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Cleft Lip And Cleft Palate

Cleft lip and cleft palate-an opening in the lip or palate - may occur separately or in combination. These deformities originate in the 2nd month of pregnancy, when the front and sides of the face and the palatine shelves fuse imperfectly. Cleft deformities usually occur unilaterally or bilaterally, rarely midline. Only the lip may be involved, or the defect may extend into the upper jaw or nasal cavity.

Cleft lip and cleft palate occur in twice as many males as females; isolated cleft palate is more common in females.

Causes

The causes of cleft lip/palate are not well understood. Studies suggest that a number of genes, as well as environmental factors, such as drugs (including several different anti seizure drugs), infections, maternal illnesses, maternal smoking and alcohol use and, possibly, deficiency of the B vitamin folic acid may be involved.

Cleft lip/palate may occur alone or with other abnormalities that may be hidden or obvious. Up to 13 percent of babies with cleft lip/palate have other birth defects. Some cases involve genetic syndromes which may pose specific problems for the baby, and may have a high risk of affecting others in the family. For this reason, babies with cleft lip/palate should be thoroughly examined by a doctor soon after birth.

Signs and symptoms

• Separation of the lip alone
• Varying amounts of nasal distortion
• Separation of the palate
• Separation of the lip and palate
• Misaligned teeth
• Poor speech
• Recurrent ear infections
• Feeding problems
• Failure to gain weight
• Nasal regurgitations during bottle feeding
• Growth retardation

Diagnosis

A typical clinical picture confirms the diagnosis. Cleft lip with or without cleft palate is obvious at birth; occasionally, more severe defects may be seen with diagnostic prenatal ultrasonography. Isolated cleft palate may not be detected until a mouth examination is done or until feeding difficulties develop.

Treatment

Treatment consists of surgical correction, but the timing of surgery varies. Some plastic surgeons repair cleft lips within the first few days of life to make feeding the baby easier. However, many surgeons delay lip repairs for 8 to 10 weeks (sometimes as long as 6 to 8 months) to allow time for maternal bonding and, most important, to rule out associated congenital anomalies.

Cleft palate repair is usually completed by the 12th to 18th month. Still other surgeons repair cleft palates in two steps, repairing the soft palate between ages 6 and 18 months and the hard palate as late as age 5 years. In any case, surgery is performed only after the infant is gaining weight and is infection-free.

Surgery must be coupled with speech therapy. Because the palate is essential to speech formation, structural changes, even in a repaired cleft, can permanently affect speech patterns. To compound the problem, children with cleft palates often have hearing difficulties because of middle ear damage or infections.

Prevention

While little is known about how to prevent oral-facial clefts, studies suggest that taking multivitamins containing folic acid before conception and during the first two months of pregnancy may help prevent cleft lip/palate and isolated cleft palate.

Other studies have shown that fetuses with certain predisposing genes may be at increased risk for isolated cleft palate if their mothers smoke.