Index
It refers to an opening that extends through the upper lip.
It can be in the middle line (center) or on the left and right sides of the lip. A cleft palate is an opening of the hard palate (the bony front of the roof of the mouth) or the soft palate (the non-bone muscular region on the back of the top of the mouth).
Like a cleft lip, the cleft palate may be the midline and to the right of the left side of the palate. The cleft palate can extend from the upper jaw to the back of the throat.
Since the lip and palate development occurs at different times during pregnancy, a baby can have a cleft lip or cleft palate or cleft of both regions.
How often do these effects of birth occur?
Cleft lip, either as a single malformation or together with cleft palate, occurs in approximately one in every 700 births.
Children are twice as likely to have a cleft lip with or without an associated cleft palate. On the other hand, girls are more likely to have a cleft palate only (those not associated with a cleft lip malformation).
It has been shown that ethnicity affects the frequency of clefts. Children of Asian, Latin, or Native American origin are affected more frequently than children of Caucasian heritage.
What are the causes and risk factors for developing a cleft lip and palate?
While gender and ethnicity are risk factors, as described above, other factors seem to play a role in cleft formation.
The specialists have observed that the more serious the defect is in a child, the greater the risk of a malformation cleft in the later siblings.
The risk of recurrence for a cleft deformity is 2.7% if an older brother has a single cleft lip. Suppose an older brother has bilateral involvement (both sides of the upper lip), and the risk of recurrence doubles (5.4%).
If a father has had a cleft lip or palate, there is a 4% chance of a cleft malformation in his children.
However, if an affected parent has a cleft lip or palate child, the likelihood of future children experiencing a cleft malformation increases to 14%.
Diagnosis
The diagnosis of the cleft lip at the time of birth is evident. All newborns are examined at the time of delivery for the cleft palate.
The direct-lighted examination of the baby’s hard and soft palate is part of the complete examination of any newborn.
In addition, the palate (hard and soft regions) is palpated with the examiner’s finger to ensure that a “partial cleft” is not lost.
The partial cleft occurs when a bony or muscular defect of the palate is obscured by the intact skin covering the tissue separation (similar to wrapping a hole in the beach sand with a towel).
Before birth, the prenatal ultrasound examination may show a malformation of the upper lip, nasal opening, or palate.
Since up to 35% of cleft lip and palate conceptions may be associated with other non-oral cavity deformities, specialized ultrasounds may be indicated.
Similarly, the obstetrician may recommend blood tests and amniocentesis. A referral to a perinatologist (an obstetrician with specialized training in high-risk pregnancies) or a geneticist can be recommended.
Other congenital disabilities that are associated with cleft lip and palate may include the following:
- Common cardiac defects.
- Pyloric stenosis (narrowing of the stomach when connecting with the small intestine).
- Deformed foot
- Scoliosis.
What are the complications of a cleft lip and palate?
Several complications can affect babies and children with cleft lip and palate.
These include the following:
Feeding problems: Due to anatomical defects, it can be challenging for newborns to breastfeed successfully.
The abnormal separation of the upper lip makes it very difficult for the newborn to obtain a good seal necessary for a successful nursing experience.
Routine nipples for the bottle-feeding present the same problem; however, specialized systems of bottles and nipples facilitate adequate nutrition.
Children with cleft palates are commonly equipped with an artificial removable palate very early in life.
This device limits the possibility of passage of liquids through the defect to the nostrils and facilitates the ability to suck the specialized nipple efficiently.
Ear infections/hearing loss: children with cleft palate are more likely to have recurrent ear infections and associated fluid buildup inside the eardrum.
Most children with cleft palate have PET (“tubes”) placed through the eardrum during their first months to limit these problems.
Speech problems: As expected, the malformations associated with the cleft palate and the lip can affect the joint. The most common problem tends to be the nasal quality of your voice.
Corrective surgery can reduce these speech problems, but most cleft lip and palate children benefit from formal speech therapy.
Dental problems: children with cleft lips often have issues with missing and malformed teeth and commonly require orthodontic treatments and oral surgery occasionally if the upper jaw (maxilla) has an altered function (such as incorrect positioning and abnormal positioning of permanent teeth).
The cleft lip and palate are congenital structural disabilities.
What are the different types of congenital disabilities?
There are two main types of congenital disabilities:
- Structural
- Functional / development.
Structural congenital disabilities are related to a problem with body parts.
Some physical problems include:
- Cleft lip or cleft palate.
- Heart defects: missing or deformed valves.
- Abnormal extremities: clubfoot.
They also include neural tube defects, such as spina bifida, related to the growth and development of the brain and spinal cord.
Functional congenital disabilities are related to a problem with how a part of the body or a body system works. These problems often lead to developmental disabilities.
What is the treatment for cleft lip and palate?
Successful treatment of a baby or child with a cleft lip and palate requires patience for both parents and the patient.
Several years of multiple surgical procedures are generally necessary to provide a satisfactory result.
Cleft lip repair is usually approached at approximately three months of age. One or two surgical procedures may be necessary to achieve both the lip’s and cosmetic repair’s practical function.
Cleft palate repair is a series of multi-step surgical procedures that begins at approximately 6 to 12 months and ends in the later years of adolescence.
The first procedure is typically the repair of the defect in the palate, which allows for better nutrition and weight gain and reduces the frequency of hearing loss and recurrent ear infections.
Repairing the palate defect also encourages proper development of the upper jaw (maxilla) and other facial bones.
Approximately at eight years of age, a bone graft is performed to support the structure of the upper jaw further and assist in articulating speech.
In general, orthopedic braces are required to straighten the permanent teeth, and the plastic revision of the surgical scar (excision) is performed after most of the growth in adolescence.
What is the prognosis?
While effective treatment for cleft lip and cleft palate requires many surgical procedures, speech therapy, and consultation with many medical specialists, it must be anticipated that an excellent result can be achieved concerning appearance and function.
To maximize medical management and coordination with multiple health professionals and parents, a cleft palate team is usually the preferred approach to care coordination.
Such equipment is commonly found in pediatric teaching hospitals in major cities. Members of the medical team will typically consist of:
- Plastic Surgeon.
- Otolaryngologist.
- Oral surgeon
- Prosthodontist (makes dental appliances).
- Dentist and orthodontist.
- Pathologist/speech therapist
- Audiologist (hearing specialist).
- Social worker/psychologist.
- Geneticist.
- Nursing coordinator.
Is it possible to prevent a cleft lip or palate?
Most babies who experience a cleft lip or palate do not have a genetic predisposition or obvious risk factors.
Some problems can increase the likelihood of producing a newborn with cleft lip and palate during pregnancy.
These may include the following:
- There are specific medications to help prevent maternal seizures or migraine, such as topiramate (Topamax).
- Certain drugs are used for cancer chemotherapy (including methotrexate[Rheumatrex, Trexall]).
- Smoking cigarettes (there is still no information regarding electronic cigarettes).
- Consumption of alcohol.
- The lack of folic acid supplements before conception and throughout pregnancy.
