Cleft Lip: Causes, Risk Factors, Diagnosis, Complications, Types, Treatment, Prediction and Prevention

It refers to an opening that extends through the upper lip.

It can be in the middle line (center) or on the left and / or right side 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 roof of the mouth).

Similar to a cleft lip, the cleft palate may be the midline and / or 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 development of the lip and palate 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 live 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 that are 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 origin.

What are the causes and risk factors for developing a cleft lip and palate?

While gender and ethnicity are risk factors, as described above, there are other factors that 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. If an older brother has bilateral involvement (both sides of the upper lip), 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 child with a cleft lip or palate, the likelihood of future children experiencing a cleft malformation increases to 14%.

Diagnosis

The diagnosis of cleft lip at the time of birth is obvious. All newborns are examined at the time of birth 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 covering 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 conceptions with cleft lip and palate may be associated with other non-oral cavity deformities, specialized ultrasounds may be indicated.

Similarly, the obstetrician may recommend blood tests and an amniocentesis. A referral to a perinatologist (an obstetrician with specialized training in high-risk pregnancies) or a geneticist can be recommended.

Other congenital defects that are associated with cleft lip and palate may include the following:

  • Common cardiac defects.
  • Pyloric stenosis (narrowing of the stomach when it connects with the small intestine).
  • Deformed foot
  • Scoliosis.

What are the complications of a cleft lip and palate?

There are a number of complications that can affect babies and children with cleft lip and palate.

These include the following:

Feeding problems : Due to anatomical defects, it can be very difficult for newborns to breastfeed successfully.

The abnormal separation of the upper lip makes it very difficult for the newborn to obtain a good seal that is necessary for a successful nursing experience.

Routine nipples for bottle feeding present the same problem; however, there are specialized systems of bottles and nipples that facilitate effective nutrition.

Those children with cleft palate 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 also facilitates the ability to suck efficiently the specialized nipple.

Ear infections / hearing loss : children with cleft palate are more likely to have recurrent ear infections and associated fluid buildup inside the eardrum.

To limit these problems, most children with cleft palate have PET (“tubes”) placed through the eardrum during their first months.

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 a nasal quality of your voice.

Corrective surgery can reduce these speech problems, but most children with cleft lip and / or palate benefit from formal speech therapy.

Dental problems: children with cleft lip often have problems 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 structural birth defects.

What are the different types of birth defects?

There are two main types of birth defects:

  • Structural
  • Functional / development.

Structural birth defects 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 , problems that are related to the growth and development of the brain and spinal cord .

Functional birth defects are related to a problem with the way 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 / or palate requires patience for both parents and the patient.

Several years of multiple surgical procedures are generally necessary to provide a satisfactory result.

Repair of a cleft lip is usually approached at approximately 3 months of age. One or two surgical procedures may be necessary to achieve both the effective function of the lip and cosmetic repair.

Cleft palate repair is a series of multi-step surgical procedures that begins at approximately 6 to 12 months of age and ends in the later years of adolescence.

The first procedure is typically 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.

Repair of the palate defect also encourages proper development of the upper jaw (maxilla) and other facial bones.

Approximately at 8 years of age, a bone graft is performed to further support the structure of the upper jaw and assist in the articulation of 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 has occurred.

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 with respect to appearance and function.

In order to maximize medical management as well as 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 commonly 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?

The vast majority of babies who experience a cleft lip or palate do not have a genetic predisposition or obvious risk factors.

During pregnancy, there are problems that can increase the likelihood of producing a newborn with cleft lip and / or palate.

These may include the following:

  • Certain medications to help prevent maternal seizures or migraine, such  as topiramate (Topamax).
  • Certain drugs that are used as 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.