Cleft Lip and Cleft Palate
What is Cleft Lip and Cleft Palate?
Cleft lip and cleft palate are congenital conditions (birth defects) that occur when a baby’s lip or mouth do not form properly during fetal development. Together, these are commonly referred to as "orofacial clefts." At Sun Dental, Dr. Sagar Jangam provides expert, compassionate care to correct these conditions, restoring both function and a natural appearance.
Cleft Lip
A cleft lip appears as a physical split or narrow opening in the upper lip. This separation can extend into the nose and may include the gum line or the palate.
Cleft Palate
A cleft palate is a split or opening in the roof of the mouth. It can involve the hard palate (the bony front portion) and/or the soft palate (the soft back portion).
Causes & Risk Factors
While the exact cause of cleft lip and palate is not definitively known, they are generally thought to be caused by a combination of genetics and environmental factors during pregnancy.
- Family History: Parents with a family history of clefts face a higher risk.
- Exposure to Substances: Smoking or drinking alcohol during pregnancy increases risk.
- Nutrition: Not getting enough crucial nutrients, like folic acid, before and early in pregnancy.
- Medical Conditions: Conditions like diabetes or taking certain daily medications during pregnancy.
Preventative Steps You Can Take:
Consider genetic counseling if you have a family history. Ensure you are taking a prenatal vitamin with at least 400 micrograms of folic acid, avoid smoking and alcohol, and get a preconception health checkup.
Why Treatment is Critical
Children facing cleft lip with or without cleft palate experience a variety of challenges if the condition is left untreated:
Difficulty Feeding
One of the most immediate concerns. While some babies can breast-feed, a cleft palate often prevents the baby from creating the suction needed to feed properly.
Ear Infections & Hearing Loss
Babies with cleft palate are especially at risk of developing fluid buildup in the middle ear, which can result in hearing loss.
Dental & Speech Problems
Clefts extending through the upper gum affect tooth development. Because the palate helps form sounds, normal speech development can be severely affected.
Feeding Guide for Newborns
Feeding challenges put babies with a cleft palate at risk for failure to thrive. It's vital to use the right techniques:
- Specialized Bottles: Babies with a cleft palate usually cannot breastfeed due to lack of suction. Specially designed squeeze bottles (like Haberman or Mead-Johnson) are required.
- Upright Positioning: Feed your baby in an upright sitting position to prevent milk from flowing back into the nose (nasal regurgitation).
- Pacing: Allow for pauses; burp your baby often (about every 5 minutes).
- Timing: Keep feedings under 30 minutes. If it takes longer, the flow rate of the nipple may need adjustment.
Comprehensive Treatment Plan
A guided, lifelong roadmap for cleft lip and palate treatment from infancy to young adulthood under Dr. Sagar Jangam.
Birth to 6 Weeks
Feeding assistance, pediatric assessments, and initial counseling. Preparation for Nasoalveolar Molding (NAM) if required.
4 to 6 Months
Primary Cleft Lip Surgery. Once the child has established a good pattern of feeding and weight gain.
9 to 18 Months
Primary Cleft Palate Surgery. Closing the gap in the roof of the mouth and rearranging muscles to ensure proper speech development.
3 to 12 Years
Speech assessments (3-5 years) and secondary alveolar bone grafting to repair the cleft in the gum area (8-12 years) as adult teeth erupt.
12 to 18+ Years
Orthodontic treatment to align teeth. Corrective Jaw Surgery (Orthognathic) between 16-18 years, and potentially Rhinoplasty to refine nasal shape post-growth.
The Hidden Diagnosis: Submucous Cleft Palate
Infrequently, a minor case of cleft soft palate known as a "submucous cleft palate" will not even be seen at birth. It becomes noticeable later when the infant experiences difficulty feeding. In this unique condition, the cleft occurs exclusively in the muscles of the soft palate, which are located at the back of the mouth and covered by the mouth's mucous lining.
This type of cleft often goes completely unnoticed at birth and may not be diagnosed until later when signs develop. Signs and symptoms of a submucous cleft palate may include severe difficulty with feeding, difficulty swallowing (with potential for liquids or foods to come out the nose), a highly nasal speaking voice, and chronic ear infections due to fluid buildup.
Genetic & Environmental Pathology
While the exact genetic mechanism remains unclear, we know that cleft lip and palate are among the most common birth defects globally. Incidence of clefts is around 1 in 800 to 1,000 births. Of all babies born with a cleft lip and cleft palate, roughly 10% to 15% are diagnosed with a larger syndrome or chromosomal abnormality.
During your consultation, our team will recommend a genetic assessment, usually happening after your child is one year of age. If tests report that chromosomes are normal, the risk for a syndrome drops drastically. Several factors may increase the likelihood, including exposure to topiramate or valproic acid, methotrexate, or conditions like Rubella during the first trimester.
Advanced Feeding Assistance
Some babies need more assistance than others due to severe reflux and breathing difficulties, such as those diagnosed with Pierre Robin Sequence.
