Children’s Health: Cleft Lip and Cleft Palate

Cleft Lip and Cleft Palate

Cleft lip and cleft palate are openings or splits in the upper lip, the roof of the mouth (palate) or both. Cleft lip and cleft palate result when facial structures that are developing in an unborn baby don’t close completely. They are among the most common birth defects and most commonly occur as isolated birth defects but are also associated with many inherited genetic conditions or syndromes.

 

Symptoms

Usually, a split (cleft) in the lip or palate is immediately identifiable at birth. Cleft lip and cleft palate may appear as:

  • A tiny notch in the upper lip, or up to a split that extends into the nose (cleft in the lip)
  • Small malformation that results in minimal problems, up to a large separation of the palate that interferes with eating, leaking into the nose, speaking with a nasal-sounding voice, and even breathing (cleft palate)

 

Less commonly, a cleft occurs only in the muscles of the soft palate (sub mucous cleft palate), which are at the back of the mouth and covered by the mouth’s lining. This type of cleft often goes unnoticed at birth and may not be diagnosed until later when signs develop. Signs and symptoms of sub mucous cleft palate may include:

  • Difficulty with feeding
  • Difficulty swallowing, with the potential for liquids or foods coming out of the nose
  • Nasal speaking voice 
  • Chronic ear infections

 

What Causes a Cleft Lip and Cleft Palate?

In most cases, the cause of cleft lip and cleft palate is unknown. These conditions cannot be prevented. Most scientists believe clefts are due to a combination of genetic and environmental factors. There appears to be a greater chance of clefting in a newborn if a sibling, parent, or relative has had the problem.

Another potential cause may be related to the medication a mother may have taken during her pregnancy. Some drugs may cause cleft lip and cleft palate. Among them include anti-seizure/anticonvulsant drugs, acne drugs containing Accutane, and methotrexate, a drug commonly used for treating cancer, arthritis, and psoriasis.

Cleft lip and cleft palate may also occur as a result of exposure to viruses or chemicals while the fetus is developing in the womb. In other situations, cleft lip and cleft palate may be part of another medical condition.

 

Several factors:

  • Family history- Parents with a family history of cleft lip or cleft palate face a higher risk of having a baby with a cleft.
  • Exposure to certain substances during pregnancy- Cleft lip and cleft palate may be more likely to occur in pregnant women who smoke cigarettes, drink alcohol or take certain medications.
  • Having diabetes- There is some evidence that women diagnosed with diabetes before pregnancy may have an increased risk of having a baby with a cleft lip with or without a cleft palate.
  • Being obese during pregnancy- There is some evidence that babies born to obese women may have increased risk of cleft lip and palate.

 

What Problems Are Associated With Cleft Lip and Cleft Palate?

  • Eating problems- With a separation or opening in the palate, food and liquids can pass from the mouth back through the nose. Fortunately, specially designed baby bottles and nipples that help keep fluids flowing downward toward the stomach are available. Children with a cleft palate may need to wear a man-made palate to help them eat properly and ensure that they are receiving adequate nutrition until surgical treatment is provided.
  • Ear infections/hearing loss- Children with cleft palate are at increased risk of ear infections since they are more prone to fluid build-up in the middle ear. If left untreated, ear infections can cause hearing loss. To prevent this from happening, children with cleft palate usually need special tubes placed in the eardrums to aid fluid drainage, and their hearing needs to be checked once a year.
  • Speech problems- Children with cleft lip or cleft palate may also have trouble speaking. These children’s voices don’t carry well, the voice may take on a nasal sound, and the speech may be difficult to understand. Not all children have these problems and surgery may fix these problems entirely for some. For others, a special doctor, called speech pathologist, will work with the child to resolve speech difficulties.
  • Dental Problems- Children with clefts are more prone to a larger than average number of cavities and often have missing, extra, malformed, or displaced teeth requiring dental and orthodontic treatments. In addition, children with cleft palate often have an alveolar ridge defect. The alveolus is the bony upper gum that contains teeth. A defect in the alveolus can displace, tip, or rotate permanent teeth, prevent permanent teeth from appearing, and prevent the alveolar ridge from forming. These problems can usually be repaired through oral surgery.

 

How Are Cleft Lip and Cleft Palate Diagnosed?

Because clefting causes very obvious physical changes, a cleft lip or cleft palate is easy to diagnose. Prenatal ultrasound can sometimes determine if a cleft exists in an unborn child. If the clefting has not been detected in an ultrasound prior to the baby’s birth, a physical exam of the mouth, nose, and palate confirms the presence of cleft lip or cleft palate after a child’s birth. Sometimes diagnostic testing may be conducted to determine or rule out the presence of other abnormalities.

 

Prevention

After a baby is born with a cleft, parents are understandably concerned about the possibility of having another child with the same condition. While many cases of cleft lip and cleft palate can’t be prevented, consider these steps to increase your understanding or lower your risk:

  • Consider genetic counseling- If you have a family history of cleft lip and cleft palate, tell your doctor before you become pregnant. Your doctor may refer you to a genetic counselor who can help determine your risk of having children with cleft lip and cleft palate.
  • Take prenatal vitamins- If you’re planning to get pregnant soon, ask your doctor to advice you on which prenatal vitamins to take.
  • Don’t use tobacco or alcohol- Use of alcohol or tobacco during pregnancy increases the risk of having a baby with a birth defect.

 

Cleft lip and cleft palate treatment

The treatment for cleft lip and cleft palate depends on a few key factors. These include the type of cleft and your baby’s overall health. Clefts can cause problems with a child’s development. So, treatment is recommended to start as early as possible.

Most babies who have a cleft lip, cleft palate, or both will need some type of surgical procedure. Surgery to repair a cleft lip is usually done before the baby is 1 year old. A cleft palate is usually repaired before the baby is 18 months old. Some children will need more surgeries as they grow.

Clefts can create other health issues, such as speech and dental problems. You should work with your doctor to form a team of experts to treat your baby. The group will contain doctors and nurses from many related areas. It could include:

  • Plastic surgeon to evaluate and perform necessary surgeries on the lip and/or palate
  • An otolaryngologist (an ear, nose, and throat doctor) to evaluate hearing problems and consider treatment options for hearing problems
  • An Oral and maxillofacial surgeon to reposition segments of the upper jaw when needed, to improve function, appearance and to repair the cleft of the gum
  • An orthodontist to straighten and reposition teeth
  • A dentist to perform routine dental care
  • A prosthodontist to make artificial teeth and dental appliances to improve the appearance and to meet functional requirements for eating and speaking
  • A speech pathologist to assess speech and feeding problems
  • A speech therapist to work with the child to improve speech
  • An audiologist (a specialist in communication disorders stemming from a hearing impairment); to assess and monitor hearing
  • A nurse coordinator to provide ongoing supervision of the child’s health
  • A social worker/psychologist to support the family and assess any adjustment problems
  • A geneticist to help parents and adult patients understand the chances of having more children with these conditions

 

The health care team work together to provide a good plan of care to meet the individual needs of each patient. Treatment usually begins in infancy and often continues through early adulthood.

Treatment involves surgery to repair the defect and therapies to improve any related or underlying conditions.

 

 

 

 

 

 

 

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