Cleft Lip and Cleft Palate

Facial Development
A babys head forms early during pregnancy. To make the face, body tissue and special cells from each side of the head
grow toward the center of the face and join together. This joining of tissue forms the facial features, like the lips and
mouth. An abnormal development or improper joining of the tissue in the lips or mouth causes to become a baby having
cleft lip and cleft palate. They are type of birth defect.

What is cleft lip & cleft palate?

Cleft lip and cleft palate are birth defects that occur when a babys lip or mouth do not form properly during pregnancy.
Together, these birth defects commonly called orofacial clefts. These birth defects happen early during pregnancy. This
occurs during the 4th and 6th week of gestation. A cleft happens when parts of the lip and mouth do not completely fuse
together. The condition varies from a small notch in the red part of the lip to a wide gap in the lip and gum line extending
into the nostril of the nose. A cleft lip may occur on the left side, the right side, or both sides.

What is the difference between cleft lip & cleft palate?

A cleft lip is a physical split or separation of the two sides of the upper lip and appears as a narrow opening or gap in
the skin of the upper lip. This separation often extends beyond the base of the nose and includes the bones of the upper
jaw and/or upper gum.
A cleft palate is a split or opening in the roof of the mouth. A cleft palate can involve the hard palate (the bony front
portion of the roof of the mouth), and/or the soft palate (the soft back portion of the roof of the mouth).
Cleft lip and cleft palate can occur on one or both sides of the mouth. Because the lip and the palate develop separately,
it is possible to have a cleft lip without a cleft palate, a cleft palate without a cleft lip, or both together.

A cleft can be on one side of the mouth (unilateral clefting) or on both sides of the mouth (bilateral clefting).
Most clefts fit into one of three categories:
1. cleft lip by itself
most common in boys
2. cleft palate by itself
most common in girls
3. cleft lip and cleft palate together more common in boys

An illustration below of a baby with normal lips, a baby having a cleft lip, cleft palate and a baby with both cleft
lip and cleft palate.

A baby with a cleft lip

A baby with a cleft palate

A baby with a cleft lip and cleft palate

Causes of cleft lip and cleft palate

Doctors don't always know why a baby develops cleft lip or cleft palate, but many clefts are thought to be a combination
of genetic(inherited) and environmental factors (like certain medications or vitamin deficiencies). Both mothers and
fathers can pass on a gene or genes that cause cleft palate or cleft lip. Clefts happen more often in children of Asian,
Latinos, or Native American descent.
Taking certain medicines (such as some anti-seizure medications) during pregnancy can increase a woman's chances of
having a baby with a cleft lip or palate. Similarly, moms who don't get the right amount of prenatal nutrients (for example,
not enough folic acid) may increase their baby's risk of having a cleft. A mother's exposure to certain chemicals also may
cause a cleft.
Women who smoke cigarettes, use drugs, or drink alcohol duringpregnancy also increase their baby's risk for birth
defects. Research) has shown that moms who binge drink (drinking four or more drinksin a short period of time)
during the first weeks of pregnancy have a higher risk of having a baby with a facial birth defect like a cleft lip or cleft
palate.

Related Health Problems

As you might imagine, cleft lip and cleft palate can affect many actions of the mouth and face. Children born with cleft lip
or cleft palate might have issues related to their feeding, hearing, teeth, and speech.
1. Feeding Problems
Babies with just a cleft lip don't usually have feeding problems. But when the palate is involved, feeding can be a bigger
challenge.
Normally, the palate prevents food and liquids from entering the nose. A cleft palate causes babies to swallow a lot of air
and regurgitate food into the nose. It also makes it harder for babies to latch on and suck during breastfeeding or bottle
feeding. As a result, a baby with a cleft palate may need a special nipple and bottle to receive pumped breast milk or
formula. Breastfeeding moms might want to talk with a lactation consultant, who can offer more guidance and
suggestions.
Babies with feeding issues should be seen regularly by a doctor to make sure that they're gaining weight well.
2. Middle Ear Fluid Buildup and Hearing Loss
Many children with cleft palate are at risk for fluid buildup in the middle ear. This fluid can't pass through the Eustachian
(yoo-STAY-shun) tube as it should, which can lead to ear infections and even hearing loss. So kids with cleft palate
usually need ear tubes placed in their eardrums to help drain the fluid and improve hearing.
Kids with cleft palate should have their ears and hearing checked once or twice a year, or more if they are having hearing
problems.
3. Dental Problems
Children with a cleft lip and palate often have dental problems. These can include small teeth, missing teeth, extra teeth
(called supernumerary), or teeth that are out of position. They may have a defect in the gums or alveolar ridge (the bone
that supports the teeth). Ridge defects can displace, tip, or rotate permanent teeth or prevent permanent teeth from coming
in properly.
Regular visits with a pediatric dentist who specializes in cleft lip and palate are important. The dentist will check a child's
mouth growth and development, identify any problems, and make treatments when needed.
4. Speech Problems
Kids with cleft lip have fewer speech problems than those with cleft palate. About 1 in 5 kids with cleft palate have speech
problems after surgical repair. Most often, this means that a child's voice is hyper nasal (sounding like the child is talking
through the nose). This happens because the palate doesn't move well enough to prevent air from leaking out of the nose.
Children with clefts also can have other types of speech problems that aren't to the cleft; for example, age-related errors
such as saying "wed" instead of "red." Sometimes, the dental problems associated with the cleft will distort some sounds,
particularly "s," "sh," "ch," and "j."

