Gap in the mouth
During the examination, a hole in the palate is visible - a small one at the back or on the entire palate. A gap hidden under the mucous membrane may not be noticed on examination.
CONDITION / FACE
Cleft palate ("cleft palate").
Cleft palate ("cleft palate") is a congenital cleft in the palate through which the mouth connects to the nose. It prevents the child from sucking, increases the risk of fluid in the ears and impairs speech without surgery. The cleft is closed surgically, usually at 6–12 months.
CONCEPTUAL VISUALIZATION- What it is
- Congenital cleft in the palate — between the mouth and the nose.
- How common
- Isolated cleft palate - 0.33 per 1000 live births, together with cleft lip - 0.45 per 1000.
- What prevents
- Feeding, hearing due to fluid in the ears and tongue.
- When surgery is performed
- Usually at 6–12 months; then the child is treated by an ENT doctor, a speech therapist and an orthodontist.
01 / WHAT IS ITWhat is
What is
cleft palate.
The palate is the "roof" of the mouth that separates the mouth from the nose. During the development of the child in the mother's womb, its halves should grow in the middle. If this did not happen, a gap remains - a cleft palate, a "wolf's mouth" in everyday life.
The cleft is only in the back, soft part of the palate, or it goes through the entire palate to the front. It can be separate or combined with a cleft lip. Sometimes the gap is hidden by the mucous membrane, and it is not noticed immediately.
Cleft palate is one of the frequent congenital defects of the face. Sometimes it is part of a wider condition, such as 22q11 deletion syndrome or Pierre Robin sequence, so the child is also examined by a pediatrician.
Treatment lasts for years: surgery, feeding, hearing, speech, teeth. But most children grow up after treatment and lead normal lives.
This is general information. What will suit your child, the doctor will tell after the examination.
02 / SIGNSHow it
How it
presents.
Cleft palate is usually found immediately after birth. The most worries are in the first months, before the operation.
It is difficult to suck
The child cannot tightly grasp the breast or nipple, swallows a lot of air, milk flows through the nose. In the first months, she may gain weight poorly.
Ears and hearing
Fluid collects in the middle ear — this is otitis with effusion. Hearing decreases, and often this is only visible on a hearing test.
language
Without surgery, speech becomes unclear and hoarse: air comes out through the nose during a conversation.
Teeth
If the gap extends into the gums, nearby teeth may grow crookedly, be missing, or be redundant.
Clear cleftSmall lower jaw
If the chin is very small, the doctor will check for Pierre Robin consistency. If the child has difficulty breathing, call 103.
Sequence by Pierre Robin03 / REASONSWhy it
Why it
develops.
The exact cause for a specific child is mostly impossible to establish. Most likely, the cleft is not related to anything you did or didn't do during your pregnancy.
Development in the womb
The tissues that make up the palate have not grown together. The cause of most non-syndromic cases is unknown.
Heredity
Most cases are isolated. If there is already a child with a cleft in the family or one of the parents had a cleft, the risk for the next child is about 2-8%.
Smoking
Smoking during pregnancy increased the chances of a cleft by 1.55 times, and passive smoking was even more harmful. Alcohol during pregnancy is also listed as a risk factor by the NHS.
Maternal weight and diabetes
Obesity increased the chances of a cleft by 1.28 times, type 1 diabetes - by 1.75 times.
Medicines and folic acid
Lack of folic acid during pregnancy and some anticonvulsant medications early in pregnancy have been linked to fissures.
Syndromes
Sometimes the cleft is part of a wider condition, such as 22q11 deletion syndrome or Pierre Robin sequence.
04 / SEEK MEDICAL ADVICE
When to seek urgent medical care?
The cleft itself does not require emergency care: it is treated according to plan. But a baby with a cleft may not eat well, and some signs in any young child require immediate help.
103 immediately if:
- it is difficult for the child to breathe: he breathes very often, croaks or pulls in his stomach during inhalation;
- the skin, lips, or tongue have turned blue, gray, or pale or marbled;
- the child is difficult to wake up or does not wake up;
- convulsions;
- weak, shrill or continuous crying;
- a rash that does not fade if you press on it;
- the child did not urinate for 12 hours;
- a temperature of 38 °C and above in a child up to 3 months or 39 °C and above — in 3–6 months.
Do not delay a visit to the doctor:
On the same day: the baby refuses to eat, vomits during the day, or you feel that something is wrong with the baby. If your child has recently had surgery, call the surgeon first. In the coming days: feeding lasts a very long time, milk constantly flows through the nose, the child does not gain weight well. Planned: consultation with a surgeon as soon as possible after birth to make a plan, and regular hearing and speech tests.
