DEAR MAYO CLINIC: I'm pregnant with my second child. During the 20-week anatomy scan, my obstetrician detected my baby has a cleft lip. Does this mean my baby also has a cleft palate? How and when is a cleft lip or cleft palate corrected?

ANSWER: Cleft lip and cleft palate are openings or splits in the upper lip, the roof of the mouth — called the palate — or both. Cleft lip and cleft palate occur when the facial structures that are developing in an unborn baby don't close completely. While a cleft lip can form independently, it's more commonly found in combination with a cleft palate.

These are among the most common birth defects. Typically, cleft lip and palate happen in isolation, but occasionally, it is part of a genetic syndrome that includes cleft lip or cleft palate as one of its signs. Cleft lip and palate also can be associated with heart conditions, which often can be screened for and identified prenatally. It is important to be assessed by a genetic counselor to rule out any inherited diseases.

Generally, a cleft lip is repaired around the time when a child is 10 to 12 weeks old to ensure your child has established their feeding pattern and shows good weight gain. To close the separation in your child's lip, the surgeon makes incisions on both sides of the cleft and creates flaps of tissue. The flaps and lip muscles are then stitched together. This approach improves the lip's appearance, structure and function.

For a cleft palate, the repair is usually planned when the child is between 10 and 12 months old. The wait from birth to surgery for a cleft palate is longer because it allows more time for the mouth to grow. To close and rebuild the roof of the mouth requires access to a small space in the littlest of patients.

Children diagnosed with cleft palate are monitored closely for ear infections. A cleft palate can affect the function of the eustachian tube, a small tube connecting your middle ear down to your throat. The muscles of your palate help open and close your eustachian tubes. Babies are assessed for the development of chronic fluid in the middle ear and a hearing test is performed to assess your child's ability to hear. Ear tubes may be placed at the time of the cleft lip surgery or, if present, at the time of the cleft palate surgery. Sometimes ear tubes can be placed in an office setting under no anesthesia.

In preparation for their cleft lip or palate repair surgery, your child may be a candidate for nasoalveolar molding, a nonsurgical option that helps reduce the gap in the upper lip and cleft on the roof of the mouth. It also can reshape your child's nostrils. Surgery is performed after the molding is complete at around 3 to 4 months. Nasoalveolar molding can significantly improve your child's outcomes and reduce their need for additional corrective operations as they grow.

Having a baby born with a cleft lip or palate can be concerning, but these conditions can be corrected. Advancements in operations result in better outcomes for your child by improving function and reducing scarring. However, it is important to seek treatment from centers such as Mayo Clinic, which specializes in treating cleft lip and palate.

Mayo's team at the Cleft and Craniofacial Clinic in Minnesota employs a multispecialty approach to address each patient's individualized needs. Directed by plastic surgeons, the team may include specialists in ear, nose and throat (ENT), oral surgery, orthodontics, lactation, speech, hearing, psychology, genetics, social services and others. Together, this team treats hundreds of children each year who have cleft lip and palate. — Dr. Samir Mardini, Plastic Surgery and Dr. Waleed Gibreel, Plastic Surgery, Mayo Clinic, Rochester, Minnesota

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Related Article

• Ask the Mayo Mom: Healing from cleft lip and cleft palate

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Having a baby born with a cleft can be upsetting, but cleft lip and cleft palate are among the most common birth defects, and both can be corrected.

Cleft lip and cleft palate are openings or splits in the upper lip; the roof of the mouth, or palate; or both. Cleft lip and cleft palate result when facial structures that are developing in an unborn baby don't close completely.

Treatment involves surgery or a series of surgeries to repair the defect and therapies to improve any related conditions. Treatment seeks to improve the child's ability to eat, speak and hear normally, and achieve a normal facial appearance.

On this edition of the Mayo Clinic Q&A podcast, Dr. Angela Mattke, a Mayo Clinic pediatrician and host of "Ask the Mayo Mom", discusses cleft lip and cleft palate with three Mayo Clinic Children’s Center experts: Dr. Samir Mardini, chair of the Division of Plastic and Reconstructive Surgery; Dr. Shelagh Cofer, a pediatric otolaryngologist and head and neck surgeon; and Dr. Waleed Gibreel, a craniofacial and pediatric plastic surgeon. 

For more information and all your COVID-19 coverage, go to the Mayo Clinic News Network and mayoclinic.org.