A speech-language pathologist can check a child's speech and language skills and recommend treatment if needed.
5. Psychosocial/Socialization
Most children who have their clefts repaired early enough are able to have a happy youth and social life. Having a cleft
palate/lip does not inevitably lead to a psychosocial problem. However, adolescents with cleft palate/lip are at an elevated
risk for developing psychosocial problems especially those relating to self-concept, peer relationships and appearance.
Adolescents may face psychosocial challenges but can find professional help if problems arise. A cleft palate/lip may
impact an individuals self-esteem, social skills and behavior.

Diagnosis
Traditionally, the diagnosis is made at the time of birth by physical examination. Recent advances in prenatal
diagnosis have allowed obstetricians to diagnose facial clefts in utero.
Clefts can also affect other parts of the face, such as the eyes, ears, nose, cheeks, and forehead. In 1976, Paul
Tessier described fifteen lines of cleft. Most of these craniofacial clefts are even rarer and are frequently described as
Tessier clefts using the numerical locator devised by Tessier.

Treatment
Cleft lip and palate is very treatable; however, the kind of treatment depends on the type and severity of the cleft.
Most children with a form of clefting are monitored by a cleft palate team or craniofacial team through young
adulthood. Care can be lifelong. Treatment procedures can vary between craniofacial teams. For example, some teams
wait on jaw correction until the child is aged 10 to 12 (argument: growth is less influential as deciduous teeth are replaced
by permanent teeth, thus saving the child from repeated corrective surgeries), while other teams correct the jaw earlier
(argument: less speech therapy is needed than at a later age when speech therapy becomes harder). Within teams,
treatment can differ between individual cases depending on the type and severity of the cleft.

Treatment Team
If your child has a cleft lip and/or palate, your pediatrician will talk to you about a cleft lip and palate treatment team. This
team of healthcare professionals will work together to meet your family's needsand, ultimately, help your child transition
to adult care.
Besides the pediatrician, your child's treatment team may include:
plastic surgeon
ear, nose, and throat physician (otolaryngologist)
oral surgeon
orthodontist
dentist
speech-language pathologist
audiologist
nurse
social worker / care giver
psychologist or therapist
geneticist
team coordinator
Your child might visit this care team a few times a year, dependingon his or her needs. Who is seen during a visit depends
on the careteam's structure and your child's needs. The team coordinator willhelp organize the visits, and the team should
communicate withyour doctor about the treatment plan.
Surgical Treatment
A cleft lip is usually surgically repaired in the hospital using general anesthesia when a child is 3 to 6 months old. If the
cleft lip is wide, special procedures like lip adhesion or a molding plate device might help bring the parts of the lip closer
together before the lip is fully repaired. Cleft lip repair usually leaves a small scar on the lip under the nose. At 9-12

months of age, a cleft palate usually can be repaired. Plastic surgeons connect the muscles of the soft palate and rearrange
the tissues to close the cleft. This surgery requires general anesthesia and a short hospital stay for recovery.
The goal of surgery is to create a palate that works well for speech. Some kids, however, will continue to sound nasal after
cleft palate repair, and some may develop a nasal voice later on.
More surgeries may be needed as children grow older and their facial structure changes - this can include surgeries like
pharyngoplasty, which helps improve speech, or alveolar bone grafts, which help provide stability for permanent teeth. A
bone graft closes gaps in the bone or gums near the front teeth and is usually done when kids are between 6 and 10 years
old.
As children become teens, they will likely want to (and should) be more involved in their care. They may want to have
their scars made less noticeable, improve the appearance of their nose and upper lip, or improve their bite with
orthognathic surgery. These operations may improve speech and breathing, overbites/under bites, and appearance.
.
Dental and Orthodontic Treatment
Maintaining healthy teeth and preventing cavities is very important for kids with cleft lip and palate, who can have more
dental problems than other kids. They should see a dentist regularly and brush and floss every day.
Kids with cleft lip and palate may begin orthodontic treatment as early as 6 years of age. It may start with palatal
expansion, a process that makes the width of the palate normal. Later, it may involve braces to position the teeth. Your
orthodontist will discuss these issues with you.
Some kids with a cleft might be missing a permanent tooth, which can be replaced with a removable appliance or, in early
adulthood, a dental implant.

