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Cleft Palate

Cleft Palate

What is cleft palate?

Cleft palate is a birth defect in which the tissues that form the roof of the mouth (the palate) don’t grow together the way they should, leaving an opening or gap in the roof of the mouth. The opening may extend up into the nasal cavities. 

Cleft palate may occur alone or together with cleft lip, an opening or split in the upper lip that extends up to one or both nostrils. Cleft palate may also be associated with other genetic conditions and abnormalities.

It is one of the most common and treatable birth defects. Surgery to repair the cleft palate will take place after your baby is born.


How does cleft palate affect my baby?

Children with cleft palate may have problems with:

  • Feeding
  • Swallowing
  • Speech development
  • Hearing
  • Ear infections
  • Dental abnormalities
  • Breathing
  • Self-esteem

Early referral to a center that specializes in birth defects of the face and head, such as Texas Children’s Craniofacial Clinic, ensures timely, expert treatment for the best possible outcomes. 


Types of Cleft Palate

The severity of cleft palate can vary widely.

In some babies, only a part of the palate is open, known as an incomplete cleft palate. In others, the opening may extend from the front of the mouth (hard palate) all the way to the throat (soft palate) and can involve the uvula, the small piece of tissues that hangs down in the back of the mouth. This is known as a complete cleft palate. The defect may also extend into the tooth sockets.

Cleft palate may involve one side of the palate, known as a unilateral cleft palate, or both sides, known as a bilateral cleft palate.  

In rare cases, the roof of the mouth appears structurally normal but the muscles underneath are affected, a condition known as submucous cleft palate that can affect the child’s speech.


Cause and Risk Factors

Cleft palate and/or cleft lip occurs in an estimated 1 in 1,000 births. 

While the cause of these birth defects is generally unknown, genetic and environmental risk factors may include:

  • Certain medications used during pregnancy, such as those used to treat seizures
  • A family history of cleft lip and/or palate
  • Smoking and drinking alcohol during pregnancy
  • Being of Asian descent  
  • Diabetes that isn’t managed properly

Diagnosis

In some cases, advanced fetal ultrasound can detect cleft palate during pregnancy. The diagnosis is then confirmed at birth during a physical exam of your newborn.

Typically cleft palate is diagnosed at birth when the physician can view and assess the inside of your baby’s mouth. 

In rare cases, some types of cleft palate aren’t visible even at birth, such as those that affect only the underlying muscles or the soft tissue at the back of the mouth. These defects might not be diagnosed until the child has difficulties with feeding or speech.


Prenatal Evaluation and Testing

If cleft palate is diagnosed during your pregnancy, you may be referred to a fetal center for a comprehensive prenatal evaluation to determine if the birth defect is “isolated” or if there are other abnormalities present.

Additional testing may include:

At Texas Children’s Fetal Center, we arrange a visit for you to meet with a team of specialists experienced in diagnosing and treating fetal birth defects, including maternal-fetal medicine physicians, neonatologists, pediatric surgeons, genetic counselors and fetal imaging experts. Following a full day of evaluations, our specialists will then meet with you about your results, answer any questions you have, and provide recommendations based on your baby’s cleft palate and any related conditions, to help you make the most informed decisions regarding care and treatment.

A cleft palate diagnosis during pregnancy enables your family and your health care team to plan ahead for any special needs your baby may have at birth and to arrange for the earliest possible treatment at a craniofacial clinic.


Pregnancy and Delivery

Depending on the severity of the defect and other abnormalities present, you and your baby may be closely monitored throughout your pregnancy, with regular ultrasounds to assess fetal growth and development.

Delivery at a hospital experienced in the care and treatment of newborns with facial anomalies and other birth defects is recommended. Here, our specialists work closely with Texas Children’s Cleft Lip and Palate Clinic to coordinate your baby’s care across a multidisciplinary team, including maternal-fetal medicine specialists, neonatologists and the craniofacial team, ensuring the best possible care beginning at birth and continuing throughout childhood and adolescence.


Treatment

While treatment depends on the individual child, surgery to close the opening in the palate is typically performed in the first year, when the baby is 9 to 12 months old.

Additional procedures may be required over time as your child grows and develops, such as surgery to address dental needs when permanent teeth come in or to straighten the nose and open the airway. Ongoing therapy may also be needed to address problems with speech and hearing.

Because treatment for cleft palate is based on the child’s growth and development, all patients at Texas Children’s Cleft Lip and Palate Clinic are assessed annually until they are fully grown.


Long-Term Outcomes

Living with cleft palate can be challenging for children and their families. With early intervention and closely monitored care by a craniofacial team, in most cases required treatment is completed by age 18, if not sooner, and children do very well.  


Why Texas Children’s Fetal Center?

  • A single location for expert maternal, fetal and pediatric care. At Texas Children’s Hospital, mother and baby can get the specialized care required for the diagnosis and treatment of fetal birth defects all in one location, for highly coordinated care and treatment planning.
  • A skilled, experienced team with proven outcomes. We have a dedicated team of maternal-fetal medicine specialists, pediatric surgeons, neonatologists, fetal imaging specialists, genetic counselors and others who work in concert to care for you and your baby every step of the way. With their unique expertise and unified approach, they offer the best possible care for babies with fetal abnormalities.
  • We care for your child’s needs at every stage of life. Our comprehensive approach starts with your first prenatal visit and continues through your child’s delivery, postnatal care, childhood and adolescence, thanks to one of the nation’s leading teams of fetal and pediatric specialists for the treatment of birth defects.

Cleft Palate in the News


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Additional Resources

For more information or to schedule an appointment,

call Texas Children’s Fetal Center at 832-822-2229 or 1-877-FetalRx (338-2579) toll-free.

Our phones are answered 24/7. Immediate appointments are often available.