mid-pregnancy. If your doctor detects a cleft, they may take a sample of amniotic fluid from you uterus in order assess whether your child may have inherited a genetic syndrome that could cause other birth defects. However, it is not necessary that they will find this to be the case as the orofacial cleft may just be an isolated defect.  Conversely, if not detected beforehand, a cleft lip of palate is usually detected soon after birth via a physical examination. 

However, some types of clefts may not be realized till later on in life as they are only noticeable once symptoms develop, such as in the case of a sub mucous cleft palate. 

Your doctor may ask for x-rays or physical examinations to assess the facial structure, and confirm a diagnosis. 

A cleft lip or cleft palate is usually surgically corrected, restoring function and achieving a more normal appearance with minimal scarring. The surgery will depend and vary according to your child’s particular symptoms and the severity of their diagnosis.

Surgeries to correct a cleft lip are usually performed under general anaesthesia when your child is between three to six months old. The surgery usually causes minimal scarring, most often a small scar on the lip under the nose. 

A cleft palate will usually be treated surgically between the ages of nine to twelve months. The aim of this surgery is to repair the palate, which will help to prevent speech impediment. However, some children will continue to sound nasal following surgery or develop a nasal voice as they grow.  

Your child may also undergo surgeries to reduce the risk of chronic ear infection by inserting ear tubes into the eardrums to prevent the build-up of fluid.  

Following the initial correctional surgeries, your child may need more surgeries as he/she matures and his/her facial structures change. Surgeries to correct orofacial deformity will have usually been completed by the time your child is a teenager. ​

Treatment is usually very successful, and many children born with a cleft lip or palate (or both) live happy and fulfilling lives. 

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the ‘Important Numbers’ section on the website homepage.

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments’ costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the ‘Important Numbers’ section on the website homepage.

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the ‘Important Numbers’ section on the website homepage.
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The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.