Cleft lip and cleft palate are malformations of the face and mouth that occur very early in pregnancy when the baby is still developing in the womb.
Cleft lip and cleft palate are malformations of the face and mouth that occur very early in pregnancy when the baby is still developing in the womb. This condition occurs when there is not enough tissue in the mouth or lip area and the existing tissue does not merge properly.
A cleft lip is the physical separation of the two sides of the upper lip. It appears as a narrow opening or gap in the skin of the upper lip. This separation usually extends to the base of the nose and includes the bones of the upper jaw and/or upper gums.
A cleft palate is a crack or opening that exists on the palate. The cleft palate can include the hard palate (the bony front of the roof of the mouth) and/or the soft palate (the soft back of the roof of the mouth).
Cleft lip and cleft palate can occur on one or both sides of the mouth. Since the lip and cleft palate develop separately, it is possible that there is a cleft lip without cleft palate, a cleft lip without cleft palate, or both.
Who Has Cleft Lip and Cleft Palate?
A cleft palate or cleft lip can occur in one of 700 babies born each year. It is the fourth most common birth defect in the United States. Compared to girls, boys with and without a cleft palate have twice as many cleft lips. However, compared to boys, twice as many girls have a cleft palate without a cleft lip.
What are the Causes of Cleft Lip and Cleft Palate?
Usually, the cause of the cleft lip and cleft palate is unknown. This cannot be prevented from happening. Most scientists believe that this condition is caused by a combination of genetic and environmental factors. If there is a problem with a sibling, parent, or relative, it is likely that the newborn baby also has this condition.
Another potential cause may be related to a drug that a mother may have taken during her pregnancy. Some medications can cause cleft lip and cleft palate problems. It can be caused by drugs such as anti-seizure/anticonvulsant drugs, acne medications containing Accutane, and methotrexate, a drug commonly used to treat cancer, arthritis, and psoriasis.
Cleft lip and cleft palate can also occur as a result of exposure to viruses or chemicals while the fetus is developing in the womb. In other cases, a cleft lip and cleft palate may be part of another medical condition.
How are Cleft Lip and Cleft Palate Diagnosed?
Since the cleft causes very pronounced physical changes, it is quite easy to diagnose a cleft lip or cleft palate. With ultrasound performed before childbirth, it is sometimes possible to see if there is a cleft in an unborn child. If a cleft has not been detected on an ultrasound before the birth of the baby, a physical examination of the mouth, nose, and palate, the presence of a cleft lip or cleft palate after the birth of the child can be detected. Sometimes diagnostic tests can be performed to determine or rule out the presence of other abnormalities.
What Are the Problems Associated with Cleft Lip and/or Palate?
Eating problems
With a separation or opening on the palate, food and liquids can pass from the mouth back through the nose. Fortunately, there are specially designed baby bottles and pacifiers that allow fluids to flow down into the stomach. Children with a cleft palate may need to wear artificial palate to help them eat properly and ensure that they are fed adequately until surgical treatment is provided.
Ear infections/ hearing loss
Children with cleft palate have a higher risk of an ear infection because they are more prone to fluid accumulation in the middle ear. Ear infections can cause hearing loss if left untreated. To prevent this from happening, children with cleft palate usually need to have special tubes inserted into the eardrum to help drain fluid and have their hearing checked once a year.
Speech problems
Children with cleft lip or cleft palate may also have problems speaking. The voices of these children do not sound good, the voice can pick up a sound coming from the nose, and it can be difficult to understand the speech. These problems do not occur in every child, and in some, surgery can completely correct these problems. For others, a special doctor, who is called a speech pathologist, will work with the child to solve speech difficulties.
Dental Problems
Children with cleft lips may have more cavities than average. Orthodontic treatment is often required. In addition, children with cleft palate often have an alveolar ridge defect. The alveoli are the bony upper gum containing the teeth. A defect in the alveoli can displace, tilt, or rotate permanent teeth. It can prevent permanent teeth from appearing and prevent alveolar protrusion from forming. These problems can usually be corrected with oral surgery.
Who Treats Children with Cleft Lip and/or Palate?
Due to the number of oral health and medical problems associated with a cleft lip or cleft palate, a doctor and a team of other specialists are usually involved in the care of these children. This team is as follows:
- A plastic surgeon who will evaluate and perform the necessary operations on the lips and/or palate
- An otolaryngologist (otolaryngologist and throat doctor) to assess hearing problems and evaluate treatment options for hearing problems
- An oral surgeon to reposition parts of the upper jaw as needed, improve function and appearance, and repair the gum cleft
- An orthodontist to correct and reposition teeth
- A dentist to do routine dental care
- A prosthetist who makes artificial teeth and dental instruments to improve the appearance and meet functional requirements for eating and speaking
- A speech pathologist to assess speech and nutritional problems
- A speech therapist who will work with the child to improve speech
- Audiologist (specialist in communication disorders caused by hearing impairment); for assessing and monitoring hearing
- A nurse coordinator to ensure constant supervision of the child’s health
- A social worker/psychologist to support the family and assess adaptation issues
- A geneticist who will help parents and adult patients understand the chances of having more children with these conditions
What is the Treatment of Cleft Lip and Cleft Palate?
A cleft lip may require one or two surgeries, depending on the size of the repair required. The first surgery is usually performed when the baby is 3 months old.
Cleft palate treatment requires multiple surgeries, usually for 18 years. The first operation for palate repair is usually performed when the baby is 6 to 12 months old. The first operation forms a functional palate, reduces the likelihood of fluid formation in the middle ear, and helps the proper development of teeth and facial bones.
Children with a cleft palate may need a bone graft at the age of about 8 to fill the upper gum line so that it can support permanent teeth and stabilize the upper jaw. About 20% of children with a cleft palate require further surgery to help improve their speech.
When permanent teeth grow, braces are usually needed to fix the teeth.
Additional surgeries may be performed to improve the appearance of the lips and nose, close the openings between the mouth and nose, assist breathing, and stabilize and realign the jaw. Final repairs to the scars left by the initial surgery probably won’t be done until adolescence, when the facial structure is more fully developed.
This article was written and published originally by Burak Sercan Erçin
