Cleft lip and palate are congenital malformations (or abnormalities) that occur while the baby is forming within the womb.
It affects the roof of the mouth, the upper lip, and you can see the split; also a malformation of the soft palate is quite visible.
In this post we will briefly define this oral deformation that happens when a baby is born; its types, main causes, symptoms and treatment.
Continue reading to know more about this condition and ways to combat it:
Cleft-lip- is it a superstition?
The cleft lip is one of the most common birth defects that affect the fetus. It is known as cleft lip and palate, you can usually see how a slit, as if the baby’s mouth were torn.
However the good thing is, you can receive treatment for this problem as well as rehabilitation for the child facing it. The biggest obstacle, however, is the prejudice against the appearance or a mistaken association of this malformation with mental illness.
According to studies, with proper follow-up, total rehabilitation of the patient with cleft lip and palate is possible and the sooner the intervention, the better.
Experts also explain that the cleft lip occurs during embryonic development, even in the first trimester of pregnancy, when the two halves of the face merge in the midline, forming facial features such as lips and mouth. Another specialist says that the cleft lip occurs when the tissues that give rise to the lips and / or palate do not come together completely during pregnancy.
Let’s discuss its types:
Types and Incidence of Cleft Lip Cases
There are two types of lesions characteristic of children with cleft lip, which may appear alone or together. They are: cleft lip or cleft – a small cleft in the upper lip – and cleft lip and palate – total separation of the upper lip, also reaching the palate, base of the nose ,and even the uvula (the “bell”).
According to the pediatrician and on duty at the children’s hospital Sabara, the patient usually presents both lesions, but the incidence of each type of cleft lip is variable and depends on the extent of the lesion.
“The cleft lip and lip / palate affect more male babies, leaving girls with a greater number of the isolated cleft palate”, as suggested by various medical experts in the field.
Causes and Detection by Ultrasound
While the causes of non-syndromic cases are not really in the clear but they probably occur due to a combination of genetic and environmental factors. People who have close family members or who have had cleft lip themselves ,are more likely to have their children develop the condition.
Let’s now look into the diagnosis element:
Cleft Lip Diagnosis
Cleft lip and palate malformation occurs between the fourth and sixth week of gestation, a period in which developmental alterations can occur due to genetic or environmental causes that lead to a cleft lip and / or palate. It can also lead to other serious complications like ear infections and dental problems.
An investigation of the pathology is lead by a prenatal ultrasound, but in many cases, the discovery is done at the time of birth, which implies a significant emotional burden for parents who were not expecting it, so the support of the medical team is essential.
Sometimes, when these unexpected cases occur, the first thing that is done at hospitals is to call the plastic surgeons. Surgeons examine the new-born to verify the diagnosis.
If you may meet any cleft-lip person around you, provide emotional support to him and explain to them that it is a treatable disease, and that it will have very few noticeable scars.
How is Environment Responsible for Cleft Lip?
In most cases, however, there is no genetic tendency. Environmental factors can be the main cause of malformation. Some well-known examples are:
−exposure to teratogenic substances in pregnancy such as alcohol and tobacco;
−use of certain medications such as anticonvulsants and corticosteroids in the 1st trimester of pregnancy;
−and maternal obesity
A few other reasons are involved that can cause this disease such as nutritional deficiency. The diagnosis of the disease can be discovered before the birth of the child through an ultrasound performed during prenatal care.
Parents get disturbed after knowing that a child has a cleft lip. But once their existence has been verified, they must prepare for treatment that involves a multidisciplinary approach including pediatricians, surgeons, ENTs, pediatric dentists and speech therapists.
Now let’s dive into the various treatment mechanisms you can adopt:
Treatments to care for the cleft lip
The treatment for palate repair often involves several procedures (medical or not) during childhood that have as main objective the rehabilitation for a good nasal and oral functionality.
The main ones are:
Performing surgery (s) to correct the problem
As from the 1st month of life, the new-born’s assessment and preparation process for corrective surgery begin. The correction of the cleft lip occurs around 3 months of life; in the case of cleft palate, reconstruction is lead on in 12-18 months. Sometimes more than one surgery is necessary to properly close the gap.
