Being born with a cleft lip and/or palate (roof of the mouth) is a common birth defect. During the first three months of fetal development, the palate and lips have a cleft (or separation) and develop separately. During normal development, the cleft closes and and the lips and mouth properly develop. The fusion of the two halves leaves horizontal lines on the upper lip that remain with the fetus throughout adulthood. Failure of the clefts to close results in cleft lip and is called a “craniofacial anomaly.”
There are varying degrees of malformation leading to cleft lip, cleft palate, or a combination of both. Within each of the disorders, there can also be varying degrees of severity ranging from mild notches in the lip or palate to a severe split through the mouth into the nose.
Risk Factors for Cleft Lip
Little is understood about why cleft lip and cleft palate occur and further research is currently being conducted. Most medical professionals lean toward the following three main rationales for cleft lip to occur.
- inheritance – genetics from one or both parents
- environment – viruses, drugs (antiseizure medications, cocaine, alcohol, smoking)
- poor prenatal health (vitamin B and folate deficiencies).
- genetic syndromes – more than 400 syndromes have cleft palate and lip as an associated deformity including Pierre Robin and Down syndrome
Because the cause often cannot be pinpointed, and 30 percent of all cases are related to a genetic syndrome, genetic counseling is usually advised. Some parents have a tendency to blame themselves but should know that there are no clear indications as to why this deformity occurs and the prior three reasons role in the development of cleft lip and cleft palate are not fully understood.
Types of Cleft Lip and Cleft Palate
In about 50 percent of cases, the main type of clefting involves both the palate and the lip. Combined cleft lip and palate occurs more commonly in males, while females more commonly have isolated cleft palate. Why some infants have combined versus single or isolated clefting is not fully understood.
How Is Cleft Lip Diagnosed?
Cleft lip or palate can be diagnosed visually during the baby's first ultrasound (around the 20th week of pregnancy), as the fusion of the palates and upper lips should have been completed by this time. Aside from ultrasound, visual inspection of the oral cavity can be used to diagnose this deformity. Other testing would only be necessary to determine if there were any other serious health conditions.
Possible Complications of Cleft Lip
Complications associated with cleft lip and palate are:
- difficulty feeding
- hearing loss
- frequent ear infections
- speech difficulties
- dental problems
In order to help overcome the complications that can arise with cleft lip and cleft lip palate, a team of various medical professionals will be helpful. In choosing a medical team to assist in the management of your child's health, consider the following:
- pediatrician
- pediatric dentist/orthodontist
- otolaryngologist
- plastic surgeon
- speech-language pathologist
- audiologist
- nutritionist
- geneticist
- social worker
How Is Cleft Palate Treated?
Within 6 to 12 weeks of birth, the cleft lip and cleft palate repair can begin. Surgical procedures will be important especially in the cases of problems with feeding. Several surgeries are often necessary and the extent of the surgeries will depend on the severity of the oral or nasal deformities. Follow-up will be an important part of the treatment process and outreach with other specialists will be necessary to overcome speech, feeding, and hearing problems.
Despite sometimes multiple challenging surgeries, cleft lip and cleft palate can be cured.
Sources:
American Academy of Otolaryngology – Head and Neck Surgery. Fact Sheet: Cleft Lip and Cleft Palate. Accessed: August 14, 2009 from http://www.entnet.org/HealthInformation/cleftLipPalate.cfm
Cleft Palate Foundation. For the Parents of Newborn Babies with Cleft Lip/Cleft Palate. Accessed: August 14, 2009 from http://www.cleftline.org/publications/newborn
March of Dimes Foundation. Cleft Lip and Cleft Palate. Accessed: August 14, 2009 from http://search.marchofdimes.com/cgi-bin/MsmGo.exe?grab_id=6&page_id=852480&query=cleft&hiword=CLEFTS+cleft
Medline Plus. Cleft Lip and Palate. Accessed: August 14, 2009 from http://www.nlm.nih.gov/medlineplus/ency/article/001051.htm
