Cleft Lip or Cleft Palate is a congenital abnormality caused by abnormalities in the development of the mouth and palate of the fetus. The baby may have a cleft in the lip or a cleft in the palate. It can occur as one or both cleft lip and palate occur together.
Cleft lip and palate are conditions that can be detected in the womb or shortly after birth, often affecting physical characteristics, eating, swallowing, speaking , and oral health. Treatment approaches for cleft lip and palate can vary depending on the severity of the condition, age, and other congenital abnormalities that may occur with the cleft lip and palate.
Cleft lip and palate
A baby can be born with either a cleft lip or a cleft palate, or both. There are three main types of cleft lip and palate:
- A cleft in the upper lip and a cleft in the roof of the mouth, which may occur on one or both sides of the lip.
- A small, indented crease that occurs only on the upper lip, or may extend to the upper gums, roof of the mouth, and under the nose.
- A specific cleft in the soft palate of the mouth that does not affect the physical appearance of the face.
Causes of cleft lip and palate
Cleft lip and palate can occur while a baby is still in the womb. Usually, in the first 2–3 months of pregnancy, the baby ‘s body begins to develop various organs, including the mouth and palate. If the body makes a mistake in developing these organs, it may cause a cleft lip and palate.
Currently, doctors do not know the true cause of the disease and believe that it may be caused by the following factors:
- Geneticfactors , which are inherited in people who have a history of cleft lip and palate from family members.
- Environmental factors, such as smoking ordrinking alcohol during pregnancy.
- Obesity during pregnancy
- Folic aciddeficiency during pregnancy
- Exposure to viruses or chemicals during pregnancy
- Use of certain medications during pregnancy, such as anticonvulsants,steroids, acne medications containing Accutane, chemotherapy drugs , methotrexate, and medications used to treat cancer, arthritis, and psoriasis .
- Other birth defects include DiGeorge syndrome, which is caused by a missing part of chromosome22, which can cause abnormalities such as difficulty eating, hearing loss, facial abnormalities, and immune system problems and thyroid problems.
Diagnosis of cleft lip and palate
Cleft lip and palate can be detected while the baby is still in the womb or after birth. There are two ways to diagnose cleft lip and palate:
- Ultrasound . Your doctor may use an ultrasound to look at the structure of your baby’s face to look for abnormalities .This test can be done as early as the 13th week of pregnancy. Cleft lip may be easier to detect than cleft palate, which occurs in the roof of the mouth alone.
- A newborn physical examination is an examination of the baby’s physical characteristics immediately after birth. The doctor may look for abnormalities on the body, such as the face and mouth, which may also help in diagnosing cleft lip and palate.
Cleft lip and palate treatment
Treatment aims to improve the ability to eat, speak, hear, and physically function normally. Treatment can be done by surgery, which may be based on the condition and symptoms of each patient. Surgical treatment methods may be as follows:
- Cleft lip surgery is performed within 12 months after birth. The doctor may stitch together the cleft lip and the cleft under the nose.
- Cleft palate surgery is performed when the patient is 18 months old or earlier. The surgeon will stitch together the crack in the soft or hard palate in the mouth.
In addition, additional surgery may be required to treat other symptoms, such as:
- Ear tube placement : This surgery may be done if you have a cleft palate. Your doctor may perform the surgery to drain fluid from your middle ear and reduce the risk of infection that can lead to hearing loss.
- Gum Cleft Repair Surgery Using Bone This surgery is usually performed when the patient is 8–12 years old and may help close the gum cleft and allow the teeth to erupt and align normally.
- Surgery to improve the appearance and function of the lip and palate. This type of surgery may be combined if cleft lip or palate surgery has not restored normal speech function.
- Jaw or lower jaw surgery. Yourdoctor may recommend this surgery for people with cleft lip and palate who have a deformed jaw or lower jaw.
Treatment requires a team of specialists from many fields, such as pediatricians, plastic surgeons, dentists, and speech therapists. The team will plan the patient’s care and provide advice on each surgical step systematically, as necessary and most appropriate for the patient.
Complications of cleft lip and palate
Cleft lip and palate can cause complications that may occur in areas of the body that are involved in the cleft lip or palate, including:
Eating problems
Patients with cleft lip and palate may have difficulty eating or breastfeeding due to the hole in the roof of their mouth or the inability to close their mouth completely , which can cause food and liquids to flow up their nose. However, there are now nipple designs or prosthetic palates for those with cleft lip and palate, which may allow them to suckle and eat like other children until it is time for surgery.
Speech problems
The mouth and palate are important parts of correct and clear pronunciation. Patients with cleft lip and palate who do not undergo surgery may have slurred speech, nasal voice, and difficulty listening. Surgery can correct this problem in some patients, but others may need to receive speech therapy to improve their speech and pronunciation.
Dental problems
Patients with cleft lip and palate are more likely to have tooth decay, teeth in the wrong place, overlapping teeth, and teeth that are not in a good shape. It is necessary to promote good oral hygiene and have regular checkups or treatment with a dentist, or may also need to have braces .
Ear infections and hearing problems
People with cleft lip and palate are at higher risk of middle ear infections or otitis media. If left untreated, hearing loss or disruption can occur . In some cases, hearing aids may be necessary. However, people with cleft lip and palate should have their hearing tested annually.
In addition, patients with cleft lip and palate may have emotional, behavioral, and social problems due to lack of confidence and stress from undergoing multiple surgeries. Parents should consult a psychiatrist for additional guidance on how to cope with the patient.
Cleft lip and palate prevention
Cleft lip and palate are conditions that occur in the womb, so there may not be any direct prevention. However, you may be able to reduce your risk of developing the condition in your next child by following these guidelines:
- Seek genetic counseling if you have a family history of cleft lip and palate. Consult your doctor and plan your pregnancyto check your risk of developing the disease.
- Eat nutrientsthat are beneficial for pregnancy, such as folic acid, iron, iodine, calcium, vitamin D, and vitamin C, so that pregnant mothers receive complete nutrients and vitamins. However, you should consult your doctor about the size and amount of nutrients that you should receive.
- Avoid smoking and drinking alcohol during pregnancy. Avoid being in places with cigarette smoke to reduce the risk of birth defects in the fetus.
