Cleft lip and cleft palate

Cleft lip and cleft palate are congenital deformities that manifest as openings or splits in the upper lip, the roof of the mouth (palate), or both. These conditions arise when the facial structures of a developing fetus do not close completely during pregnancy.

These birth defects are among the most common, frequently occurring as isolated anomalies but also associated with various genetic syndromes and conditions. Although having a baby with a cleft can be distressing, surgical interventions can correct these defects, restoring functionality and achieving a more typical appearance with minimal scarring.

Symptoms

Cleft lip and cleft palate are typically noticeable at birth. Their appearance can vary:

• A split in the lip and palate on one or both sides of the face.
• A split in the lip that may range from a small notch to a larger opening extending from the lip through the upper gum and palate into the nose.
• A split solely in the roof of the mouth, which might not affect the facial appearance.

Less common is a submucous cleft palate, occurring only in the muscles of the soft palate at the mouth's back, often covered by the lining. This type may not be immediately obvious and can go undiagnosed until later signs emerge, including:

• Difficulty with feedings.
• Difficulty swallowing, potentially causing food or liquids to exit through the nose.
• A nasal speaking voice.
• Chronic ear infections.

When to See a Doctor

A cleft lip or palate is usually identified at birth, prompting immediate care coordination. If signs of a submucous cleft palate appear later, a prompt doctor's appointment is essential.

Causes

Cleft lip and cleft palate occur due to incomplete fusion of facial tissues during the second and third months of pregnancy. This fusion process can fail entirely or partially, resulting in a cleft. Most cases are believed to stem from a combination of genetic and environmental factors, though a specific cause is often undetermined.

Genes from either parent can contribute to clefting, either alone or as part of a syndrome. Sometimes, an inherited gene makes a cleft more likely, with environmental triggers causing the condition.

Risk Factors

Certain factors can increase the risk of cleft lip and palate:

• Family History: A family history of these conditions heightens the risk.
• Substance Exposure: Smoking, alcohol consumption, and certain medications during pregnancy can increase risk.
• Diabetes: Pregnant women with pre-existing diabetes may have a higher risk.
• Obesity: Maternal obesity has been linked to an increased risk of cleft lip and palate.
• Gender and Ethnicity: Males are more likely to have a cleft lip with or without a cleft palate, while cleft palate alone is more common in females. Native Americans in the United States have the highest prevalence, with African-Americans having the lowest.

Complications

Children with cleft lip and/or palate face several challenges:

• Feeding Difficulties: Sucking can be challenging, especially with a cleft palate.
• Ear Infections and Hearing Loss: Middle ear fluid buildup can lead to hearing issues.
• Dental Problems: Tooth development may be affected if the cleft extends through the upper gum.
• Speech Difficulties: A cleft palate can impede sound formation, leading to nasal speech.
• Social and Emotional Challenges: The appearance and medical care associated with clefts can lead to social, emotional, and behavioral issues.

Prevention

While not all cases of cleft lip and palate can be prevented, the following steps can help reduce risk:

• Genetic Counseling: For those with a family history, genetic counseling before pregnancy can help assess risks.
• Prenatal Vitamins: Consult your doctor about taking prenatal vitamins if you plan to conceive.
• Avoid Tobacco and Alcohol: Refrain from using these substances during pregnancy to lower the risk of birth defects.

Conclusion

Cleft lip and cleft palate are treatable conditions, with most cases successfully corrected through surgery. Early diagnosis and intervention are crucial for optimal outcomes, addressing feeding, hearing, speech, and dental issues. Awareness and preventive measures can help manage and reduce the risk of these birth defects.

Sources

1. Mayo Clinic Staff. (n.d.). Cleft Lip and Cleft Palate. Mayo Clinic. Retrieved from mayoclinic.org
2. Centers for Disease Control and Prevention (CDC). (2020). Facts about Cleft Lip and Cleft Palate. Retrieved from cdc.gov
3. American Cleft Palate-Craniofacial Association. (2020). Cleft Lip and Palate. Retrieved from acpa-cpf.org