Feeding Tubes: A feeding tube may be recommended as a temporary but life-saving solution to allow for proper weight gain. This is a tiny, soft tube that passes from the nose directly into the stomach. It’s the most common and safest method of feeding babies who cannot get enough nutrition orally.
Starting Solid Food: Spoon feeding for infants with a cleft lip or palate should begin at approximately 6 months of age, just as it would for children without a cleft. Strained, thin, pureed foods without chunks should not be a problem. Avoid any sticky or spicy foods due to the extreme sensitivity of the nasal mucosa.
Nasoalveolar Molding (NAM)
NAM is an advanced presurgical therapy used to reduce the size of the cleft in the lip, gum, and nose before surgery. Beginning in the baby's first week of life, a custom molding plate works by gently directing the growth of the gums and the shape of the nose.
This flexibility allows our specialists to achieve a much more symmetric lip and nose during the primary surgery, often eliminating the need for secondary lip revisions.
The Multidisciplinary Team
Cleft repair isn't just one surgery—it's a journey. At Sun Dental, Dr. Sagar Jangam leads a customized care plan that may involve several specialists as your child grows:
- Maxillofacial Surgeon: Primary surgical repairs.
- Orthodontist: Jaw alignment and NAM management.
- Speech Pathologist: Proper sound development.
Advanced Surgical Expertise
State-of-the-art repair techniques by Dr. Sagar Jangam to ensure structural integrity and natural aesthetics.
Primary Lip Repair
Performed around 4-6 months of age. Dr. Jangam uses advanced techniques modified from the Millard method to meticulously align the skin, muscle, and mucosa, resulting in a barely visible scar and a naturally contoured cupid's bow.
Palate Repair (Palatoplasty)
Usually conducted between 9 to 18 months. The primary goal is morpho-functional repair—reconstructing the speech muscles to ensure total closure of the soft palate during speech, effectively eliminating hypernasal sound.
Alveolar Bone Grafting
Required between 8 to 12 years of age. Bone from the hip (iliac crest) is grafted into the cleft gum line (alveolus). This provides a stable foundation for erupting permanent teeth and supports the base of the nose.
Post-Surgery Care & Recovery Protocol
Proper aftercare is vital for optimal healing. Below is the comprehensive care protocol to follow after your child undergoes cleft surgery.
Protecting the Incision
Padded arm splints are crucial. They prevent the child from bending their elbows and touching or scratching the delicate surgical site. Keep the child sleeping on their back to prevent rubbing the lip against the bed. Keep hard toys, spoons, and pacifiers completely away.
Nutrition & Feeding Rules
For the first 24 hours, adhere to a strict liquids-only diet without straws. Afterward, pureed and soft foods are essential. Approved: Mashed potatoes, yogurt, creamy soups, and blended purees. Avoid: Crunchy foods, chips, raw fruits, peanut butter, and seeded foods.
Hygiene & Washing
Carefully clean the lip incision with prescribed fluids using cotton swabs after every meal. Do not use a toothbrush on the surgical areas for at least 3 weeks. Give water after meals to naturally rinse built-up formula or food.
Complex Needs: Speech & Facial Growth
Velopharyngeal Insufficiency (VPI)
Even after palate repair, around 20% of children develop VPI—where the soft palate doesn't seal tightly against the throat. This results in hypernasal speech. Dr. Jangam utilizes nasoendoscopies to diagnose the exact gap and performs corrective procedures like Sphincter Pharyngoplasty or Furlow Palatoplasty to permanently restore speech clarity.
Corrective Jaw Surgery
The scar tissue from early palate surgeries can restrict the upper jaw's natural forward growth. By age 16-18, a patient may develop an underbite or facial asymmetry. We use Virtual Surgical Planning (VSP) within Orthognathic surgery to advance the upper maxilla and coordinate the bite perfectly, optimizing both airway function and facial aesthetics.
Frequently Asked Questions
Can cleft lip and palate be detected on an ultrasound?
Yes, high-resolution 3D or 4D prenatal ultrasounds can often detect a cleft lip as early as the 13th week of pregnancy. However, an isolated cleft palate is more difficult to see and is detected prenatally in only about 7% of cases.
What is an Oronasal Fistula?
An oronasal fistula is a small opening or communication between the mouth and the nose that can occasionally occur after palate surgery. It can allow liquids to enter the nose. Dr. Jangam surgically closes these using advanced local or buccal flaps once the primary tissue has fully healed (4-6 months post-op).
Will my child's intelligence be affected?
Most children with isolated cleft lip or palate have normal cognitive and motor development. However, because of potential hearing and speech challenges, close monitoring during early schooling is highly recommended.
When do we need to call the doctor after surgery?
Immediately contact our clinic if your child has a fever over 101°F, trouble breathing, heavy bleeding from the surgical site, inability to tolerate fluids, or a dry diaper for more than 8 hours.
Is Cleft Rhinoplasty different from regular Rhinoplasty?
Yes. A cleft rhinoplasty is far more complex due to altered anatomy, missing cartilage, and severe septal deviation. Dr. Sagar Jangam uses specialized open-rhinoplasty techniques with cartilage grafting (from rib, ear, or septum) to reconstruct the nasal infrastructure.