05 / DIAGNOSTICSHow to determine
How to determine
cleft
- During pregnancy
Cleft lip is often visible on ultrasound, and cleft palate is very difficult to detect on ultrasound.
- After birth
Usually, a cleft is found immediately after childbirth or during a newborn examination in the first 72 hours.
- Pediatrician review
To check for other defects or syndromes with which the cleft is associated.
- Hearing test
From the first weeks of life onwards regularly due to the risk of fluid in the middle ear.
- Language assessment
A speech therapist evaluates speech at 18 months, at 3 and 5 years, and more often if necessary.
06 / TREATMENTHow we treat
How we treat
cleft palate.
The main treatment is an operation that closes the cleft and restores the muscles of the palate. Before it, it is important to establish feeding, and after that to monitor hearing, language and teeth while the child grows.
01
Feeding
The first weeks and months before the operation.
- Parent education
- A doctor or nurse shows how to hold and feed the baby. In a review of studies, educational programs for mothers improved child weight gain.
- Special bottle
- If it is not possible to suck the breast, breast milk is expressed and given from a soft bottle for children with clefts. Special bottles and obturator plates in the studies did not give a noticeable advantage in the growth of the child compared to ordinary bottles or without them.
- Breast feeding
- With a cleft palate, it is less likely to succeed than with a cleft lip only, and more often it is difficult.
- probe
- Sometimes before surgery, the baby is fed through a thin tube inserted through the nose.
02
Plastic palate
Operation under general anesthesia.
- What are they doing?
- The cleft is closed, and the muscles and mucous membrane of the palate are moved into the correct position. The operation lasts about 2 hours, in the hospital - usually 1-3 days. The scar remains inside the mouth.
- when
- Usually at 6-12 months. In a study of 558 infants with isolated cleft palate after surgery at 6 months, 8.9% of children had cleft palate problems at 5 years, and 15.0% after surgery at 12 months. Complications were rare and similar in both groups.
- Methodology
- In a review of 12 studies, failure occurred less frequently after palate Z-plasty than after direct muscle suture: 9.7% versus 16.5% for isolated cleft.
03
Ears and hearing
Hearing is checked regularly; treated by an ENT doctor.
- Fluid in the ear
- Otitis with effusion is a common finding in children with cleft palate. Hearing can improve after palate plastic surgery.
- Shunts
- If the liquid interferes with hearing, tiny tubes - shunts - are placed in the eardrums, or a hearing aid is selected. Shunts helped restore hearing, but caused complications on the tympanic membrane in 11–37% of cases; when exactly to put them, studies are clearly inconsistent.
04
Language and repeated operations
- speech therapist
- Approximately half of children with clefts at the age of 5 are referred to a speech therapist. Classes help many of them.
- Stiffness after surgery
- If the palate does not block the way to the nose during speech, it is called velopharyngeal insufficiency. Its signs in a review of 10,795 patients had 20%. Some children need another operation.
- Fistula
- An opening between the mouth and nose after plastic surgery was formed in an average of 8.6% of children; with combined cleft lip and palate — more often. If it interferes, it is closed.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Cleft palate is operated on at Dr. Valikhnovskyi's Institute of Surgery in the field of "Congenital Defects Surgery". Treatment of a cleft is a team for years: in addition to the surgeon, the child is led by an ENT doctor, a speech therapist and an orthodontist.
CLINIC SERVICE
Surgery of birth defects
Congenital defects of the face and body in children and adults — from the first operation to the correction of the consequences.
View service
What we do for this condition
- Plastic palate — closing of the cleft with restoration of the palate muscles, usually up to a year.
- Microsurgical technique — magnifying optics and thin suture material to accurately match tissues.
- Operations for velopharyngeal insufficiency — pharyngeal flap or sphincter pharyngoplasty, if the tongue remains slurred after the first operation.
- Closure of the palate fistula — if air or food enters the nose through the opening or the tongue suffers.
- Bone plastic is clear - if the gap goes into the gums, - at school age.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend a photo and statements of the child - the doctor will first assess the situation.
- ConsultationExamination of the child; talking about feeding, weight, breathing and hearing.
- PlanWhen to operate, what examinations and specialists are needed before the operation.
- SurgeryPalate plastic surgery under general anesthesia; parents are next to the child in the hospital.
- Recovery and supervisionThe feeding regimen will be explained before discharge; then follow-up examinations, hearing and speech as they grow.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is it possible to breastfeed the baby?
