Cleft Lip and Cleft Palate Problem

Cleft lip and cleft palate are clefts or separations that occur in the upper lip and mouth while a fetus is developing in the womb. Cleft lip and cleft palate treatment requires surgery and may require speech therapy and dental treatment.

What is Cleft Lip and Cleft Palate?

Cleft lip and cleft palate are openings in a baby's upper lip or roof of the mouth (palate). It occurs as a result of congenital abnormalities (birth defects) that occur while a fetus is developing in the womb. Cleft lips and cleft palates occur when the tissues of the upper lip and roof of the mouth do not come together properly during fetal development. Surgery is required to repair a cleft lip and palate.

What is a Cleft Lip?

Our lips form between four and seven weeks of pregnancy. The tissues on both sides of our head unite in the middle of the face to form our lips and mouth. A cleft lip occurs when the tissues that make up the lips do not fully unite. As a result, an opening or gap occurs between the two edges of the upper lip. The cleft can range from a small indentation to a large gap that reaches the nose. This separation can occur on the gums or the palate (roof of the mouth).

What is a Cleft Palate?

The roof of your mouth (palate) forms between six and nine weeks of pregnancy. A cleft palate is a cleft or opening in the roof of your mouth that forms during fetal development. A cleft palate can occur in the hard palate (the bony front of the roof of the mouth) or the soft palate (the soft back of the roof of the mouth).

Cleft lip and cleft palate can occur on one or both sides of the mouth. Since the lip and palate develop separately, problems such as the following may be encountered;

• Cleft lip without cleft palate.
• Cleft palate without cleft lip.
• Both cleft lip and cleft palate (the most common disorder).

How does a cleft lip or cleft palate affect babies?

Babies born with a cleft lip or cleft palate may have difficulty eating (from both the breast and bottle). They may also have difficulty speaking and often have fluid behind their eardrums that can affect hearing. Depending on the case, some may also develop problems with their teeth.

What Causes Cleft Lip and Cleft Palate?

In most cases, there is no cause for a cleft lip or cleft palate, and parents cannot prevent it. Most scientists believe clefts are caused by a combination of genetic (inherited) and environmental factors. If a sibling, parent, or other relative has a cleft, the newborn may be more likely to have a cleft.

Another cause of cleft lip or cleft palate may be related to medications the giving birth parent took during pregnancy. This includes anti-seizure medications, acne treatment medications, or medications commonly used to treat cancer, arthritis, and psoriasis.

In addition, cleft mouth and palate may occur due to the following reasons;

• Vitamin deficiency (folic acid)
• Obesity
• Smoking or tobacco use during pregnancy
• substance abuse
• Birth disorders such as DiGeorge syndrome or Pierre Robin syndrome

Cleft lip and cleft palate can also occur due to exposure to viruses or chemicals while the fetus is developing in the womb.

How to Treat Cleft Lip and Palate?

Because of the number of oral health and medical problems associated with cleft lip or cleft palate, physicians who specialize in different fields work together. Treatment usually begins in infancy and often continues into early adulthood. In the treatment of cleft lip and palate;

• The cleft surgeon will evaluate and perform any necessary surgeries on the lip or palate.
• An orthodontist performs the necessary procedures to straighten and reposition the teeth.
• Works with a dentist or pediatric dentist to perform routine dental care.
• If necessary, work with a prosthodontist to make teeth and other equipment to complete missing teeth.
• If necessary, an otolaryngologist is consulted (head and neck surgeon).
• Oral, facial and maxillofacial surgeon is involved in the operation process.
• An audiologist (hearing disorders specialist) is required to check and monitor the presence of hearing impairment.
• The social worker/psychologist may be involved to support the family and note adjustment problems.

Treatment for a cleft lip and palate depends on the size of the cleft, the child's age, and other special needs or health conditions. The surgery is performed under anesthesia in a hospital.

Cleft Lip Treatment

Cleft lip treatment may require one or two surgeries. The first surgery is usually done when the baby is 3 to 6 months old, and the cleft in the baby's lip is closed with the surgery. If necessary, the second surgery is usually done when the child is 6 months old.

When used properly before surgery, various techniques can improve the results of cleft lip and palate repairs. They are noninvasive, meaning they do not require surgery, and significantly change the shape of a baby's lip, nose, and mouth. These noninvasive methods are as follows;

• Lip taping method: it can narrow the gap in the child's cleft lip.
• A nasal-alveolar molding (NAM) device may be used to assist in repositioning the lip tissues in preparation for lip repair.

Cleft Palate Treatment

Cleft palate treatment at 12 months creates a properly functioning palate and reduces the likelihood of middle ear fluid buildup. Children with cleft palate often need special tubes placed in their eardrums to help prevent fluid buildup in the middle ear and help with fluid drainage. Children using these special tubes should have a hearing check once a year.

Up to 40% of children with cleft palate need further surgery to improve their speech. Speech pathologist assesses speech level in children between 4 and 5 years of age. If surgery is needed to improve speech, this surgery is usually done around age 5.

Children with a cleft in the gum line may also need a bone graft to fill the upper gum line between the ages of 6 and 10, so it can support the permanent teeth and stabilize the upper jaw. When the permanent teeth grow, they will need braces to straighten the teeth and a palatal expander to widen the palate. In some cases, the following treatments have to be performed additionally;

• Improving the appearance of the lips and nose
• Performing the operations required to close the openings between the mouth and nose
• Performing operations to assist breathing
• Fixation and correction of the chin by the maxillofacial surgeon

Possible risks of surgery include bleeding, infection, and damage to nerves, tissues, or other structures. Surgery is usually successful and the risks are low. Cleft lip surgery leaves a small pink scar that becomes less noticeable as the child grows.