Craniofacial Conditions
Cleft lip or palate
Facts About Cleft lip or palate
Clefts occur as gaps or openings in the lip, palate, or both. The gaps are a result of incomplete closure when the baby’s facial structures were developing before birth. A cleft lip and/or palatemay be classified as unilateral or bilateral. A unilateral cleft affects one side of the lip and may extend back along one side of the hard or soft palate. A bilateral cleft affects both sides of the mouth and may also comprise only the lip or may extend back into the hard and/or soft palate. Children may have a cleft lip and cleft palate together, an isolated cleft lip, or an isolated cleft palate. Some babies have only a cleft lip. However, most babies with cleft lip have a cleft palate or cleft in the gum line as well. Cleft palate also can occur by itself without cleft lip.
Babies with unrepaired cleft lip and palates may need to use special bottles for feeding, which fill in the gaps in the mouth to prevent milk or formula from dripping out of the mouth or nose. Babies need to be held to take a bottle and will take longer periods of time to feed. They may also need to eat smaller amounts and eat more often. As a result, children with unrepaired clefts in institutional settings are often underweight.
Causes:
Studies suggest that a number of genes; as well as environmental factors, such as pollution, maternal smoking and drugs such as anti-seizure medications, may contribute to the development of orofacial clefts in babies. Other environmental factors that are suspected of playing a role include infections, maternal alcohol use and deficiency of the B-vitamin folic acid.
Cleft lip or palate Challenges
Children with cleft lip and palate may have difficulty speaking clearly or speech sounds may have a nasal quality, even after surgery. Children may also be prone to frequent middle ear infections and may be more likely to have dental cavities.
Cleft lip or palate Treatment
Treatment for children with cleft lip and palate often requires consultation from multiple specialties to ensure adequate care of the affected areas of the mouth, nose, and face. For instance, a child may need to see a plastic surgeon, dentist, orthodontist, speech therapist,and nutritionist. Many cleft “teams” are available to provide continued care as a child grows.
- Surgery: Treatment of the cleft lip and/or palate is performed by a surgeon to repair the gap. The amount of surgery required depends on the extent of the child’s condition. Children often need initial surgery to repair the lip, followed by another surgery to repair the palate. At times, a gap may occur after the palate has been repaired, which is called a fistula. Depending on the size, a fistula may need to be surgically corrected to completely close the gap. As the child ages, another palate surgery known as a bone graft may be necessary to provide permanent closure of the palate. The initial surgeries typically take place under the age of 1; however, children living in institutional settings may not have had access to surgical care and may be much older when surgery is done. Depending on the child’s condition and if any complications develop, there are many other types of surgeries that a child with a cleft lip and/or palate may need to undergo as part of correction, including ear tube placement, nose or lip revision, dental extractions, or placement of a prosthesis in the roof of the mouth.
- Dental Care: Children with cleft lip and palate often need orthodontics to realign the teeth. Some teeth may break easily or be prone to cavities, so regular dental care is important.
- Speech Therapy: Many children with a cleft lip or palate need speech therapy to develop appropriate sounds and to prevent a nasal quality to speech. Scar tissue may cause difficulties with a child’s abilities to create certain sounds or move the mouth to form words. Additionally, a child with cleft lip and palate should have a hearing evaluation to determine if fluid accumulation may be occurring in the ears or if the cleft somehow affects his ability to hear sounds and produce speech.
Cleft lip or palate Prognosis
Children born with cleft lip and palate generally lead healthy lives.
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