A cleft lip or palate is one of the most common birth defects in the United States. Fortunately, a variety of early interventions are available to treat the child with cleft lip or palate. From surgeries to different therapies, treatments are designed to improve a child's ability to eat, to speak and hear, and to normalize the child's appearance.
Description
The face and skull of the fetus develop during the first two months of pregnancy. A cleft or gap develops when tissues forming the lip and/or palate do not fuse together properly. Oral-facial clefts may take the form of a cleft in the lip; a cleft in the palate or roof of the mouth; or a cleft in the lip and palate. Clefts vary in size, from partial to encompassing the entire roof of the mouth and can occur on one side of the face, unilateral, or both sides, bilateral.
Causes
There is no one definitive cause of cleft lip or palate. Researchers believe that most clefts are caused by genetic makeup in interaction with environmental factors. If there is a family history of cleft palate on either parent's side, the risk for cleft palate for their children is higher. Other risk factors include gender--boys are twice as likely to have a cleft lip, whereas girls are more likely to have cleft palates, but not lip; race--babies of Native American or Asian descent are more likely to have clefts; a vitamin B folic acid deficiency during pregnancy; and a mother who smokes, drinks alcohol or uses drugs during pregnancy. The March of Dimes indicates that approximately 400 syndromes include an aspect of cleft lip or palate.
Problems
Multiple complications may result from having a cleft lip or palate. The most immediate is difficulty feeding. A baby with a cleft palate may not be able to suck efficiently. Children with cleft palates are more susceptible to middle ear infections, fluid buildup in their ears and hearing difficulties. A child's ability to produce speech sounds may also be compromised. Some cleft palates affect the alveolar ridge, the bony plate in the roof of the mouth where teeth grow. Teeth may be misplaced or there may not be enough tissue available for a tooth to take root. Social-emotional concerns may develop, especially when the child's appearance is affected.
Treatment
The myriad of potential problems necessitates the need for a multidisciplinary or team approach to treatment. Pediatricians, oral surgeons, plastic surgeons, dentists, orthodontists, otolaryngologists, speech-language pathologists, audiologists, psychologists and geneticists are some of the professionals who may contribute to a child's care.
MayoClinic.com suggests that surgery for cleft lip be done between 10 weeks and 3 months of age, for the palate from 6 to 18 months, and follow-up surgeries from 2 years to the late teens. Additional therapies, for example speech and language therapy, genetic counseling, psychological therapy, and routine follow ups to assess the child's hearing may also be necessary.
Promising Future
MayoClinic.com suggests two potential future treatments of cleft lip or palate: minimally invasive surgery in utero and tissue engineering to create bone growth in the alveolar ridge. The March of Dimes is supporting genetic research along with investigating the role of folic acid in the prevention of clefts.
