Cleft lip is a kind of facial deformity, often congenital in nature, which occurs as a small /wide split or gap in the upper lip since birth. On the other hand, cleft palate is the occurrence of a split in the roof of the mouth. Both, cleft lip and cleft palate, occur due to an improper joining of facial tissues during the development of the fetus in the mother’s womb.
In India, there are almost 1 million untreated cleft afflicted patients and every year almost 35000 infants are born with cleft lip and palate.
Usually, cleft i.e. a split in the lip or in the palate can be recognized easily at the time of birth. According to its physical manifestations, the types of cleft deformities of the lip are categorized as
The different types of cleft palate deformities are –
In addition to the above signs (physical identification), other signs of cleft occurrence are –
The usual symptoms of cleft deformities are –
A particular reason for cleft deformities is still unknown. Although widely considered a congenital birth defect, cleft occurrences have also been observed in babies among couples with no history of similar deformity in both maternal and paternal sides. Among others causes cleft lip and cleft palate are linked to:
As per latest studies among reasons for cleft palate and cleft lip, a defect in chromosome 22 – also referred to as the velocardiofacial/ DiGeorge syndrome – is a popular theory in this regard.
In most of the cases, cleft lip and palate are identified right at the time of birth and hence doesn’t need any particular type of diagnostic test. In fact, a cleft lip can be noticed on ultrasound even before the birth of the child. Cleft palate, on the other hand, is difficult to detect through ultrasound.
A ‘prenatal ultrasound’ can be conducted to detect the growing baby’s cleft deformity. For proper cleft lip identification, this test can be performed after the 13th week of pregnancy. If a cleft lip is detected after performing a prenatal ultrasound, the doctor may also perform another test by collecting amniotic fluid from the uterus as a sample. Through this test, it can be determined whether the cleft lip occurrence is congenital or not.
Due to abnormality occurring in the joining of the lip and/ or palate, feeding a cl;eft baby becomes a concerning issue for the parents. In fact, while trying to feed food/ liquid often spills out from the mouth and enters the nose of the baby. So the parents have to be very cautious during feeding. Moreover, as cleft babies cannot feed fully they mostly suffer from malnutrition and if not intervened timely, it can be fatal. Specially designed feeding bottles and nipples for cleft babies are available that ensure the safe flow of the liquid down the food pipe without interfering with their breathing.
Cleft babies often experience trouble swallowing food. Even when, the food intake is through specially designed feeding bottles and nipples, the food/ liquid can flow back into the nose causing blockage in the air passage. Babies with cleft palate deformities may need to wear an artificial palate protection cap to help them swallow food, without interfering with their breathing.
The untreated cleft palate can lead to speech problems resulting in nasal-voiced speech and/ or unclear vocal sound when the baby turns a little older. After cleft lip and cleft palate repair, speech therapy needs to be given to the patient so that he/she can speak clearly.
Sometimes, cleft afflicted children are found suffering from ear infections. The accumulation of fluids in the middle ear blocks their auditory perception, and if not treated timely can lead to deafness. Even after cleft lip repair, the patient can experience such problems of ear, nose, and throat. That’s why regular check-up following clip surgery is essential to determine any problems occurring in the patient. If diagnosed on time, ear fluid build-up can be treated by doctors by draining off the fluid from the ear, thereby restoring hearing loss.
Cleft afflicted children commonly experience dental problems. Their dental problems can be varied; ranging from missing teeth, small teeth or extra teeth occurring as a result of cleft lips and palate (these are called supernumerary teeth) as well as teeth that are misaligned/ improperly formed resulting in tooth line deformity. Among other dental problems occurring in children with cleft lip and cleft palate are – gum (alveolar ridge) defects which can dislodge, rotate or tip a permanent tooth or prevent the new tooth from growing out properly. Children having clefts are also vulnerable to cavities and need orthodontic treatments.
Cleft lip and palate deformities occur in the mouth (oral) and maxillofacial regions which have numerous nerve endings and muscles. Even the slightest of mistakes can become life-threatening for the patient and might cause a permanent damage. Thus, while conducting the surgical procedure to treat children with cleft deformities, specialists are deployed to address issues specific to the facial location where the cleft deformity has occurred/ extended. A team of physicians consisting of maxillofacial surgeons (plastic surgeons), oral wellness specialist (dentists), ENT specialist, anesthesiologists and other medical support staff work together to correct cleft lip and cleft palate through surgical means. A usual team consist of –
The healthcare crew works together to build a plan of care to meet the special needs of every cleft affected patient once they’re inducted into a comprehensive cleft care program.
In a nutshell, after preliminary identification of cleft occurrence, the child’s health condition is thoroughly monitored, i.e. whether the child has proper body weight and is fit enough to undergo the cleft surgery procedure or not. If the cleft child is found to be suffering from nutritional deficiency and exhibits signs of physical weakness/ exhaustion, he/she is recommended for the nutrition program. Under the guidance of a nutritional counselor, the cleft child is fed with nutritional supplements; a few months of care results in health improvement. Once the child attains set parameters (proper weight and health condition), the surgery is conducted on the cleft child gifting him/her with a lifelong smile! A surgical procedure to correct a cleft lip is almost always carried out at 3-6 months and an operation to repair a cleft palate is regularly carried out at 6-12 months.
In this connection, the importance of a few other supportive procedures following up to the rectification surgeries is worth a mention.
Feeding Support -Cleft babies cannot feed normally like normal babies. As breastfeeding is of vital importance for the early development of a child, it becomes a necessity for the parents of a cleft child to learn the proper feeding technique to aid their cleft afflicted new-born in breastfeeding. Alternatively, a feeding bottle with an extended nipple designed to feed babies with cleft deformities is recommended by nutritionists.
Monitor Hearing -Newborns affected with cleft palates often suffers from ‘glue ear’ a condition in which there is a fluid build-up in the space of the middle ear behind the ear drum leading to loss of hearing and even to deafness. Close supervision (through auditory tests, ear exams) can help diagnose the problem. A grommet (a surgically implanted tube placed in the eardrum of the patient to drain off the fluid build-up in the middle ear) is used by ENT (Ear-Nose-Throat) physician to aid babies with glue ear.
Speech and Language Therapy -This recovery procedure is used as a follow-up to the cleft rectification surgeries. Once the cleft lip and palate surgeries are successfully conducted, the child recovers gradually. He/she, then, needs to be taught proper speech and pronunciation. Early intervention and speech and language therapy enable the speaker to learn fast by overcoming his/her difficulty occurring due to surgery. Gradually the child not only smiles like others of his/her age but also learns to speak properly without hesitation/ stuttering.