Speech Therapy
Some kids will need speech therapy after a repair is done. The speech-language pathologist will closely monitor your
child's progress and talk with you about whether therapy is needed.

Dealing With Emotional and Social Issues

It can be hard when kids miss school for frequent doctor's appointments, or when speech problems prevent them from
communicating well with their peers. In spite of these and other social, psychological, and educational challenges, kids
with clefts just want to be treated like everyone else.
Children may face teasing and bullying because of how a cleft lip and palate look. If your child is teased, talk about it and
be a patient listener. Try to give your child tools to confront teasers. Find out what your child would like to say to them
and practice it together.
Some kids struggle growing up with a cleft lip or cleft palate and might need help handling certain situations. The
psychologists and social workers on the treatment team can help guide you through these difficult times, so turn to them if
your child needs added support. The good news is that most kids with cleft lip or cleft palate grow up to be healthy, happy
adults.
As your child nears the teen years, remember that your interactions may change. You could be his or her greatest
confidante, or your child may not share his or her worries with you. Either way, stay open to communication and support
your child with these tips:

Encourage your child to be confident and not allow the cleft to define who he or she is.
Make your home a warm, supportive, and accepting place where individual worth and accomplishments are
celebrated.
Encourage your child's friendships and relationships. Make friends with people who are different from you and
lead by example.
As for all kids, being involved in sports, music, and other activities will go a long way toward helping kids with
clefts realize their self-worth.

Give your child the freedom to make decisions and take appropriate risks. Having chances to make decisions
early on like picking out which clothes to wear or foods to eat gives kids the confidence and skills to make
bigger decisions later. It will help them become more independent.
If your child especially a young child wants to talk to the class about cleft lip and palate, set up something
with the teacher. Consider asking someone from the treatment team to attend. But remember that your child may
need an extra boost of confidence to get up in front of the class, so give lots of encouragement.

Prevention tips and advice

In some cases there is not much, if anything, you can do to prevent your child from developing this condition. If you have
already had a child who has cleft lip and palate, then the chances of any other children you conceive having the condition
increase. Nonetheless, there are still steps you can take to help prevent the condition from developing:
Folic acid supplements - A shortage of folic acid in the body has been linked to children who develop cleft lip and palate.
Though the evidence to support this thesis is not all that strong, it is none the less advised that you take a folic acid
supplement during the first two months of pregnancy. This is the period during which the roof of the babys mouth and the
lips develop in the womb. You should ask your physician for advice on the level of folic acid supplements you should be
taking.
Medication - There are several drugs and medications that have been linked to the development of cleft lip and palate. If
you are currently taking medication and are thinking about having a baby then you should discuss this with your doctor. If
medication is not of utmost importance then you can choose to stop taking it during the period of pregnancy. Medication
that has been linked to the development of cleft lip and palate include:
Benzodiazepine is a medication that is prescribed to patients suffering from anxiety and insomnia. You should discuss
any other methods you can choose to undertake during pregnancy in order to stop using this medication.
Anticonvulsant is a medication that is prescribed to those suffering from epilepsy. It is also prescribed to other conditions
that cause seizures. You should discuss the use of this medication with your doctor if you are planning on having children.
Corticosteroid is a medication that can have a negative affect during the early stages of pregnancy, during which the roof
of the babys mouth and the lips develop. This form of medication is prescribed to patients who it is believed may have a
premature baby. You will therefore need to consider the positives and negatives of using such medication.
If you are unsure about what medication will have an adverse affect upon your child then you can discuss such matters
with your doctor. They will be able to advise you on the side-effects of any medication you are taking and whether or not
you would be safe to stop using them during pregnancy.

Healthy living
Though it may seem an obvious thing to say, living a healthy life style before and during pregnancy can make a real
difference to whether or not your child develops symptoms of cleft lip and palate. You must consider what dangerous
habits you have and then make the necessary changes. Below are some tips on behavioural activities you should and
should not partake in:
Alcohol consumption - Women are recommended an allowance of fourteen units per week, but when pregnant this is
shortened to below ten units per month. Going above this limit has been found to quadruple the chances of your child
developing cleft lip and palate.
Smoking - Smoking is never a healthy habit and this is the case even more so when you are pregnant. You could even use
the period of pregnancy to give up the habit all together. A doctor would be able to offer advice on the necessary steps to
take to quit smoking.
Eat and live healthy - Generally there is nothing better than living a healthy lifestyle. Get enough exercise each week,
but also take into account how far you are into your pregnancy as to how much exercise you should be doing. Also, eat
healthy and try to get in those five-a-day of fruit and vegetables. It really can make a difference to the health of your child.

Magnitude of the cleft lip and palate problem in the world

A cleft lip or cleft palate is more common in developing countries than in developed countries. Cleft lip and palate occurs
in about 1 to 2 per 1000 births in the developed world.
a) Highest in Asian populations
b) Intermediate in Caucasian populations
c) Lowest in African populations

Successful cleft surgery