Some people are born with a cleft palate, a congenital split in the roof of the mouth or lip.
Although seemingly strange at sight, both of these conditions are treatable.
What is Cleft Lip / Cleft Palate?
Around 4,440 infants are born with cleft lip and 2,650 with cleft palate annually in the United States. The associated concerns about these orofacial clefts raise apprehension of parents everywhere.
However, like most congenital problems, a baby can live a normal life if they are treated soon after birth.
Cleft Lip and Cleft Palate Defined
Cleftings are birth malformations that occur when an infant’s mouth or lip does not properly form. This is a result of incomplete development during the early stage of fetal formation. A cleft palate happens when insufficient tissue in the lip or mouth area. Therefore, the remaining tissue does not adjoin completely.
Orofacial clefts develop during the fourth and seventh weeks of pregnancy when lip development takes place. On the other hand, the palate is formed between the sixth and ninth weeks of pregnancy.
Cleft palettes and lips vary in size. For instance, it might involve the soft palate only or involve a wide slit that runs through the hard palate. A cleft lip can involve a large opening that runs from the nose to the lip or a small slit.
Additionally, it can appear on both sides of the mouth (bilateral clefting) or just one side (unilateral clefting).
- Both cleft palate and cleft lip
- Only cleft lip
- Only cleft palate
Bullets 1 and 2 are more prevalent in boys than girls. However, cleft palate by itself is more widespread in girls.
Causes of Cleft Lip and Cleft Palate
In most cases, the cause of these birth deformities is unknown. Generally, research suggests that clefting is multifactorial.
Some children have a cleft lip or palate due to an inherited genetic condition. It can also be associated with environmental factors. These might include the pregnant mother’s exposure to cigarette smoke, certain medications, and chemicals. Some research suggests that clefting might also be due to vitamin deficiency during pregnancy.
If not treated, cleft lip and palate can cause dental malformations, hearing loss, feeding difficulties, and speech problems.
- Dental malformation. Children that have cleft lip or palate tend to have dental abnormalities. For example, these might include malpositioned teeth, missing teeth, small teeth, or extra teeth. Clefting can also adversely affect the gums, the supporting bone of the teeth, or the alveolar ridge. Alveolar ridge defects can pose a problem in the eruption of permanent teeth. It can rotate, tip, or displace permanent teeth.
- Loss of Hearing. Congenital cleft palate tends to damage the Eustachian tube in the middle ear. In turn, this makes those affected more susceptible to ear fluid buildup and ear infections. Unfortunately, hearing loss is one of the effects of this eardrum malfunction. The placement of small PE or pressure equalization tubes helps improve hearing by draining the accumulated fluid.
- Feeding difficulty. Feeding can be a big challenge for babies with clefting. The palate serves as a barrier preventing liquid and food from penetrating the nose. To feed, an infant with an untreated cleft palate necessitates the proper positioning of the bottle with a specialized nipple.
- Speech problem. After a palatoplasty or the repair of a cleft palate, 15 to 20 percent of children may have speech difficulty. This is commonly a result of the disruption of sound quality due to hypernasality. This occurs with the incomplete closure of the palate that segregates the mouth from the nose.
A cleft lip is easier to spot than cleft palate alone. A cleft lip may be diagnosed via ultrasound. Since it cannot be seen yet, a cleft palate is determined after childbirth. However, certain types of clefting are not noticeable until later in life. Some of these include bifid uvula and submucous cleft palate.
Treatment and Management
Considering the number of medical problems connected with clefting, different treatments need to be sought. Treatment and management may be necessary from childhood to adulthood, depending on the severity. The appropriate team might include the following:
- An oral surgeon to move sections of the upper jaw when necessary and to improve the appearance and function of the clefting
- An orthodontist to reposition and straighten the teeth
- A Plastic surgeon to assess the condition and conduct the needed surgeries to repair the lip or palate
- A dentist to conduct routine oral health care
- An ear, nose, and throat doctor or otolaryngologist to examine the extent of damage to the ear and manage treatments to address hearing problems
- A prosthodontist creates oral appliances and artificial teeth to sustain the function and appearance of the mouth.
- An audiologist to monitor and evaluate the status of the patient’s hearing
- A speech therapist to help the patient with their speech problem
- A speech pathologist to evaluate the problems in feeding and speech
- A geneticist to orient adult patients and parents about the possibility of having other children with these orofacial defects
- A psychologist/social worker to assess and support the family with each adjustment difficulty
- A nurse coordinator to offer continuing care to the patient’s health needs
Fortunately, with proper management and treatment, children with cleft lip and/or cleft palate don’t have to suffer with low self-esteem. Apart from medical and dental intervention, parent support is vital. The important takeaway is, children with these malformations can lead a healthy and normal life.
Mayo Clinic Staff. (n.d.). Cleft lip and cleft palate. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/cleft-palate/symptoms-causes/syc-20370985