BACKGROUND: Cleft lip and palate is most common birth defect in the . One in every 598 babies will be born with a cleft palate and lip -- a separation between the lip and the roof of the mouth. Causes of this birth defect include genes passed down from one or both parents, viruses or other toxins. Cleft lip and palate may occur in conjunction with other birth defects or syndromes. Risk factors for this birth defect include a family history of cleft lip or palate and other birth defects.

 ASSOCIATED HEALTH PROBLEMS: A cleft lip and palate can affect the appearance of the face, and may create problems with eating, breathing and speech, also hearing loss, misalignment of teeth and ear infections. The physical appearance of this defect may range from a small notch in the lip to a larger groove that runs into the nose and the roof of the mouth.

DIAGNOSIS AND TREATMENT: Cleft lip and palate is generally diagnosed by a physical examination at birth. Though a cleft lip can be detected in the womb via ultrasound, a cleft palate generally cannot. Other forms of cleft palate can be diagnosed later, if a child experiences difficulties with swallowing or speech. 

A cleft palate is usually surgically closed in the child’s first year of life to facilitate normal speech development. Prior to surgery, the child may be fitted with a prosthetic device for feeding. Though treatments may continue for several years, most children with a cleft lip and palate can achieve a normal appearance, and eat and breathe normally.  

A UNIQUE APPROACH: Doctors at Children’s Hospital of Pittsburgh are taking a unique approach to preparing infants for surgery to repair cleft lip and palate. These young patients are diagnosed prenatally during a routine ultrasound procedure, then after the child is born, doctors begin a unique treatment called nasoalveolar molding or . In this procedure, an orthodontist makes a dental impression of the newborn’s mouth so that an appliance can be made to fit. This appliance resembles a tiny denture, made of the same material as a denture or retainer. This appliance is worn 24 hours a day until the time of surgery, and is adjusted weekly to help mold the infant’s lips and gums. These adjustments are done in very small increments so that the appliance fits, is comfortable for the baby, and the baby is able to grow into the adjustment. During this time, nasal stents are also added to mold the cartilage of the nose and stretch the tissue between the nostrils. The idea is to get everything as close as possible before surgery. Surgery to repair the cleft nose and lip is done after five months of this nasoalveolar molding. Though this pre-surgery procedure is painless, it does require weekly appointments for adjustments and can be time-consuming. For parents, however, it can provide an opportunity to participate in the repair of their child’s condition.

FOR MORE INFORMATION, PLEASE CONTACT: Children's Hospital of Pittsburgh Patient information line: (412) 692-7337