Cleft Lip and Palate

A cleft lip is a separation of the two sides of the lip, usually involving the bones of the upper jaw, upper gum, or both. A cleft palate is an opening in the roof of the mouth in which the two sides of the palate did not fuse or join together properly. Cleft lip and cleft palate can occur on one side or both sides.

The fourth most common birth defect in North America, cleft lip and cleft palate affect one in every 700 newborns each year. The highest prevalence rates are reported for Native Americans and Asians. Africans have the lowest prevalence rates.

Because cleft lip and cleft palate are apparent at birth, most people have surgery to correct the defect early in life.

However, follow-up surgery often is necessary later on to treat any deformities that still exist after initial treatment. These may include:

  • Crooked, poorly shaped or missing teeth
  • Misalignment of teeth and jaw
  • Deformities of the upper jaw, known as the maxilla
  • Speech problems
  • Un-repaired oronasal fistulae, which is a hole between the mouth and nose cavity. This hole may allow substances in the mouth to enter the nose cavity, resulting in infection
  • Alveolar clefts, which are defects in the bone that supports the teeth

Treatment for cleft lip and palate involves surgery and may include:

  • Bone grafting — Although bone grafting is most frequently performed on children under the age of 10, adults also can benefit from the procedure. Bone grafting in the dental ridge of the upper jaw, called the maxilla, is now the standard treatment for patients with facial clefts. The procedure involves taking a small amount of bone from one place — usually the hip, head, ribs or leg — and placing it in the area of the cleft near the teeth.
  • Surgical Closure of Oronasal Fistulae — An oronasal fistulae is a hole between the mouth and nose cavity. Fistulae can be problematic in that they allow substances in the mouth, such as liquids and foods, to enter into the nose cavity, resulting in infection. In rare cases, when fistulae become very large, they create speech problems.Most fistulae can be surgically closed using local tissue from the roof of the mouth, the tongue or the inside cheek.
  • Dental implants –Many people with cleft lip and palate have one or more missing teeth. In addition, their teeth adjacent to the cleft often have a deficiency of supporting bone. In these instances, osseointegrated implants are the most effective approach for replacing missing teeth.The dental implants are small titanium “fixtures” that take the place of the natural root of the tooth. Your surgeon will gently implant them into your bone, using local anesthesia. These very tiny titanium roots will then bond or integrate with your bone, more securely than natural root would. These implants serve as an “anchor” for permanent artificial teeth, which are built and custom designed to aesthetically suit your facial features by a prosthodontist — a dentist who specializes in the restoration and replacement of teeth.