OVERVIEW
What is Cleft Lip and Palate?
A baby's top lip or palate (palate) may have openings called cleft lip or cleft palate. These are birth defects or congenital anomalies that arise during the uterine development of a fetus. When the tissues of the upper lip and roof of the mouth don't correctly fuse together during fetal development, it can result in cleft palates and lips. Cleft lip and/or cleft palate can be corrected surgically.
What is cleft lip?
Between weeks four and seven of fetal development, our lips begin to form. The lips and mouth are formed by the union of tissues from each side of the head at the center of the face. When the tissues that form the lips don't unite perfectly, a cleft lip results.The outcome is a separation or opening between the top lip's two sides. The cleft may be as little as a small depression or as wide as a gap that extends to the nose. The palate (the roof of the mouth) and the gums may be separated in this way.
What is cleft palate?
The palate, or roof of your mouth, develops between weeks six and nine of pregnancy. A split or opening in the roof of your mouth that develops during fetal development is known as a cleft palate. The hard palate, which is the bony front part of the roof of the mouth, and/or the soft palate, which is the soft rear part of the roof of the mouth, can both have cleft palates.
A child can have cleft lip and cleft palate on one or both sides of the mouth. Since the palate and lip develop at different times, one could have a:
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Cleft palate absent from cleft lip.
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Cleft lip absent from cleft palate.
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A cleft palate in addition to a cleft lip (most frequent).
Male/Female Ratio
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With or without cleft palate, males are more likely to have cleft lips.
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Females are more likely to have cleft palates without cleft lips.
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Diagnosis
Because most lip clefts result in actual alterations to the fetus's face, prenatal ultrasonography is a useful tool for diagnosing these conditions. This makes isolated cleft palate—where there is no cleft lip—more difficult to diagnose. Merely 7% of them are seen during a fetal ultrasound.
A physical examination of the mouth, nose, and palate after birth can identify cleft lip or cleft palate if an ultrasound fails to identify the condition before birth.Your doctor could occasionally advise amniocentesis to look for related genetic disorders. The process of extracting amniotic fluid from the amniotic sac is known as amniocentesis.
Signs and symptoms
A split (cleft) in the palate or lip is typically noticeable from birth. Cleft palate and lip can manifest as:
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A rift between the palate and lip that can affect one or both sides of the face
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A lip split that starts as a tiny notch in the lip and goes all the way through the palate and upper gums to the base of the nose
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A fissure in the palate that is inconspicuous and leaves the face looking normal
Less frequently, a cleft merely affects the sub mucous cleft palate, which affects the muscles of the soft palate at the rear of the mouth that are covered by the lining of the mouth. This kind of cleft is frequently undetected at birth and may not be identified until later on when symptoms appear. Submucous cleft palate symptoms and indicators could include:
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Having trouble feeding
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Having trouble swallowing, sometimes causing foods or drinks to escape via the nose
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Speaking in a nasal tone
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Recurrent ear infections
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Risk factors
Several variables can enhance a baby's chances of acquiring a cleft lip and palate, including:
Background in the family: A kid born to parents with a family history of cleft lip or cleft palate is more likely to have a cleft.
Exposure to specific drugs while a pregnant woman: Pregnant women who use tobacco products, consume alcohol, or take certain medications may have an increased risk of developing cleft lip and palate.
Diabetes: Pregnant women who have been diagnosed with the disease may be more likely to give birth to a child who has a cleft lip or palate, depending on the evidence.
Obesity during pregnancy: Research suggests that babies delivered to obese mothers are more likely to suffer from cleft lip and palate.
Male/Female Ratio
With or without cleft palate, males are more likely to have cleft lips. Females are more likely to have cleft palates without cleft lips.
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Treatment
Who Provides Care for Kids With Cleft Palate and/or Lip?
A team of physicians and other specialists are typically involved in the care of these youngsters because of the numerous oral health and medical issues that are linked to cleft lip or cleft palate. Typical members of a cleft lip and palate team are:
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A Plastic Surgeon to assess and execute any required lip and/or palate operations
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An Otolaryngologist, or ear, nose, and throat physician, to assess hearing issues and discuss possible solutions
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If necessary, an Oral surgeon will realign some upper jaw segments to enhance look and function and close the gum cleft.
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To straighten and relocate teeth, consult an Orthodontist.
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A Dentist to handle regular dental procedures.
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A Prosthodontist can create dental appliances and replacement teeth to enhance looks and fulfill speech and eating needs.
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A Speech-language pathologist to evaluate issues with feeding and speaking.
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A Speech therapist to assist the youngster in developing their speech.
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An Audiologist to evaluate and track hearing. Audiologists specialize in communication issues resulting from hearing impairments.
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A Coordinator of nurses to oversee the child's health on a continuing basis.
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A Psychologist or social worker to assist the family and evaluate any issues related to adjustment.
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A Geneticist to assist parents and adult patients in understanding the likelihood of having further children with these problems.
A newborn who is born with a cleft lip palate receives therapy from birth until they are a young adult. For the newborn with cleft palate to receive enough calories and grow weight, specific feeding methods must be used. Early infants have surgical repair, and as they grow and develop, they may need additional surgical treatments. Surgical correction is not the end of treatment for cleft palate and/or cleft lip. A kid with cleft lip and/or palate needs comprehensive cleft lip treatment that addresses their speech and hearing, dental and orthodontic requirements, and psychological health.
Cleft Lip surgery
Depending on the size of the cleft, one or two procedures may be required for cleft lip correction. Between three and six months is when the baby has its first operation. The surgeon closes the lip incision while your infant is pain-free and asleep.
Cleft Palate Surgery
A cleft palate is closed surgically in the first year of life. The baby's mouth roof is rebuilt and the palate aperture is closed by the surgeon. The child's ears may be fitted with special tubes to drain fluid and stop hearing loss.
As they get older, many kids with cleft palates will require a few surgeries. Between the ages of 6 and 10, some people may require a bone graft to maintain their jaw and teeth. Additional procedures help with breathing, block mouth-to-nose apertures, straighten teeth and jaws, and enhance the appearance of the lip and nose. After their faces have matured, some kids wait until they are teenagers to have their final surgery.
Speech-Language Therapy
Speech-language therapy is crucial for children with cleft lip and palate, as these conditions can significantly impact their ability to produce clear speech. Therapy focuses on improving articulation, resonance, and oral motor skills, addressing issues such as nasal air emission, compensatory articulation errors, and hypernasality. Speech therapists often work closely with surgical teams to assess the child’s progress before and after corrective surgeries. Therapy is tailored to each child's needs, emphasizing techniques like phonetic placement and visual-tactile cues to enhance sound production. Early intervention ensures children develop effective communication skills, boosting confidence and aiding social integration.
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Tips for parents
Speech treatment should start as soon as possible. Children who begin speech treatment early are more likely to succeed. Therapy can also benefit older children, albeit their improvement may be slower because their motor habits are more ingrained.
Parental support is critical to a child's success in speech therapy. Children whose parents are involved complete the speech program the quickest and with the best long-term outcomes.
Your therapist should assign homework for you and your kid to complete following each appointment. Helping your child complete these tasks will ensure continuing progress and the transfer of new abilities. For example, practicing the P sound for 30 minutes per week in treatment is far more beneficial than doing it for 10 minutes per day at home.
Overcoming a speech or language impairment may require some time and effort. So all family members must be patient and understanding.
