Cleft Lip and Cleft Palate in Children

A cleft is an abnormal vertical split or fissure between two body parts that should be joined together. It occurs during the development of the embryo. The palate is the upper and top portion of the mouth. It is the skeletal and muscular division that separates the nasal and oral cavities of the mouth. A cleft palate is a fissure in the roof of the mouth. It occurs when there is an abnormality of the two palatal shelves that ordinarily join together to form the complete palate. In some children, the front (hard) and back (soft) portions of the palate fail to join. In others, only one part of the palate is open.

A cleft lip is the presence of one or two abnormal, vertical splits in the upper lip. It can be a small opening or a sizable gap that goes from the lip to the nose. Cleft lip and palate are categorized as “orofacial” clefts because they affect the mouth and face. They are most common in babies of Asian and Native American descent.

There can be a cleft lip without cleft palate and vice versa, or both can occur simultaneously. This irregularity develops during pregnancy when there is insufficient tissue for the proper formation of the upper lip and palate, or when the tissue fails to join properly. Cleft lip and cleft palate can occur on both sides of the mouth as they develop separately. They affect the way the baby’s face looks and can lead to problems associated with eating, speaking, and listening.

In most cases, these abnormalities develop for no apparent reason, but there is a higher risk of cleft if it exists in a family member. There is also a higher risk if a child’s mother has taken anticonvulsants or medicines to treat cancer, psoriasis, or arthritis during her pregnancy. Cleft lip and cleft palate can be part of other medical conditions such as Pierre Robin Malformation Sequence, a congenital condition of facial abnormalities. Another such condition is Amniotic Banding, a congenital disorder caused by entrapment of fetal parts in areas that protect the uterus. Another is Hemifacial Microsomia/Glodenhar Syndrome or Tessier facial cleft. This condition prevents the lower side of the face from growing normally.

In most cases, cleft lip and cleft palate are found at the time of birth. But more and more cases are being discovered during ultrasound exams during pregnancy. If the ultrasound exam indicates cleft, the doctor may take samples of the fluid from mother’s womb to check for any genetic abnormalities. After birth, these defects can be diagnosed through physical examinations of the mouth, nose, and palate. Sometimes other diagnostic tests may be required to rule out other abnormalities.

Since cleft lip and cleft palate may involve a series of reconstruction surgeries, a team of medical specialists and doctors is necessary for the proper care of the children affected. The team may include cosmetic or plastic surgeons, dental specialists, ear/nose/throat specialists, and psychologists, depending on the patient’s specific needs.

Depending on the extent of deformation, a cleft lip may need one or two surgeries which may be performed when the baby is three months old.

Cleft palate generally requires many surgeries over a long period, possibly extending to age 18. The initial surgery to repair the palate is done when the baby is between 6 and 12 months old. This surgery is carried out to create a functional palate, to decrease the risk of fluid buildup in the middle ears, and to aid in the proper development of the teeth and facial bones. Around the age of eight, these children may require a bone graft to fix the upper gum to hold permanent teeth and stabilize upper jaw. To correct any problems related to speech, 20 percent of children with cleft palate require further surgeries. Subsequently, braces are often required to straighten the teeth. Cosmetic surgeries are also available to improve the child’s appearance and repair scars, but these cannot be performed before the adolescent years, when the facial structure has been completely formed.

Preventing cleft lip and palate

Not much is known to prevent oral and facial clefts. The National Institute of Environmental Health Sciences suggests that the risk is lower if the mother eats food high in folic acid during pregnancy. Experts at the Centers for Disease Control and Prevention recommend that all women who can become pregnant should take a multivitamin containing 400 micrograms of folic acid before pregnancy

Conclusion

Orofacial clefts are the congenital defects that affect babies while they are still in the process of development. The risk of development may be lower if the mother takes multivitamins with folic acid and avoids certain medications before and during pregnancy. A child is born with these conditions needs medical attention, but a parent can help, too by enabling a child, and those around him or her, to discover that the positive attributes of a person extend far beyond physical appearance.

Written by AnswersMedia LLC editorial staff
Reviewed by Doctors Office Media
© 2011 AnswersMedia LLC All rights reserved.

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