Cleft lip and palate are situations in which the baby’s orofacial structures (face and mouth) don’t form properly during pregnancy, causing a fissure.
Said fissure can appear on the upper lip, on the palate, or in both the lip and palate; and can be a small slit or a large fissure that goes from the lip to the nose.
Orofacial clefts are some of the most common birth defects and, fortunately, can be cured through a repair surgery that fixes functionality and facial aesthetics.
Causes of cleft lip and cleft palate
Orofacial clefts are of multifactoral origins, which means they can have different causes, among the most frequent are:
- Environment: Exposure to external agents like contamination, alcohol, cigarettes, radiation, etc; can prevent the fetus from developing properly.
- Genetics: The expression of some genes might cause cleft lip and palate, which is why having a family history of orofacial clefts is a risk factor.
- Genetic syndromes: Cleft lip and palate are present in a lot of genetic syndromes, though it doesn’t mean orofacial clefts are always present.
- Mother’s health: The mother’s health, especially during the first trimester of pregnancy, has a direct influence on the fetus’ development, mothers diagnosed with diabetes constitute a risk factor for orofacial clefts.
- Medication: Taking some medications like antiepilectics, or some strong antibiotics during pregnancy can also cause cleft lip and palate.
Health issues caused by cleft lip and palate
- Feeding: Feeding properly will be difficult for a baby with cleft lip and/or palate since the disruption in their anatomy won’t allow them to suck properly. The mother should receive clear instructions and guidance from an occupational therapist to make sure the baby is feeding properly and safely.
- Hearing: A cleft palate that affects the soft palate area usually causes hearing problems such as recurring ear infections and even temporary hearing loss.
- Speech: An unrepaired cleft palate will prevent the child from speaking properly, so after the surgery repair it will be necessary to get assistance from a speech therapist.
- Tooth development: Both cleft lip and palate can affect the normal development of teeth making them absent, small, or crowded; it is important to provide dental care from the start, along with other treatments.
- Orthodontics: Depending on how severe the clefts are, these could cause deformations on the maxillary bone and thus, prevent the teeth from erupting properly, it will be necessary to provide orthodontic guidance to correct the form and also stimulate the proper growth of the maxillary bone.
Types of cleft lip and palate
A cleft lip can occur with or without a cleft palate, and a cleft palate can also occur in combination with a cleft lip or alone.
Types of cleft lip
- Microform cleft lip (Forme fruste): this is a small notch in the upper lip, and usually does not affect functionality.
- Incomplete unilateral cleft lip: A cleft on one side of the upper lip that does not extend into the nose.
- Complete unilateral cleft lip: A cleft on one side of the lip that extends into the nose.
- Incomplete bilateral cleft lip: two clefts, one on each lip side that does not extend into the nose.
- Complete bilateral cleft lip: two clefts, one on each lip side that extends into the nose.
Types of cleft palate
- Incomplete cleft palate: A small cleft in the back of the mouth (soft palate).
- Complete cleft palate: A cleft that affects all the roof of the mouth (hard and soft palate) causing the nose and mouth structures to be in direct contact with each other.
- Submucous cleft palate: A cleft that can affect the soft or hard palate or both but is covered by the mucosal tissue that covers the roof of the mouth, making the palate look normal at first sight.
Treatment for cleft lip and cleft palate
The main treatment is the surgical repair of the clefts to restore functionality and facial aesthetics, cleft lip surgery should be performed within the first 12 months of age, and cleft palate surgery within the first 18 months of age; the sooner the clefts are fixed, the healthier the baby will grow.
Depending on the severity of the clefts, a baby might need more than one surgery, especially in the case of a complete cleft palate, as well as monitoring by an otorhinolaryngologist along the surgical treatment to make sure all the ear structures are properly taken care off.
Once all the repair surgeries are done, it will be necessary to keep regular dental appointments so the orthodontist can make a follow-up of the dental and maxillofacial structures development over the years and provide the required assistance on time.
Finally, the child might need speech therapy, though not all kids with cleft lip and palate have the same difficulties when speaking, counting on a professional speech therapist will simplify the learning process for them.
Cleft lip and cleft palate surgery cost
The cost of a repair surgery varies widely depending on multiple factors, like the cleft severity, the healthcare provider, the medical insurance, the financial support from non-profit organizations, etc.
