Openings or cracks in the upper lip, the roof of the mouth (palate), or both are examples of cleft lip and cleft palate. Cleft lip and cleft palate occur when face tissues in an unborn newborn do not close fully.
The most frequent birth abnormalities are cleft lip and cleft palate. They are most usually seen as solitary birth abnormalities, although they are also linked to a variety of inherited genetic disorders or syndromes.
It might be unpleasant to have a baby born with a cleft, but cleft lip and cleft palate can be fixed. A series of procedures can restore normal function and provide a more typical look in most newborns with minimum scars.
WHAT ARE THE SYMPTOMS OF CLEFT LIP AND CLEFT PALATE?
A split (cleft) in the lip or palate is usually noticeable from birth. Cleft lip and palate can manifest as:
- A split in the lip and palate that affects one or both sides of the face.
- A lip split that appears as a little notch in the lip or that runs from the lip through the upper mouth and palate into the bottom of the nose.
- A split in the roof of the mouth that has no effect on the face's look.
A cleft occurs less frequently in the muscles of the soft palate (submucous cleft palate), which are located at the back of the mouth and are covered by the mouth lining. This form of cleft generally goes unreported at birth and may not be recognized until symptoms appear later. Submucous cleft palate symptoms and signs may include:
- Feeding difficulties
- Difficulty swallowing, with the possibility of liquids or meals coming out the nose
- Nasal speaking voice
- Chronic ear infections
WHAT ARE THE CAUSES OF CLEFT LIP AND CLEFT PALATE?
When tissues in the baby's face and mouth fail to fuse properly, cleft lip and cleft palate develop. During the second and third months of pregnancy, the tissues that make up the lip and palate normally fuse together. However, in newborns with cleft lip and palate, the fusion never happens or occurs just partially, leaving a hole (cleft).
Most occurrences of cleft lip and cleft palate, according to researchers, are caused by a combination of hereditary and environmental factors. A precise reason is not found in many newborns.
Clefting genes can be passed down from either mother or father, either alone or as part of a genetic condition that includes a cleft lip or cleft palate as one of its symptoms. In certain circumstances, newborns inherit a gene that makes them more prone to develop a cleft, and then the cleft is caused by an environmental trigger.
WHAT ARE THE RISK FACTORS FOR CLEFT LIP AND CLEFT PALATE?
Several variables can raise a baby's chances of having cleft lip and palate, including:
- Family history: Parents who have a family history of cleft lip or cleft palate are more likely to have a cleft baby.
- Exposure to certain chemicals when pregnant: Cleft lip and palate may be more common in pregnant women who smoke, consume alcohol, or take certain drugs.
- Having diabetes: There is some evidence that women who had diabetes before becoming pregnant are more likely to have a kid with cleft lip and palate.
- Obesity during pregnancy: There is some evidence that infants born to obese mothers are more likely to develop cleft lip and palate.
Males are more likely than females to have a cleft lip and palate. Females are more likely to have cleft palate without cleft lip. Cleft lip and palate are said to be most frequent in Native Americans and least common in African-Americans in the United States.
WHAT ARE THE COMPLICATIONS OF CLEFT LIP AND CLEFT PALATE?
Depending on the kind and severity of the cleft, children with cleft lip and palate encounter a number of issues.
Feeding difficulties: One of the most pressing considerations following delivery is feeding. While most newborns with cleft lip and palate can breastfeed, sucking may be challenging.
Hearing loss and ear infections: Babies with cleft palate are predisposed to develop middle ear fluid and hearing loss.
Dental issues: Tooth development may be hampered if the cleft extends through the upper gum.
Difficulties with speech: Because the palate is needed to generate sounds, a cleft palate can interfere with the development of regular speech. Speech may come off as nasal.
The difficulties of dealing with a medical condition: Due to disparities in appearance and the stress of rigorous medical treatment, children with clefts may experience social, emotional, and behavioral issues.
HOW IS CLEFT LIP AND CLEFT PALATE DIAGNOSED?
