Cleft Lip and Cleft Palate - Causes, Symptoms, Diagnosis, and Treatments

What Is Cleft Lip and Cleft Palate?

Cleft lip is an abnormal opening in the lips and roof of the mouth. It is a common birth defect in children. It can occur on one or both sides depending on the severity. Orofacial clefts include both cleft lip and cleft palate. This condition is often accompanied with other disorders. Recent advances have made both cleft lip and palate completely treatable.

Classification:

1. Unilateral complete - The slit or the gap extends from the lips to the nose only on one side.

2. Unilateral incomplete - The slit or the gap extends only upto the lip region only on one side.

3. Bilateral complete - The slit or gap extends from lip upto to nose on both sides.

What Are the Causes of Cleft Lip and Palate?

• Genetics.

• Environmental factors.

• Consumption of alcohol and smoking in pregnant mothers.

• When the mother had taken certain toxic medications during pregnancy. Drugs such as anticonvulsants and steroids are included in this.

• Fetal exposure to chemicals and toxins in the womb.

• Gestational diabetes (mother with diabetes during pregnancy).

• When the tissue is not sufficient in the lip area.

  Related Topics

  ---

  I was always bullied as I am a transgender with cleft palate. What would I do?

  Is it necessary to repair soft cleft palate with surgery?

  Do children with soft cleft palate also need multiple surgeries to fix the issue?

• Mother being obese during pregnancy.

• Folic acid and vitamin B deficiency in pregnant mothers.

What Are the Risk Factors?

1. Consanguineous marriage.

2. Risk increases if one of the family members is diagnosed with this condition.

3. Women who conceive in the later years tend to have more risk.

4. Exposure to radiation.

5. It is common in Asian and American children.

6. Mongoloids have high reported cases of this condition.

7. Boys are more frequently affected than girls.

How Does It Look Like?

Every two minutes, a child is born with cleft somewhere in the world.

What Are the Problems Faced by the Baby?

1. Swallowing problems.

2. Breathing problems.

3. Difficulty in speech.

4. Difficulty in hearing.

5. Ear infections.

6. Dental problems.

   1. Gum and bones surrounding the teeth may be affected.

   2. Higher risk of tooth decay.

   3. Missing or displaced tooth which might require orthodontic treatment (braces).

7. Imbalance in social and emotional states.

8. Malnutrition (deficient nutrient supply).

9. Memory problems.

10. Attention deficit.

How Is It Diagnosed?

Before birth, it can be identified using ultrasound imaging. It is a very helpful non-invasive diagnostic tool.

After birth, it can be identified using physical examination of the mouth, nose, and palate. It is usually done within 72 hours of birth.

What Is the Treatment?

The treatment for cleft lip and palate requires a multidisciplinary approach.

1) Surgical Treatment:

With proper surgical techniques, the lip, nose, and facial structures can be restored. This will thereby promote normal functioning. The repair of cleft lip is done by a surgical procedure called cheiloplasty.

A rule of 10 has to be followed for the surgery to be more successful. The child who is undergoing surgery:

• should be at least 10 weeks of age.

• should be at least 10 pounds of weight.

• should have a hemoglobin (Hb) value of about 10 gm/dL.

2) Non-Surgical Treatment:

For patients who have high risk involved in surgery and those who are not willing for surgery, dental obturator is the treatment of choice. It can be used in the sites of deficient tissues. The main advantage of an obturator is high degree of closure. One of its notable disadvantages is the irritation of oral mucosa.

Rehabilitation:

1. Hearing - Most of the children with cleft lip and palate suffer from hearing disabilities. Children can be given appropriate hearing aids. An audiologist will help to assess and monitor hearing. Otolaryngologists also play a vital role.

2. Speaking - Children will need help from speech-language pathologists and occupational therapists to conduct speech therapies. It is highly effective and will help the children to speak normally.

3. Eating - Feeding and growth of the child will be a primary concern for the parents. Infants will not be able to breastfeed like others. Feeding tubes and specialized bottles will be required to feed the infant. Draining of oral fluids in the nasal cavity should be done to enable better feeding.

4. Nasality - Velopharyngeal insufficiency is the inability of the soft palate to close while speaking. It can cause hypernasality (increased nasal resonance), hyponasality (reduced nasal resonance), or both, which is known as mixed nasal resonance.

5. Psychological factors - Having a kid with this condition is a great psychological disturbance for the parents. As these parents are generally under constant stress, they are given psychological counseling. In case the child is suffering from inferiority complex, it is advisable for the child to undergo psychotherapy.

6. Dental problems - This might require the help of pediatric dentist, prosthodontist, and orthodontist.

a. Prosthodontic care - Prosthodontists help in designing a feeding obturator. It is also known as a speech bulb. This prosthesis will help the patient to close the separation between oral and nasal cavity. It helps in proper development of jaws. It helps to reduce nasal regurgitation (food and liquids coming out through the nose). It reduces choking. In case of a missing tooth, it can be replaced with fixed partial dentures, complete dentures or dental implants in the later stages. The prosthodontist formulates the treatment plan with plastic surgeons.

b. Orthodontic care - Orthodontists help to regulate the growth of facial structures and monitors the jaw development.

How Can You Prevent It?

There is no exact way to prevent cleft lip and palate. But, intake of Folic acid by the mother during pregnancy might help. Carrying mothers should strictly avoid cigarettes and alcohol. Vitamin supplements should be taken by the mother.

Prognosis:

If the treatment is a well-planned teamwork by general dentists, plastic surgeons, oral and maxillofacial surgeons, orthodontists, psychologists, occupational therapists, geneticist, etc., then the rate of prognosis is definitely high. Ideal surgical methods can help in restoring all the vital functions along with minimal scarring. Children who are over 8 years of age might require bone grafting.

The treatment of cleft lip and palate would require highly skilled professionals. For more information, consult a doctor online.