Cleft lip and Cleft Palate
Introduction
Cleft lip and cleft palate are among the most common birth defects, affecting more than 5,000 infants a year in the United States — or about one in 700. A cleft is an opening or a split in the upper lip, the roof of the mouth (palate) or both. In the womb, every baby has this opening when the mouth is forming, but the structures fuse together during the first three months. In babies with cleft lip or cleft palate, the fusion never takes place or occurs only partially, leaving an opening.
Cleft lip can affect one or both sides of the upper lip. Cleft lip and cleft palate commonly occur as isolated birth defects, but they're also associated with more than 300 known genetic conditions.
The look of a cleft lip may be startling at first, but know that this defect is correctable through surgery. In most babies, doctors can correct the defect with minimal scarring, restoring normal function and resulting in a more normal appearance.
Signs and Symptoms
The cleft, or split, in the lip or palate is usually immediately identifiable at birth. Clefts can appear as only a small notch in the lip or can extend from the lip through the upper gum and palate.
Less commonly, a cleft occurs only in the muscles of the soft palate (submucous cleft), which is at the back of the mouth and covered by the mouth's lining. Because it's hidden, this type of cleft may not be diagnosed until later.
Causes
Researchers believe that most cases of cleft lip and cleft palate are caused by a unique interaction of genetic and environmental factors, although a definite cause may never be discovered for every baby.
- Genetic factors. Either the mother or father can pass on genes that cause clefting, either as an isolated defect or as part of a syndrome that includes clefting as one of its signs. In some cases, babies inherit a gene that makes them more likely to develop a cleft and then an environmental trigger causes the cleft to occur.
- Environmental factors. Fetal exposure to cigarette smoke, alcohol, certain medications, illicit drugs and certain viruses have been linked to the development of a cleft. Researchers believe that some clefts may be caused by nutritional deficiencies in the mother, particularly a lack of folic acid.
Treatment
A health care team that specializes in cleft lip and cleft palate is ideal because the condition often affects other areas of a child's health. Treatment involves surgery to repair the defect and therapies to improve any related conditions.
Surgery
Children with cleft lip should have surgery between birth and 3 months. Children with cleft palate should have surgery during the first 12 months of life. Following the initial cleft repair(s), your doctor may recommend follow-up surgeries to improve speech or improve the appearance of the lip and nose. Surgeries typically are performed in this order:
- Cleft lip repair — between birth and 3 months
- Cleft palate repair — by one year of age
- Follow-up surgeries — between age 2 and late teen years
For children with cleft palate, ear tubes also may be placed during the first surgery to ventilate the middle ear and prevent hearing loss. Your doctor will determine the optimal time for all needed surgeries.
Therapies
Your doctor may recommend additional treatments based on continuing assessment of your child's speech, developmental and cognitive abilities. These may include speech and psychological therapies.
Emerging treatments
Based on new research, it may soon be routine for doctors to repair cleft lip and cleft palate in fetuses before birth. Doctors hope that minimally invasive surgical techniques will make this possible, since the risk to the mother and baby is reduced by smaller incisions. One major advantage of in utero repair of cleft lip and cleft palate is "scarless healing," a phenomenon in which the surgical wounds made in a young fetus heal with little or no noticeable scar. This early repair also has the potential to interrupt the secondary effects of cleft lip and cleft palate, such as speech, dental and hearing problems, as well as counteracting psychological issues for the child and family.
Prevention
After a baby is born with a cleft, parents are understandably concerned about the possibility of having another baby with the same condition. While many cases of cleft lip and cleft palate are unpredictable, you can take steps to understand or lower your risk:
- Genetic counseling. Your doctor will advise you on what genetic testing can tell you, such as how much a history of clefting in both your families increases your risk, as well as how blood or DNA samples can test for chromosomal syndromes.
- Prenatal vitamins. Some researchers believe that lack of folic acid or certain vitamins may be related to some cases of cleft lip and cleft palate. If you're planning to get pregnant soon, begin taking a prenatal multivitamin now.
Informations obtained from National Institute of Health.