Cleft lip and palate – the condition and its treatment

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Cleft Lip and Palate – The Condition and Its Treatment Cleft lip and palate are facial and oral malformations that happen very early during pregnancy, that is, when the baby is developing in the mother’s body. These conditions can occur independently or together. Clefting occurs when the tissue that makes up the lip fails to join properly before the child is born.

The defect appears as a narrow gap or a large opening that goes through the lip into the nose. The split in the lip can occur on both sides of the lip and rarely, in the middle of the lip. When the split occurs in the roof of the mouth, it called a cleft palate. In some cases, both the front and back portions of the palate are open, while in others, only part of the palate is open.

Causes It is believed that a combination of genetic and environmental conditions could be responsible cleft lip and cleft palate, though the specific factors for the problem remain largely

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unknown. According to the Centers for Disease Control and Prevention (CDC), research studies point out that factors such as smoking, diabetes and the use of medication to epilepsy during the 3 months of pregnancy can increase the chances of a baby being born with an orofacial cleft.

Overcoming Problems Cleft Lip and Palate

Associated

with

• Difficulty in feeding: The opening in the palate may cause difficulty in feeding as food and liquids can pass from mouth to the nose. An artificial palates and specially designed baby bottles and nipples are used to overcome the problem.

• Hearing Loss and Ear Infections: As there are chances of fluid build-up in the middle ear, infants with the condition are at the risk of ear infections. If not addressed, these infections can affect hearing capacity. Special tubes are placed in the eardrums to drain the fluid.

• Difficulty in Speaking: Normal speech is affected in most cases. A nasal tone may interrupt the clarity of speech and make it difficult for others to understand the communication. More than half of children

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affected by this congenital defect require speech therapy. • Dental Problems: Children with cleft palate are susceptible to dental problems such as malformed, missing, or displaced teeth. A defect in the alveolar ridge (the bone that supports the teeth) could occur which would displace, tip, or rotate permanent teeth and prevent permanent teeth from appearing. These issues can be set right with surgery.

Diagnosis and Treatment Cleft lip and palate, whether present together or independently, are usually diagnosed during pregnancy using ultrasound. They can also be diagnosed after the child is born, though some types of cleft palate would be diagnosed only at a much later stage in life. A plastic surgeon specialized in craniofacial surgery can provide the right treatment for cleft lip palate.

Cleft lip surgery is usually performed when the child is two to three months old and the nature of the procedures and the number of procedures required would depend on the extent of the cleft, the amount of lip and skin tissue present. Cleft palate surgery is advised

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within the first 18 months after birth or if possible, earlier.

A cutting edge technique, Nasal Alveolar Molding (NAM) is a pre-operative adjustment that is performed to optimize the results of surgery for orofacial clefts. The procedure • Realigns the cleft segments of the upper jaw • Brings the edges of the cleft lip in closer proximity for greater accuracy • Initiates correction of the nasal deformity to allow for a more normal looking nose Cleft palate repair is a lengthy process and the duration may vary depending the correction required • An upper jaw mold is created using maxillary impressions • The mold is used to construct an acrylic plate • The plate is fitted in the mouth and adjusted on a weekly basis to correctly align the growing bone • Lip alignment and nasal correction

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• A stent is placed that extends to nostril, with weekly modifications for nasal tip elevation • The lining of nose is stretched Additional surgeries, dental and orthodontic care, and speech therapy may be required as the child grows older.