Sometimes yes, but with a cleft palate, it is less likely: it is difficult for the child to hug the chest tightly. Then the milk is expressed and given from a soft bottle for children with clefts.
At what age is the palate operated on?
Usually at 6-12 months. In a large study, surgery at 6 months was less likely to cause language problems at 5 years than surgery at 12 months. The doctor determines the terms for your child.
Will there be a scar?
The scar after plastic surgery of the palate remains inside the mouth, it is not visible on the face.
Why does an ENT doctor check the ears?
In children with cleft palate, fluid often collects in the middle ear and hearing is reduced. Therefore, hearing is checked regularly, and if necessary, shunts or a hearing aid are installed.
Will the child speak normally?
Surgery greatly reduces the risk of speech problems, but some children will need a speech therapist, and a small number will need another surgery if their speech remains slurred.
Am I to blame for the fact that the child has a cleft?
Most likely, no. The exact cause is mostly unknown. The risk is slightly increased by smoking and alcohol during pregnancy, obesity, type 1 diabetes, folic acid deficiency, and some anticonvulsant medications.
Will the next child have a cleft?
Mostly this is an isolated case. If there is already a child with a cleft in the family, the risk for the next one is approximately 2-8%. If the cleft is associated with a syndrome, the risk may be higher.
Sources
16 sources · NHS guidance, reviews and researchshowCollapse
- Timing of Primary Surgery for Cleft PalateThe New England Journal of Medicine, 2023doi:10.1056/NEJMoa2215162 ↗
- Global prevalence of cleft palate, cleft lip and cleft palate and lip: A comprehensive systematic review and meta-analysisJournal of Stomatology, Oral and Maxillofacial Surgery, 2022doi:10.1016/j.jormas.2021.05.008 ↗
- Maternal factors increase risk of orofacial cleft: a meta-analysisScientific Reports, 2024doi:10.1038/s41598-024-79346-7 ↗
- Maternal Cigarette Smoking and Cleft Lip and Palate: A Systematic Review and Meta-AnalysisThe Cleft Palate-Craniofacial Journal, 2022doi:10.1177/10556656211040015 ↗
- A Systematic Review of Feeding Interventions for Infants with Cleft PalateThe Cleft Palate-Craniofacial Journal, 2022doi:10.1177/10556656211051216 ↗
- Breastfeeding and Cleft Lip and Palate: A Systematic Review and Meta-AnalysisThe Cleft Palate-Craniofacial Journal, 2024doi:10.1177/10556656231170137 ↗
- Grommets for otitis media with effusion in children with cleft palate: a systematic reviewPediatrics, 2014doi:10.1542/peds.2014-0323 ↗
- Managing Chronic otitis media with Effusion in Children with non-Syndromic Cleft Palate: Short-Term Ventilation Tubes Versus SurveillanceThe Cleft Palate-Craniofacial Journal, 2024doi:10.1177/10556656221148368 ↗
- Tympanostomy Tubes: Are They Necessary? A Systematic Review on Implementation in Cleft CareThe Cleft Palate-Craniofacial Journal, 2023doi:10.1177/10556656211067901 ↗
- Systematic Review of Postoperative Velopharyngeal Insufficiency: Incidence and Association With Palatoplasty Timing and TechniqueThe Journal of Craniofacial Surgery, 2023doi:10.1097/SCS.0000000000009555 ↗
- A systematic review comparing Furlow double-opposing Z-plasty and straight-line intravelar veloplasty methods of cleft palate repairPlastic and Reconstructive Surgery, 2014doi:10.1097/PRS.0000000000000637 ↗
- Fistula incidence after primary cleft palate repair: a systematic review of the literaturePlastic and Reconstructive Surgery, 2014doi:10.1097/PRS.0000000000000548 ↗
- On the Benefits of Speech-Language Therapy for Individuals Born With Cleft Palate: A Systematic Review and Meta-Analysis of Individual Participant DataJournal of Speech, Language, and Hearing Research, 2022doi:10.1044/2021_JSLHR-21-00367 ↗
- Cleft lip and palateNHS, 2023nhs.uk/conditions/cleft-lip-and-palate ↗
- Cleft lip and palate: TreatmentNHS, 2023nhs.uk/conditions/cleft-lip-and-palate/treatment ↗
- When to get urgent medical help for babies and children under 5NHS, 2026nhs.uk/baby/health/when-to-get-urgent-medical-help-for-babies-and-children-under-5 ↗
The figures on the page are from these sources.
The child has a cleft
palate?
Send a photo and statements of the child. The doctor will tell you how to adjust feeding, when to operate and what is needed before the operation.