Medicines for Cleft lip and palate

What it is

A cleft lip and/or cleft palate is a gap or split in the upper lip, the roof of the mouth (palate), or both, that is present from birth. It is one of the most common conditions present at birth (congenital conditions). It happens when the parts of the baby’s face and mouth do not fully join together during development in the womb; a cleft lip is a gap in the upper lip, and a cleft palate is a gap in the roof of the mouth, and a baby can have one or both, on one or both sides, and to varying degrees. In many cases the cause is not known, and it usually happens by chance; sometimes there are genetic or other contributing factors, and occasionally a cleft is part of a wider condition. A cleft lip is often visible at birth or seen on antenatal (pregnancy) ultrasound scans, while a cleft palate (inside the mouth) may be found at the newborn examination. A cleft can affect feeding (as a cleft palate can make it harder for a baby to feed, needing support and sometimes special techniques or bottles), and, over time, if untreated, can affect speech, hearing (as cleft palate is associated with a higher chance of glue ear and ear problems), dental development, and appearance. The very reassuring point is that cleft lip and palate are treatable, and are managed by specialist cleft teams who provide coordinated care from birth through childhood: the cleft is repaired with surgery (a cleft lip is usually repaired in the first few months of life, and a cleft palate a little later, with the timing planned by the team), and ongoing care addresses feeding, speech, hearing, dental, and other needs as the child grows. With this specialist, multidisciplinary care, most children with cleft lip and palate do very well, with good outcomes for appearance, speech, feeding, and development. The key messages are that cleft lip and palate are common birth differences, that they are treated with surgery and coordinated specialist care, and that most children have excellent outcomes.

How it is treated

Cleft lip and palate are managed by specialist cleft teams who provide coordinated, multidisciplinary care from birth through childhood, centred on surgical repair and support for feeding, speech, hearing, dental, and other needs; most children do very well. Care usually begins early — a cleft lip is often detected on antenatal ultrasound scans (allowing information and support for the family before birth), and clefts are confirmed at or soon after birth. Families are referred to a specialist cleft team, which includes a range of professionals (such as surgeons, specialist nurses, speech and language therapists, and others) who coordinate care. Early support focuses on feeding: a cleft (particularly of the palate) can make feeding harder, so specialist support, advice, and sometimes special bottles or techniques help ensure the baby feeds and grows well. The main treatment is surgery to repair the cleft: a cleft lip is usually repaired in the first few months of life, and a cleft palate a little later (typically within the first year), with the exact timing planned by the team; further surgery may sometimes be needed later in childhood for particular aspects. Alongside surgery, ongoing care addresses the associated needs as the child grows: speech and language therapy and monitoring (as a cleft palate can affect speech, and support helps achieve good speech); hearing care (as cleft palate is associated with a higher chance of glue ear and hearing problems, so hearing is monitored and treated as needed); dental and orthodontic care (as clefts can affect the teeth and jaw); and support for appearance, psychological wellbeing, and any other needs, with the family and child supported throughout. Because occasionally a cleft is part of a wider condition, the child is assessed for any associated features. Genetic counselling may be offered to discuss causes and any implications for future pregnancies. The care continues in a coordinated way through childhood and adolescence, tailored to the individual child’s needs, with the aim of achieving good outcomes for feeding, speech, hearing, dental development, appearance, and overall wellbeing. The reassuring messages are that cleft lip and palate are common and treatable, that specialist cleft teams provide coordinated, comprehensive care (surgical repair and support for feeding, speech, hearing, and dental and other needs), and that, with this care, most children with cleft lip and palate do very well, with excellent outcomes — so families are supported throughout, from before or soon after birth.