The following data is an estimation and only for informative purposes: for cleft lip repair surgery costs go around $5.116, and for cleft palate repair surgery goes around $3.511.
Orofacial clefts associated syndromes
- Van der Woude syndrome.
- Treacher Collins syndrome.
- Goldenhar syndrome.
- Stickler syndrome.
- Velocardiofacial syndrome (VCF).
- Pierre Robin sequence.
- Oculo-auriculo-vertebral spectrum (OAV).
- Median facial dysplasia.
Cleft lip and cleft palate in adults
In developed countries almost all cases of orofacial clefts are treated within the first months of life, so there are low chances of finding an adult who has not undergone repair surgery, but statistics are very different in sub-developed countries, where there is a lack of awareness and resources to attend these topics.
In those cases, an adult can also undergo plastic surgery to repair the clefts for functional and cosmetic reasons, yet, we must clarify that repair surgery for adults is way more complex and has less satisfactory results compared to repair surgery in babies and kids.
In cases of teens and adults who got repair surgery when they were babies, there is still a chance that they will require new procedures as they grow to further improve functionality, speech problems, and facial aesthetics, but these will be much simpler surgeries.
Cleft lip and cleft palate awareness
Bringing awareness about cleft lip and palate is a vital part of preventing it, that’s why many hospitals, associations, and foundations work together to share valuable information, educate future parents, provide assistance for babies with cleft lip and palate, and raise funds to support the work of those who aim to improve quality of life of those affected by orofacial clefts, especially during July when we celebrate cleft lip and palate awareness month.
Frequent Q&A
Can cleft lip and cleft palate be seen on ultrasound?
A cleft lip can be seen and diagnosed during a routine ultrasound, but a cleft palate is almost impossible to diagnose until the baby is born.
What’s the difference between cleft lip and palate?
A cleft lip is a fissure on the upper lip that sometimes can extend into the nose but usually doesn’t affect the inside of the mouth, while a cleft palate is a fissure in the roof of the mouth that can cause exposition of the nose and ear structures to the mouth and prevent the teeth and maxillary bones from developing properly.
Cleft lip and palate can be cured?
Yes, there are many improvements and new treatment options in plastic surgery to repair cleft lip and palate and restore functionality and aesthetics, there are also multidisciplinary teams of professionals ready to assist and educate patients on ways to recover from cleft lip and palate aftermath.
Who is a cleft palate specialist?
A cleft palate must be treated by a multidisciplinary team of professionals, this includes plastic and maxillofacial surgeons, otorhinolaryngologists, orthodontists, dentists, speech therapists, psychologists, and occupational therapists.
What is the cleft palate hereditary percentage?
Only around 20% of cleft lip and palate (not related to any syndrome) are hereditary, while 80% appear sporadically.
How to prevent cleft lip and palate during pregnancy?
The best way to prevent cleft lip and palate (and also many other birth defects) is by taking care of the mother’s health, this includes: adopting healthy habits before getting pregnant, reaching a healthy weight by your physical characteristics, going to general health check-ups before pregnancy, once pregnant avoid alcohol consumption and cigarettes, maintain a nutritious diet, go to control check-ups regularly and from the beginning of pregnancy, take folic acid and any other supplements that your doctor recommends, and finally avoid self-medication, especially with antibiotics.
What is the Cleft lip and palate foundation of smiles?
The Cleft Lip and Palate Foundation of Smiles is a non-profit organization that provides information, assistance, and care for those suffering from orofacial clefts and other rare craniofacial diseases, their mission is to bring awareness on how these conditions affect the quality of life of patients and how to get professional help.
You can check the Cleft Lip and Palate Foundation of Smiles website here.
References
- Venkatesh, R. (2009). Syndromes and anomalies associated with the cleft. Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India, 42(Suppl), S51. https://doi.org/10.4103/0970-0358.57187
- Murthy, J. (2009). Management of cleft lip and palate in adults. Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India, 42(Suppl), S116. https://doi.org/10.4103/0970-0358.57202
- Kohli, S. S., & Kohli, V. S. (2012). A comprehensive review of the genetic basis of cleft lip and palate. Journal of Oral and Maxillofacial Pathology: JOMFP, 16(1), 64-72. https://doi.org/10.4103/0973-029X.92976
