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WHAT IS CLEFT LIP AND PALATE?

Cleft means split or separation. A cleft lip is an opening in the upper lip that can affect one or both sides of the lip; a cleft palate is an opening in the roof of the mouth.

 

This part of the face develops in the womb at about six weeks into a pregnancy, and failure of the different parts of the face to fuse together creates the cleft. The cleft may be tiny, creating a small dent in the lip line or big, causing a complete separation extending into the nose and through the gums and soft palate.

 

A baby can have a cleft lip and a normal palate, a cleft palate and a normal lip, or both cleft lip and palate.

 

The majority of children with a cleft are normal in every other aspect of their anatomy, intelligence and abilities.

 

Causes of cleft lip and palate

 

If a developing baby's lip or palates fail to fuse in the uterus, a cleft will form. There are three reasons why this happens:

 

Congenital deformity: although clefts can appear in families with no previous history of the problem, there is almost certainly a genetic element. If a parent has had a cleft, the chances of the child having one are much higher. Similarly, if one child has a cleft, another child born to the same parents has a much higher chance of being affected than a child in the general population.

 

Maternal drugs: certain drugs taken in early pregnancy may affect a baby's development and lead to a cleft lip and/or palate.

 

Syndromes: in some cases, a cleft lip and palate may be associated with a syndrome. A syndrome is a known collection of physical abnormalities that occur together.

 

Diagnosing the conditions

 

If there is a family history of cleft lip or palate, a high resolution ultrasound scan may pick up some clefts but, if there is a small, unsuspected cleft lip, it may not be identified.

 

Cleft palate may be seen in the womb using ultrasound scanning. Spotting it depends upon the size of the cleft and the level of suspicion

 

Part of the examination before a baby is discharged from hospital is to place a finger into her mouth to check that the palate is intact A cleft lip will be obvious at birth.

 

Shortly after the birth, a doctor will press his finger against the roof of your baby's mouth to check for signs of a cleft palate. Damage to the palate will be corrected by surgery.

 

Cleft lip and palate are corrected by surgery. The amount of surgery required will depend on the severity of the cleft. If a child has a severe cleft through the lip and the hard and soft palate, he will need three operations:

1.   Cleft lip repair: this is done very early on, sometimes within the first few days of birth

and certainly within the first three months. The baby will be under a general anaesthetic and the operation takes about one-and-half hours. 

2.   Soft palate repair: the soft palate is repaired when the baby is older, usually at around the age of six months. 

3.  Hard palate: this area involves the teeth so surgeons will usually wait until the permanent teeth are through and then perform a bone graft at between 10 and 12 years. 

4.  Further surgery: sometimes a child will need a touch-up operation to improve the appearance of scars. As a teenager, he may need nasal surgery to improve his breathing and also his appearance. As he grows, his jaw may need to be aligned, and he may need final lip and nose surgery once his face has reached maturity at 17 to 21 years.

 

Complication

 

Feeding: if there is a large cleft palate, a baby will have problems forming a seal around a breast or bottle and won't be able to suck properly. The baby may be a very slow feeder and may be upset by milk coming out through his nose. There are special bottles and teats designed for babies with cleft palates.

 

Hearing and ear infections: hearing loss is frequently associated with children with cleft palate; it is essential, that all children with cleft palate have full hearing tests. There is a high incidence of middle-ear infection and glue ear, which can reduce hearing. This is because the eustachian tube, which maintains an air-filled middle ear, lies just above the soft palate and may be affected by the cleft. A grommet can 'be inserted to correct the condition.

Dental problems: if the cleft palate involves the gum line, a child's teeth may be absent or crooked. Once the permanent teeth arrive, the child may need a brace. As he grows, an operation, called an alveolar bone graft, may be needed to put some extra bone into the gum.

 

Speech: all children with this condition will have had their palates and lips repaired by the time they start to talk. They can have problems with pronouncing some sounds, giving their speech a nasal tone. This can usually be treated with speech therapy. In about 20 per cent of cases a child needs an extra operation to reduce the amount of air going into the nose.

 

Disfigurement: the skills of surgeons nowadays make this a much less likely outcome than even 20 years ago.

 

Informing your child's carers

 

If your child has a cleft lip or palate inform his carers and teachers so that they can look out for potential problems that could affect his progress.

 

It is important for carers to be aware of; and understand, the condition. A child who looks different is often treated differently, and presumed to be less able than his peers. This can affect self-esteem and confidence if it is not nipped in the bud at every opportunity

 

A child may be reluctant to speak and find it difficult to make friends. He may also be absent from school to have surgery. If teachers are aware of this, they can ensure the child does not lose touch with schoolwork, and make the child's peers more understanding of his condition.

 

For  More  Information:  Please  consult  your  physician  on  your  next  visit.