In early pregnancy, when the unborn baby’s face and mouth are being formed, the upper lip and palate may not fuse together fully, leaving a gap.

Sometimes just the lip is affected, resulting in a lateral (one side) or bi-lateral (both sides) cleft lip. In other cases, only the palate is affected. More frequently, babies born with cleft have both conditions.

A cleft lip is easy to see and recognise. But a cleft palate (a gap in the roof of the mouth) is only visible when the baby’s mouth is wide open – for example when he or she cries. Other indications of a cleft palate are difficulty in feeding, or milk running from the baby’s nose.

Cleft lip and palate are believed to be one of the most common craniofacial differences worldwide. Without intervention, affected children battle a lifetime of difficulties with eating, breathing, speaking and mental health.

Surgery to repair a cleft lip can be performed as early as three months of life. Specialist cleft surgeons will suture the two sides of the lip together, leaving a scar that blends into the lip. Repairing a cleft palate is more complicated and is usually done when the child is older – between the ages of 6 to 18 months. During surgery, tissue from either side of the mouth is used to fill in the gap.

Several subsequent surgeries may be required during childhood and into adolescence.

Children who grow up without access to plastic surgery may have a cleft condition repaired at any age. Operation Smile recently operated on 36 year old Zivezile Nojamanga who had lived with stigma of being ‘different’ all his life.

Cleft lip and palate are not an aesthetic problem. Individuals with untreated cleft conditions face a host of medical complications that affect every facet of their lives.

Malnutrition

Infants with cleft conditions can struggle with nursing and feeding, which can lead to malnutrition. 

Dental problems

Teeth may erupt in the wrong place or out of alignment, making it difficult for the child to chew properly. Following surgery, the child may need orthodontistry to ensure teeth are correctly aligned.

Speech difficulties

Speech difficulties are common among children born with cleft conditions. They may struggle to make themselves understood, and need speech therapy after surgery.

Mental health problems

In many cultures children born with cleft conditions – and their families – are shunned. Children may be bullied or shunned by their peers, leading to social isolation and lack of self esteem.

As they grow, these children may become self conscious about their appearance, and may feel hopeless about the future.

Comprehensive cleft care is essential to ensure that children born with the condition can lead a life free from stigma and filled with hope for a brighter future.

Although we still don’t know exactly what causes these conditions, there are many known risk factors that can increase the likelihood of a baby being born with cleft lip or cleft palate. Genetics and family history, pre-existing medical conditions, poor nutrition and exposure to harmful environmental substances (for example smoke inhalation from cooking over an open fire) can affect the healthy development of an unborn baby.