The head and face of a developing fetus form early in pregnancy at the intersection of several separate sections of tissues. In order for the face to form normally, the tissues must fuse when they come together. If the tissues that form the head and face do not completely fuse when they meet, the resulting hole manifests as a gap, or cleft. Clefts can form on one or both sides of the mouth. The cleft can range in severity from a slight notch to a complete division of tissues. The cleft and can be confined to the lip or may extend to the nose or may include oral structures in the top of the mouth such as the gums and palate. In rare cases, an isolated cleft in the palate can form.
Diagnosis and Testing
Cleft lip and palate are easily identified at birth; however, many cases of cleft lip and palate are diagnosed during prenatal ultrasound examinations. No matter when the diagnosis is made, it is likely that genetic testing will be performed in order to determine if the cleft is part of a genetic syndrome that may place the baby at risk for other complications. This information can be used to help create an appropriate treatment plan.
Risks and Causes
There is no single cause for cleft lip and palate. Rather, there are a variety of risk factors that may contribute to the formation of a cleft during development. It is not always possible to determine the underlying cause of a cleft.
Cleft lip and palate can occur as a result of the presence of several different genetic syndromes, although it can also occur alone. There is also a definite family connection, as parents who were themselves born with a cleft are much more likely to have children with a cleft of some type. There is a relationship with gender, as clefts are more common in boys than in girls. Environmental factors such as maternal obesity and prenatal exposure to tobacco smoke, alcohol or illicit drugs also appear to be risk factors for the development of a cleft.
Surgical Repair
Surgery to repair a cleft lip is generally performed within the first three months of life, depending on the health of the baby. During this surgery, the child is placed under general anesthesia, and the tissue of the lip is trimmed, pulled together and then stitched. Cleft palate repair is done when the child is a little bit older, generally between nine and twelve months of age. Under general anesthesia, the surgeon pulls together the tissues of the roof of the mouth and stitches them. This is a more complex operation, and it may require more than one surgery to completely close a cleft palate.
Immediate Complications
The first and most immediate issue that a child with cleft lip and palate will face is obtaining nourishment. Although most babies with a cleft can be successfully breast or bottle fed, they are likely to have difficulty maintaining adequate suction and may be more likely to gag or pass milk out their noses. Specially designed bottles can be used to reduce these problems. Babies with a cleft palate may be helped by the use of a small plastic plate, called an obturator, which is placed inside the mouth during feeding to cover the hole in the palate.
Long Term Complications
Children who were born with cleft lip and palate require monitoring by a medical team throughout their childhood in order to address the special challenges and complications that they may face. These challenges include an increased risk of ear infections, problems with speech articulation, as well as the potential for missing or malformed teeth, particularly if the cleft extends into the upper gums.
