What is Cleft Lip and Palate

Cleft lip and cleft palate are known as the orofacial cleft. In simpler words, it is actually the discontinuity in the normal structure of the lip and palate (roof of the mouth). This discontinuity is deep and affects the structure relating to it.

There could be the presence of cleft lip which means, the only lip is affected and the discontinuity is seen on the lip surface. Then there could be cleft on the palate, which means the roof of the mouth is affected and due to this there is the presence of communication between the nose (nasal cavity) and the mouth (oral cavity) or it can be both together.

Cleft lip and palate

Pattern of Occurrence

Here in this, we will discuss different types of clefts in relation to palate and cleft lip. So, in case of the cleft lip, in which the opening is in the lip, there could be three types seen:

Unilateral and bilateral cleft lip

  • One-sided.
  • Both sided.
  • In middle.

But in the cleft palate. The opening is due to the splitting of 2 plates of the skull which forms the roof of the mouth. There could be

Complete Cleft Palate

In this, the cleft is present in the anterior part of the palate, which is hard palate and then extends in the posterior-most part of the palate which is called soft palate hence called complete cleft palate.

Incomplete Cleft Palate

In this a hole is of limited area, it is mostly seen in the posterior part of the palate ie, soft palate. In this uvula is also split.

Combination Type

Now in the combination type, there could be unilateral complete cleft lip and cleft palate or bilateral cleft lip or cleft palate. In unilateral only one side (right or left) is affected, but in bilateral two types of clefts are seen.

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Causes of Cleft Lip, Cleft Palate or Both

The exact cause behind the occurrence of cleft lip and cleft palate is unknown, but with the study and observation of the pattern of occurrence, it is known that there are several kinds of risk factors or we can say contributing factors present.

Hereditary

It is the congenital anomaly so it can be related to hereditary cause. In this, the genetics is considered as one of the contributing factors, a family history of cleft lip and palate increases the chances of its occurrence by 40 percent, it is significant to relate its occurrence with hereditary cause, but still, it is not predictable.

Contributing factors

Certain events which mostly if occurs during the first trimester of the pregnancy can influence the normal formation of the palate and can contribute to the defect occurrence.

Viral Infection

Viral infections make the body weak and cause a decrease in the overall well being of a person. Mostly rubella infection during 1st trimester is seen to be affecting the unborn child and causing a congenital anomaly in some cases.

Radiations

Radiation exposure during the first trimester can be a risk factor for the child. Exposure to the radiations could occur while taking radiographs for diagnosis. Hence, it is advised to avoid radiographs, especially during the 1st trimester.

Medications

Excessive use of drugs (medicines like antibiotics, steroids, insulin, antiepileptic drugs, anti-inflammatory drugs, metronidazole, etc) increases the risk of congenital anomalies (birth-related defects)  in the child, as they all are teratogenic drugs (ie, drugs which are harmful to the unborn child and hinder in their proper development.

Vitamins

Deficiency in certain vitamins (vitamin A and B-folic acid). Also, excessive vitamin A intake can also be harmful.

Anemia, anorexia, stress can also act as contributing factors.

Habits

Excessive consumption of alcohol during pregnancy is very harmful to the child. Also, the habit of Tobacco chewing and tobacco smoking is very harmful.

Hypoxic condition in mother causes bad effects over the child’s development.

Maternal Age

The studies have shown elder aged mother have increased chances of having a child with the developmental anomaly. Mostly, it is seen in conceiving mothers who are above 35 years of age.

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Problems occur due to Cleft Lip and Palate

Physically

Feeding

Infants born with cleft lip and palate find it difficult to have their feeds. Because due to the opening between the nose and oral cavity, the vacuum build-up required for sucking in milk do not occur and hence it is difficult to have a feed. Also, if the milk or water is given through bottle or spoon feed, then also it leaks out through the opening of the palate. Hence, infants can be malnourished due to this.

Dental Problem

There can be seen malocclusion in relation to primary as well as permanent teeth. This occurs due to the improper formation of the alveolus, which also affects the positioning of the tooth buds (from which the tooth formation starts).

Speech Problems

People with cleft lip and palate have blistering speech and also lack some words. This occurs due to lack of proper seal of lips and also due to air leakage through the oral and nasal opening because of a cleft in the palate.

Psychological Aspects

There are various psychological aspects which are also related to the CLP. The patient with cleft lip and palate is seen more sensitive emotionally, they are not confident due to their appearance and speech problems, anger management issues, fear of social unacceptance is very high, peer pressure and facing social shyness is seen. Due to all of this, the patient is mostly sad and can also go into the state of depression.

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How to know at Early Stage

Diagnosis

Ultrasound: The cleft lip and palate can be detected in the 13th week of pregnancy through the ultrasound. With ultrasound, the prenatal picture of the baby can be seen and its development can be judged whether it is normal or not. And if any kind of abnormality is seen then the treatment plan can be made accordingly.

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Treatment

The treatment basically focuses on achieving normal speech, normal hearing and normal appearance. For the proper treatment, the combined effort of several specialties is required.

Such as oral surgeons who are specialized in treating cleft palate and cleft lip, ENT specialists, pediatricians, pediatric dentists, orthodontists, speech therapists, psychologists.

Treatment

Now at what age the correction procedures are done:

  • Within the first week of birth evaluation of the defect and testing of hearing, ability must be done.
  • From 0-6 months primary surgical repair of the lip is done along with the tip rhinoplasty (nose reshaping).
  • In between 6-12 months the primary palatal repair is done, also hearing impairment is treated with placement of pressure equalization tubes.
  • From 3-6 years, evaluation of speech and evaluation of hearing and also behavioral changes.
  • And at 5-7 years of age if necessary then secondary surgical procedure and rhinoplasty must be done.

After the surgical procedure:

  • Visit your doctor to check the progress of treatment.
  • Regular check up is necessary to have a check on erupting teeth.
  • Orthodontic appliances might be given by your dentist to avoid any malpositioning of the tooth.
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Now most of the people have concerns that if in the family anyone had this problem or one of the parent have this problem then what are the chances of its occurrence in next generation,

So for this, the answer  is not clear that the problem is heredity linked, but it is seen that in some cases it appears in offsprings of affected people, but the chances of its appearance in children whose family have a history of someone with cleft lip and palate is less than 1 percent, but still people who either themselves have the problem or have a family history of the problem must be more alert, as the chances of its occurrence in their children are higher than the ones with no family history, but the good news is that it can be easily diagnosed during pregnancy stage and the treatment can be planned before birth only, also nowadays the treatments are satisfactorily good that it does not affect the future life of the child in any way.

But the most important thing is, the person must avoid all the inducing or causative factors during pregnancy as much as possible, as it is said that prevention is much better than cure.

So this was brief about the cleft lip and palate, the topic is vast and has so many aspects and details about its types and treatment procedures if you want to know any detail or have any doubts or suggestion let us know in the comment section below.

 

 

Dr Deepak Kansal is a dentist, who is currently working in Sri Ganganagar. He did his Bachelor of Dental Surgery from Rajasthan University of Health Science.

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