Cleft Lip and Cleft Palate

INTRODUCTION

Cleft Lip and Cleft Palate are common congenital malformations (birth defects), also known as oral clefts or orofacial clefts. Birth defects are health conditions that are present at birth and they change the shape or function of one or more body parts. During the development of lip and palate in early pregnancy period, incomplete fusion of upper lip and palate leads to the formation of cleft lip and palate in a child.

A child can have a cleft lip, a cleft palate or both because development of lips and palate occur at different times during gestation. Children with these birth defects have difficulty in feeding and talking. They are also prone to ear infections, hearing loss, and dental problems.

Cleft lip and cleft palate are common birth defects and happen very early in the pregnancy. Asian population have highest frequency, often 1 in 500 or higher. Cleft lip with or without cleft palate is more common in males than in females. Isolated cleft palate is more common in females whereas males have more severe defects.

Cleft lip is an opening in the upper lip due to incomplete formation of the upper lip before birth. It may be unilateral or bilateral (on both sides of lip).

Cleft palate is an opening of the hard palate or soft palate (roof of the mouth) due to its incomplete fusion. It may also be unilateral or bilateral.

REFERENCES

https://medlineplus.gov/cleftlipandpalate.html

https://www.cdc.gov/ncbddd/birthdefects/cleftlip.html

https://www.nhs.uk/conditions/cleft-lip-and-palate/

SYMPTOMS 

Cleft lip and Cleft palate can be easily identified at birth as these may appear as:

• An opening in the upper lip and roof of the mouth (palate) that may be unilateral or bilateral.
• Only a small notch in the upper lip or extended from the upper lip through palate into the bottom of the nose.
• An opening in the palate (roof of the mouth) that doesn't affect facial appearance.

Children with the cleft lip and palate deformities face several problems such as:

• Difficulty in feeding: new born child is not able to breast feed properly due to child’s inability to suck efficiently. Nipples for bottle feeding present the same problem.
• Difficulty in swallowing, as liquids or foods come out the nose.
• Nasal speaking voice and various speech problems.
• These children are more prone to chronic ear infections and fluid accumulation in the middle ear.
• May have malformed and missing teeth.

Certain other birth defects that may be associated with cleft lip and palate are - Common cardiac defects, Pyloric stenosis (narrowing of stomach as it connects to the small intestine), Club foot, and Scoliosis.

REFERENCES

https://medlineplus.gov/cleftlipandpalate.html

https://www.cdc.gov/ncbddd/birthdefects/cleftlip.html

https://www.nhs.uk/conditions/cleft-lip-and-palate/

CAUSES

Definite aetiology of cleft lip and palate is still unknown but heredity is the most important factor. Environmental factors also play an important role.

• Heredity: If there is a family history of cleft lip and cleft palate there are more chances of a baby having these birth defects. 
• Smoking or drinking alcohol during pregnancy increases the risk of having a baby with cleft lip and palate.
• Nutritional disturbances may also have a role in causing these birth defects.
• Strean and Peer reported that physiologic, emotional, or traumatic stress may play an important role in development of human clefts.  
• Epilepsy and anti-seizure medicines during the first trimester of pregnancy, may cause cleft lip (with or without cleft palate) or isolated cleft palate.

Other possible causes of CLP are:

• Defective blood supply to the area involved
• Infections
• Alcohol, certain drugs, and toxins
• Lack of inherent developmental forces

REFERENCES

https://medlineplus.gov/cleftlipandpalate.html

https://www.cdc.gov/ncbddd/birthdefects/cleftlip.html

https://www.nhs.uk/conditions/cleft-lip-and-palate/

DIAGNOSIS

Most of the children are diagnosed with cleft lip or cleft palate after birth. The diagnosis of cleft lip at birth is obvious whereas to rule out cleft palate, direct illuminated examination of the infant's hard and soft palate is done. Palpation of hard and soft palate is also done to ensure that a partial cleft is not missed. Prenatal ultrasound may demonstrate deformities like cleft lip and palate.

REFERENCES

https://medlineplus.gov/cleftlipandpalate.html

https://www.cdc.gov/ncbddd/birthdefects/cleftlip.html

https://www.nhs.uk/conditions/cleft-lip-and-palate/

PREVENTION

Following measures can be taken to reduce the risk factors of birth defects:

• Get early and regular prenatal care
• Take proper nutrition
• Quit smoking and drinking alcohol
• Maintain healthy weight
• Get medical consultation before taking any medications during pregnancy
• Get vaccinated to protect yourself from infections

REFERENCES

https://medlineplus.gov/cleftlipandpalate.html

https://www.cdc.gov/ncbddd/birthdefects/cleftlip.html

https://www.nhs.uk/conditions/cleft-lip-and-palate/

TREATMENT

Treatment of cleft lip and palate is mostly surgical. Cleft lip surgery is usually done before 12 months of age, and cleft palate surgery is done before 18 months. Surgeries help in improving the facial appearance of the child along with eating, breathing and speech improvement. Children may need several years of multiple surgeries for a satisfactory outcome. Dental and orthodontic care (braces), speech therapist, hearing specialist, plastic surgeon, ENT specialist, oral surgeon, prosthodontist, psychologist, and a nurse coordinator need to work as a team along with parents’ cooperation for the successful treatment of a child with CLP. Most children with clefts lead a healthy life post treatment.

REFERENCES

https://medlineplus.gov/cleftlipandpalate.html

https://www.cdc.gov/ncbddd/birthdefects/cleftlip.html

https://www.nhs.uk/conditions/cleft-lip-and-palate/