The post Ask the Mayo Mom: Healing from cleft lip and cleft palate appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Pritish Tosh, an infectious diseases specialist at Mayo Clinic, will discuss shingles and who should get vaccinated. Also on the program, Dr. John Volz, an orthodontist at Mayo Clinic, will explain treatment for cleft lip and cleft palate. And Dr. Scott Litin, an internal medicine specialist at Mayo Clinic, will share information about the latest edition of the Mayo Clinic Family Health Book. Dr. Litin is the medical editor.

Here's your Mayo Clinic Radio podcast.

The post Shingles / cleft lip and palate / Mayo Clinic Family Health Book: Mayo Clinic Radio Health Minute appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Pritish Tosh, an infectious diseases specialist at Mayo Clinic, will discuss shingles and who should get vaccinated. Also on the program, Dr. John Volz, an orthodontist at Mayo Clinic, will explain treatment for cleft lip and cleft palate. And Dr. Scott Litin, an internal medicine specialist at Mayo Clinic, will share information about the latest edition of the Mayo Clinic Family Health Book. Dr. Litin is the medical editor.

To hear the program, find an affiliate in your area.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: Shingles vaccine appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Pritish Tosh, an infectious diseases specialist at Mayo Clinic, will discuss shingles and who should get vaccinated. Also on the program, Dr. John Volz, an orthodontist at Mayo Clinic, will explain treatment for cleft lip and cleft palate. And Dr. Scott Litin, an internal medicine specialist at Mayo Clinic, will share information about the latest edition of the Mayo Clinic Family Health Book. Dr. Litin is the medical editor.

To hear the program, find an affiliate in your area.

Miss the show?  Here's your Mayo Clinic Radio podcast.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: Shingles / cleft lip and palate / Mayo Clinic Family Health Book appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: 

ANSWER: Learning that your baby may have a cleft lip or a cleft palate can be upsetting. But fortunately, in most cases these conditions can be successfully repaired with surgery. The specific timing of surgery depends on how extensive the cleft is, and that cannot be definitely determined until your baby is born.

A cleft lip is an opening, or split, in a newborn’s upper lip, and a cleft palate is an opening in the roof of the mouth. Cleft lip and cleft palate may occur separately, or they can happen together. These birth conditions result when the developing facial structures in a growing baby don’t close completely during the first trimester of pregnancy.

As in your situation, a cleft lip may be identified on an ultrasound before a baby is born. But the exact nature of a cleft is often hard to accurately determine using prenatal testing. That means the cleft may be more or less severe than indicated by the ultrasound. This is especially true for a cleft palate, which is very difficult to assess before a baby is born. 

When your baby is born, his doctor likely will do a thorough head-to-toe physical exam to make sure your baby is healthy. This evaluation also will help the doctor decide if any additional testing or evaluations may be needed. The vast majority of cleft lips and cleft palates are isolated birth conditions. Rarely, however, they can be a symptom of an underlying genetic disorder.

Once the specific nature of your baby’s cleft is known, a surgical schedule can be set. The goal of surgery is to ensure that a child can breathe, eat, speak and hear properly, as well as to achieve a symmetrical appearance of the child’s face.

When an otherwise healthy baby has only a cleft lip, the surgery to repair it typically is done between 10 and 12 weeks of age. If the child has other health problems, surgery may have to wait longer than that.

Cleft palate surgery often is performed between 10 and 18 months of age, again depending on the baby’s health and other medical concerns. Follow-up surgeries to improve nasal function, enhance speech or repair scarring may be needed as the child grows.

Until they have surgery, many babies with only a cleft lip can breastfeed, although it may take some experimentation to find a method that works best. Working with a lactation consultant often can help. If the palate is involved, then the baby may not be able to create the suction needed for breastfeeding. A bottle designed for babies with a cleft palate may be necessary, or you may need to explore other special feeding strategies to ensure your baby gets the nutrition he needs.

When your baby is born, early referral to a surgeon who specializes in cleft lip and cleft palate repair is key. That specialist can work with you to determine the best treatment plan for your child and help him get the comprehensive care his situation requires. With that plan in place, you will be able to focus on caring for and enjoying your new baby. — Shelagh Cofer, M.D., Otorhinolaryngology, Mayo Clinic Children’s Center, Mayo Clinic, Rochester, Minn. 

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