A cleft palate is an opening or gap in the roof of the mouth that forms when tissue doesn’t fully close during early pregnancy. It can range from a small split in the back of the mouth to a wide opening that runs the entire length of the palate, from behind the front teeth all the way to the throat. About 1 in 1,563 babies in the United States is born with a cleft palate alone, and roughly 1 in 1,031 is born with a cleft lip that may also involve the palate.
What a Complete Cleft Palate Looks Like
A complete cleft palate is the most visually obvious form. It extends through both the hard palate (the bony front portion of the roof of the mouth) and the soft palate (the muscular tissue toward the back of the throat). When you look into a baby’s mouth, you can see a gap that runs from behind the upper gum all the way back, essentially creating an open channel between the mouth and the nasal cavity above it. In some cases, you can see directly into the nasal passages through this opening.
The cleft can appear on one side (unilateral) or both sides (bilateral). A unilateral complete cleft creates a single opening that runs along one side of the midline, while a bilateral cleft splits along both sides, sometimes leaving a small strip of tissue in the center. When the cleft also involves the lip and the upper gum line, the gap is visible from the outside as a split running from the lip upward toward the nose, with the inner mouth opening connecting to it.
What an Incomplete Cleft Palate Looks Like
An incomplete cleft affects only the soft palate at the back of the mouth, leaving the hard palate intact. This means the bony roof of the mouth looks normal, but there’s a visible split in the softer tissue closer to the throat. The opening is typically smaller and further back, so it’s less immediately noticeable than a complete cleft. Parents or doctors might see it when the baby cries or opens their mouth wide, revealing a gap or notch in the tissue near the uvula (the small piece of tissue that hangs at the back of the throat).
The Hidden Type: Submucous Cleft Palate
Some cleft palates don’t look like an opening at all. In a submucous cleft palate, the skin lining of the mouth is intact, but the muscles underneath never joined together properly at the midline. The roof of the mouth may appear closed, which is why this type often isn’t caught at birth.
There are three physical signs that point to a submucous cleft. The first is a bluish, translucent streak along the center of the soft palate, caused by the separated muscles showing through the thin tissue covering them. The second is a bifid uvula, where the uvula is split into two small points instead of forming a single teardrop shape. The third is a bony notch at the back edge of the hard palate that a doctor can feel by pressing a finger along the roof of the mouth. Some children with a submucous cleft aren’t diagnosed until they start talking and have noticeable speech difficulties, or until feeding problems prompt a closer look.
How It Affects the Gum Line and Teeth
When a cleft extends through the upper gum (the alveolar ridge), it changes the shape and alignment of the dental arch. Instead of a smooth, horseshoe-shaped upper gum, there’s a gap or notch where bone is missing. This can cause permanent teeth to come in crooked, tilted, or rotated. Some teeth may never develop at all in the area of the cleft, and others may fall out prematurely because they lack bone support.
Children with a cleft involving the gum line often need a bone graft between the ages of 6 and 10. This procedure fills in the missing section of the upper jaw with bone tissue, giving permanent teeth a foundation to grow into and stabilizing the jaw’s structure.
A Less Common Shape: The U-Shaped Cleft
Most cleft palates appear as a V-shaped or narrow gap, but one specific variant looks distinctly different. In Pierre Robin sequence, the baby’s lower jaw is unusually small, which prevents the tongue from dropping down into its normal position during development. The tongue physically blocks the palate from closing, resulting in a wide, U-shaped cleft that is broader and more rounded than a typical cleft. This type is usually accompanied by a noticeably recessed chin.
Feeding Signs That Reveal a Cleft
Even when a cleft palate isn’t immediately visible, certain feeding behaviors in newborns can signal its presence. Because the gap between the mouth and nasal cavity prevents a baby from creating proper suction, breastfeeding and bottle-feeding become difficult. Milk may come back out through the baby’s nose during feeds. The baby may take in excessive air, tire quickly while eating, or gain weight slowly. These signs are sometimes the first clue that leads to a diagnosis, particularly with smaller or submucous clefts that aren’t obvious on visual inspection.
When a Cleft Palate Can Be Detected
Complete clefts involving both the lip and palate can sometimes be spotted on ultrasound as early as 16 weeks of pregnancy, especially when 3D imaging is used. Smaller or incomplete clefts are harder to see on ultrasound and may not be detected until closer to 27 weeks, if they’re detected prenatally at all. Isolated cleft palates without any lip involvement are particularly difficult to identify before birth because the palate is hidden inside the mouth and doesn’t show up well on standard imaging.
Most cleft palates are diagnosed shortly after delivery during the newborn’s first physical exam, when a doctor visually inspects and feels the roof of the mouth. Surgical repair typically happens between 6 and 14 months of age, closing the gap and reconnecting the muscles so the palate can function normally for eating and, eventually, speech.