Cleft lip & cleft palate are congenital deformities of the face, occur when a baby’s lip or mouth do not develop congruously during pregnancy. These defects are known as orofacial cleft & occurs in about 1-2 per 1000 births in the developed world.
An infant can be born with a cleft lip without a cleft palate, a cleft palate without a cleft lip or simultaneously with both.
During the stages of pregnancy when different parts of face fail to join, it causes an infant born with a cleft.
Cleft lip
Cleft lip is a split or separation in the upper lip that may or may not extend into the nose i.e. when the cleft extends into the nose it is considered as complete & when it does not extend into the nose it is incomplete or partial cleft.
It can be unilateral (affecting one side of the mouth) or bilateral (including both the sides). At times cleft lip may also affect the gums.
The deformity results due to non fusion of maxillary & medial nasal processes.
Cleft palate
Cleft palate is an opening or separation in the roof of the mouth, occurs due to failure in the fusion of two plates of the skull that forms the hard palate.
When cleft involves both the soft & hard palate it is considered as complete cleft palate & when only involves soft palate, it is incomplete.
Causes of Cleft lip & palate
As mentioned above, such orofacial deformity results due to non-fusion of few structures during the morphogenic events of the developmental stage. But, why few structures fail to fuse, is still unclear.
Most believe these cleft are often caused by changes in the genes or combination of genetic & environmental factors.
Genetic factors include inheriting the deformity from family members. At times, it results with no family history as well.
Environmental factors are things the mother comes in contact with the environment before & during the pregnancy.
Few of them include:
- Cigarette smoking & alcohol consumption during pregnancy.
- Use of medications like: Valproic acid or topiramate for seizures, methotrexate for arthritis, cancer & psoriasis, & accutane for treating acne.
- Folic acid or vitamin deficiency.
- Use of other psychoactive drugs like cocaine.
- Hypoxia
- Parental exposure to lead, etc.
Complications associated with cleft lip & palate
Babies born with these congenital deformities might have problems with their feeding, hearing, speech & dentition.
Nursing:
Presence of cleft causes lack of suction & backward flow of milk into the nose & mouth which further causes difficulties & challenges during feeding.
To counteract such issues, baby bottles or nipples are customized or use of Haberman feeder in order to help milk flow downwards & prevent milk from coming via baby’s nose.
Hearing:
Many infants born with cleft are usually at risk of middle ear infections which may eventually lead to hearing loss. This occurs because of fluid build-up in the middle ear, if left untreated, causes hearing loss. In order to prevent the fluid build-up, a tympanostomy tubes must be placed to drain the fluid & their hearing must be checked once in a year.
Speech:
Children with cleft often face challenges with their speech. Their voice may have nasal twang & difficulty in pronouncing sounds especially the one’s involving: s, sh, ch & j.
The problems might lessen with the treatment & with the aid of a speech therapist.
Dentition
At times, the cleft also involves alveolar ridge or gums that further cause issues with one’s dentition like: supernumerary teeth, missing teeth, rotation, tipping, displacement of teeth etc. Such problems might even affect the permanent dentition.
It’s always recommended to see your pediatric dentist in North Delhi.
Treatment of cleft lip & palate
Cleft lip & palate can be repaired surgically. However, the mode of treatment depends upon the severity & type of the cleft.
Cleft lip
Surgery for cleft lip can be performed within the first 2-3 months after birth. An infant must stand by the “rule of 10s” coined by Wilhelmmesen & Musgrave in year 1969, which says the child must be at least 10 weeks of age; 10 pounds of weight & at least 10g haemoglobin.
In case of bilateral involvement, it’s recommended to close the clefts at few weeks of interval i.e. one side first & the other side a few weeks later.
The Millard procedure or rotation advancement procedure is designed to repair & create more natural looking lip. The surgery involves rotation of tissues & creates a “Z” shaped scar that further provides more elasticity to the tissue & restores the Cupid’s bow.
In cases of extensive cleft, sometimes the lips protrude far outside the mouth. For such cases, nasoalveolar moulding devices might help bring the lips closer together & improve nasal symmetry prior to the surgical repair.
Cleft palate
Often the preferred age for cleft palate repair is between 6 & 12 months of age & requires multiple surgeries as child grows.
The aim of surgery is to create a competent velopharyngeal valve in order to create a palate capable of producing non-hypernasal speech.
In case of extension of cleft into the maxillary alveolar ridge, it is corrected by acquiring bone tissue from patient’s chin, rib or hip & eventually corrected by filling the bone tissue into the gap.
A palatal obturator can be used temporarily in order to cover the roof of the mouth or the gap.
How can you help your child?
It can be quite hard for your kid to grow up with such deformity & might face bullying or teasing. However, you could be your child’s greatest confidant & can encourage him/her to confront the tormentors.
Encourage them to be confident enough & always try to communicate & listen what they want to say & do not let the deformity define who he or she is.