Most occurrences of cleft lip and cleft palate are discovered at birth and do not require any specific testing to be diagnosed. Cleft lip and palate are increasingly being detected on ultrasonography before the infant is born.
Prenatal ultrasound
A prenatal ultrasound is a technique that creates images of the growing fetus using sound waves. A doctor may notice a variation in the face structures while reviewing the images.
Beginning about the 13th week of pregnancy, ultrasonography can identify cleft lip. It may become simpler to appropriately detect a cleft lip as the fetus develops. Cleft palate that forms on its own is more difficult to detect with ultrasonography.
If a cleft is discovered during a prenatal ultrasound, your doctor may suggest taking a sample of amniotic fluid from your uterus (amniocentesis). The fluid test might reveal that the fetus has inherited a genetic condition that could result in additional birth abnormalities. However, the etiology of cleft lip and cleft palate is frequently unclear.
WHAT ARE THE TREATMENTS FOR CLEFT LIP AND CLEFT PALATE?
The aim of cleft lip and cleft palate therapy are to enhance the child's ability to eat, speak, and hear normally, as well as to attain a normal facial look.
Children with cleft lip and cleft palate are frequently cared for by a multidisciplinary team of doctors and specialists, including:
- Plastic surgeons or ENTs that specialize in cleft repair
- Oral surgeons
- Nurses
- Auditory or hearing professionals
- Speech therapists
- Ear, nose, and throat specialists (ENTs, also called otorhinolaryngologists)
- Pediatricians
- Pediatric dentists
- Orthodontists
- Genetic counselors
- Social workers
- Psychologists
Surgery to fix the defect is followed by therapy to improve any associated problems.
Surgery
The surgery to fix cleft lip and palate is tailored to your child's specific condition. Following the first cleft repair, your doctor may advise you to have follow-up procedures to enhance your speech or the look of your lip and nose.
Typically, surgeries are conducted in the following order:
- Cleft lip repair — within the first 3 to 6 months of age
- Cleft palate repair — by 12 months of age, or sooner if possible
- Follow-up procedures — between the ages of 2 and late teenage years
A hospital is used for cleft lip and palate surgery. Your kid will be given a general anesthesia, which means he or she will not experience pain or be aware during the procedure. To correct cleft lip and palate, reconstruct the afflicted regions, and prevent or treat associated problems, a variety of surgical methods and procedures are performed.
Procedures in general may include:
- Cleft lip repair: To close the lip cleft, the surgeon makes incisions on both sides of the cleft and generates tissue flaps. The flaps, including the lip muscles, are then sewn together. The restoration should restore the lip's look, structure, and function. If necessary, initial nasal repair is frequently performed at the same time.
- Cleft palate repair: Depending on your child's circumstances, several operations may be utilized to repair the gap and reconstruct the roof of the mouth (hard and soft palate). Incisions are made on both sides by the surgeon.
- Ear tube surgery: Ear tubes may be implanted in children with cleft palate to lessen the risk of chronic ear fluid, which can lead to hearing loss. Ear tube surgery is inserting small bobbin-shaped tubes into the eardrum to create an aperture that allows fluid to drain.
- Surgery to reconstruct appearance: Additional procedures to enhance the look of the mouth, lip, and nose may be required.
Surgery can enhance your child's looks, quality of life, and capacity to eat, breathe, and communicate dramatically. Surgery hazards include bleeding, infection, poor healing, scar widening or elevation, and temporary or permanent nerve, blood artery, or other structural damage.
Complications treatment
Additional treatment for cleft lip and cleft palate issues may be recommended by your doctor. Here are several examples:
- Feeding methods, such as the use of a customized bottle nipple or feeder
- Ear infection monitoring and treatment, which may involve ear tubes
- Hearing aids or other assistive equipment for a hearing-impaired child
- Speech therapy to help with speech difficulties
- Braces and other orthodontic changes to the teeth and bite
- From a young age, a pediatric dentist will monitor tooth development and oral health.
- Psychological therapy to assist the kid in coping with the stress of recurrent medical procedures or other issues