Guidance regarding breastfeeding care
Some doctors warn that breastfeeding babies with cleft lips is possible, as long as the mother receives adequate guidance. In some cases, a special bottle may be necessary.
Follow-up with a speech therapist.
You are not of the right age, but this monitoring must start early. It is best to consult a speech therapist in the first months of life and know the step by step of treatment.
Cleaning the mouth
As the crack can cause separation of the teeth or even the absence of them and involve gums, guidance on oral hygiene care is important.
It is also important to accompany the parents with a psychologist to adapt to the condition and to prepare for the series of procedures and tests that they will have to perform with their child. As it is a difficult decision to let such a small child undergo an operation, there must be preparation in advance for this.
Let’s now look into one of the main topics that need attention in this discussion:
Cleft lip X breastfeeding
Some cleft lip babies have no problems with feeding, while others have difficulties. Babies who have cleft lip and palate deserve special attention, especially when feeding. In breastfeeding, the child needs to create a vacuum between the mother’s mouth and nipple so that she can suckle well. This is difficult when there is a fissure.
Let’s see how doctors explain this phenomenon:
Children born with cleft lip, therefore, may have more difficulty in making the correct“ grip ”on the mother’s breast. This, therefore is creating this vacuum, which makes breastfeeding somewhat more complicated.
However, most of them end up being able to breastfeed after proper guidance and adjustment of the baby’s position.
The doctors are aware of the mother’s problem so they inform that if breastfeeding is not possible, the bottle can be used. In certain cases, it is necessary to use special bottles, with larger nipples that seal the gap, facilitating suction. Breast milk is the best food for the baby; the mother can take her own milk and offer it in the bottle.
Drastic Consequences (In case of negligence)
Sometimes, let it go approach is not good. One must go to doctors otherwise consequences are drastic: •hearing loss •recurrent pulmonary infections delay in speech and language development as well as difficulty in communication and phonation •feeding difficulties with choking and regurgitation in large quantities • difficulty in chewing due to poor position or absence of teeth •nutritional deficit and growth problems
Not to mention psychological suffering and prejudice. But the aesthetic results of corrective surgery are getting better and better.
If the crack is still very visible, there is the possibility of making new operations, even during childhood, to improve the aesthetic aspect. The drawback is that the treatment is long, starting practically from birth.
Psychological Treatment for Cleft Lip
Here comes the real test! And unsurmountable patience is best to apply:
Among these specialists, support groups and / or psychologists can play a fundamental role. Both in helping the parents and the patients themselves. While those may suffer from feelings of anguish over the problem due to the visible differences that their children have, the patients themselves often manifest insecurities and self-esteem problems.
The complexity of the cases can compromise the best results, but, in general, most children heal without major problems and, within their possibilities, end up leading a normal and healthy life.
Maxillofacial Surgery and Cleft Lip
Along with psychological treatments, other medical interventions vary depending on each patient. The main ones include maxillofacial surgery and orthodontics, as well as speech therapy.
It is the most effective option to close a cleft lip. An intervention done sooner between a month and a half and 9 months of age is ideal. This first operation may require another in the future, especially in case of complications.
And, above all, when it affects the nose area, and in the same way, the scar needs repair surgery. For its part, the cleft palate needs treatment.
With regard to orthodontics, especially children undergoing palatal surgery may require corrections as their teeth emerge. It will be in the dentist or orthodontist’s office where the necessary tests are done, establishing diagnoses and treatments from a multidisciplinary perspective.
Then come the touch-ups, if the nose is taken care of a little or there is deviation on the tip at four years of age, according to the program.
If you have speech problems, it is evaluated at four years and if necessary, an intervention is performed to improve speech.
Whether you are a practitioner, parent, or sibling of a cleft-lip patient, always remember that it is an ongoing process. They need emotional and moral support along with the physical treatment. With your constant encouragement, they will regain their encouragement. In case for more details on the condition and further queries, you can reach out to our capable team of healthcare providers at Dr.Amal Al-Qedrah to know more.