Cleft lip and cleft palate are birth defects that affect thousands of newborns around the world every year. These conditions are typically visible at birth and can be identified through clinical examination or prenatal ultrasound. However, while the structural abnormality is obvious, many parents and caregivers may not fully understand the range of symptoms that make surgical intervention not just recommended—but essential.
Symptoms for Cleft lip and palate repair surgery is a medical necessity for most affected children. The decision to operate is not based solely on cosmetic concerns, but more importantly on a wide range of functional symptoms that interfere with normal development.
Understanding Cleft Lip and Cleft Palate
A cleft lip is a separation or opening in the upper lip. It can range from a minor notch to a deep gap that extends into the nose. A cleft palate refers to an opening in the roof of the mouth, which may involve the hard palate (front portion), the soft palate (rear portion), or both.
These malformations occur when the facial structures fail to fuse properly during early fetal development, typically between the 6th and 12th weeks of pregnancy. A child can be born with a cleft lip, a cleft palate, or both.
While some symptoms are visible, others are functional and impact feeding, speaking, hearing, and even breathing. The presence and severity of these symptoms guide the timing and approach of cleft repair surgery.
Symptoms for Cleft Lip and Palate Repair Surgery
Visible Deformity of the Lip or Mouth
The most obvious sign indicating the need for surgery is a visible cleft in the upper lip and/or the roof of the mouth. This physical gap is usually apparent at birth and varies in size.
In cleft lip cases, the cleft can be:
- Unilateral (on one side of the lip)
- Bilateral (on both sides of the lip)
- Complete (extends into the nostril)
- Incomplete (partial separation)
In cleft palate cases, the separation may not always be seen externally, especially if it only involves the soft palate. However, it can often be detected during a newborn’s examination or feeding.
Surgical correction is essential for both functional restoration and facial symmetry.
Difficulty Feeding
Feeding problems are among the earliest and most significant symptoms in infants with cleft palate. The ability to suck and swallow effectively is impaired due to the gap in the lip or roof of the mouth.
Common feeding symptoms include:
- Inability to latch properly onto the breast or bottle
- Milk leaking through the nose (nasal regurgitation)
- Poor suction during feeding
- Long and tiring feeding sessions
- Frequent choking or gagging
Because of these difficulties, babies may fail to gain weight, become irritable, or show signs of malnutrition. While special bottles and nipples can help, surgery is often required to correct the structural issue and ensure safe, effective feeding.
Delayed Speech Development
Children with a cleft palate often struggle with speech development. The soft palate plays a crucial role in producing clear speech by closing off the nasal passages during certain sounds. When this closure is incomplete, speech becomes nasal and difficult to understand.
Speech-related symptoms include:
- Delayed onset of speech
- Hypernasal speech (excessive nasal tone)
- Articulation problems
- Inability to produce certain consonants (like “p,” “b,” “d”)
- Weak voice or low volume
Surgical repair of the cleft palate—usually done between 9 to 18 months of age—helps restore the muscle function needed for normal speech. In many cases, speech therapy is needed after surgery, but the repair itself is a critical first step.
Recurrent Ear Infections
Children with cleft palate are particularly prone to ear infections due to poor function of the eustachian tube, the canal that connects the middle ear to the back of the nose. This dysfunction causes fluid to accumulate in the middle ear, leading to frequent infections and sometimes hearing loss.
Symptoms to watch for include:
- Recurrent middle ear infections (otitis media)
- Fluid behind the eardrum
- Hearing difficulties
- Delay in responding to sounds or name
- Poor balance or coordination
Chronic ear infections not only affect hearing but can also delay language development. In many cases, ear tube surgery (tympanostomy) is performed along with cleft palate repair to prevent fluid buildup.
Nasal Deformities and Breathing Difficulties
Cleft lip, especially when it extends into the nose, often affects the structure of the nostrils and nasal septum, leading to breathing problems.
Common symptoms include:
- Noisy or labored breathing
- Nasal congestion without infection
- Frequent upper respiratory issues
- Asymmetrical nostrils or collapsed nasal cartilage
These symptoms often persist unless corrected through cleft lip repair and sometimes nasal reconstruction. Early surgical intervention helps normalize nasal airflow and improves oxygenation.
Psychological and Social Impact
As a child grows older, the social symptoms of cleft deformities can become increasingly apparent. Children may face:
- Teasing or bullying due to facial appearance
- Low self-esteem or social anxiety
- Avoidance of social settings or group activities
- Self-consciousness when speaking or eating
While not physical symptoms, these emotional and psychological issues can have a deep impact. Repair surgery—along with supportive counseling—helps children feel more confident and socially accepted.
Dental and Orthodontic Issues
The alveolar ridge, which houses the upper front teeth, is often affected in children with cleft lip and palate. This leads to several dental concerns:
- Missing or extra teeth
- Misaligned teeth or bite
- Delayed eruption of permanent teeth
- Increased risk of tooth decay
- Malocclusion (misfit of upper and lower jaws)
These problems often necessitate a combination of alveolar bone grafting, orthodontics, and jaw surgery as the child grows. However, early cleft repair surgery lays the groundwork for these later interventions.
Failure to Thrive
In severe cases, especially when feeding issues are not managed properly, infants may exhibit failure to thrive. This means that they do not grow at the expected rate, either in weight or height.
Symptoms include:
- Weight below the 5th percentile for age
- Fatigue and irritability
- Delayed milestones
- Weak immune system
Failure to thrive is a medical emergency, and cleft repair surgery becomes essential to ensure proper nutrition and development.
When to Seek Surgical Intervention
The symptoms mentioned above are strong indicators that cleft lip and/or cleft palate repair surgery is necessary. While the cleft deformity is usually diagnosed at birth (or even before, through prenatal ultrasound), the decision for surgery is guided by:
- Severity of structural deformity
- Functional impairments (feeding, speech, breathing)
- Risk of developmental delay
- Social and psychological wellbeing
Most surgical interventions begin in the first year of life and are followed by staged procedures throughout childhood and adolescence as needed.
Conclusion
Cleft lip and palate are conditions that affect more than just facial appearance—they touch every aspect of a child’s development, from nutrition and speech to hearing and social integration. The symptoms are varied and complex, and they require timely recognition and professional management.
Surgical repair is not just recommended—it is often critical to ensure a child’s physical, emotional, and developmental health. Parents and caregivers should be aware of the symptoms and work closely with a cleft care team, including surgeons, speech therapists, pediatricians, and dentists, to plan a long-term treatment strategy.
With proper intervention and follow-up care, children born with cleft lip and palate can lead full, healthy, and confident lives.
