Cleft lips and palates are among the most common oral and facial malfunction that can occur pregnancy, typically during the 2nd or 3rd months of development. So, how does it happen, and how is it treated?
A cleft lip is a physical separation between the left and/or right side of the upper lip. During fetal development, the two sides don’t fuse properly and as a result, a narrow gap forms in the upper lip and can even be present in the upper jaw or gums. A cleft palate is similar, except that it’s a physical separation between the left and right sides of the hard palate (front of the roof of the mouth) or soft palate (back of the roof of the mouth), rather than the lip. Both conditions can also range in size from a small slit to a wide gap, and this often plays a large role in determining how much treatment is needed to fix the problem.
The CDC estimates that there are 2,650 babies born each year with a cleft palate, and 4,440 children born with a cleft lip. Most commonly, these babies are of Asian, Latino or Native American descent, and boys are more likely to have a cleft lip while girls are more likely to have a cleft palate. It’s also possible for a child to have both conditions at the same time.
The causes of cleft lips and palates are largely unknown, but several potential factors have been identified. Scientists think that there is a genetic component to the condition, as it has been seen to occur in siblings. Some medications taken during pregnancy are also thought to contribute, such as medications for cancer, seizures, arthritis, and psoriasis. Diabetes and obesity in the mother are also thought to increase the likelihood of cleft lips and palates, though the association is not yet clear.
These days the malformation can often be diagnosed during an ultrasound before birth, but it’s not always possible depending on the position of the baby or the clarity of the images. In those cases, the condition will only be diagnosed right after birth, as it is physically obvious and easy for the doctors and nurses to identify.
A series of surgeries are needed to repair a cleft lip or a cleft palate, and it often takes a team of surgeons and specialists to ensure all aspects of the condition have been properly treated. Often, the team will including a plastic surgeon, oral surgeon, orthodontist, dentist, and otolaryngologist (ear, nose and throat doctor), and speech therapy and support from an audiologist will also likely be necessary depending on the child’s speaking and hearing capabilities.
Babies as young as 3 months can undergo the initial correction surgery, and additional surgeries can take place during the first year and a half or even later into childhood and adolescence, depending on the size of the gap and the affect it has on the rest of the mouth, jaw, and face. These later surgeries will help improve the aesthetic appearance of the lip or palate, and also improve the functionality or structure of the oral cavity and sometimes even the alignment and stability of the jaw.
Children with cleft lips or palates may have a difficult time eating due to the space in the lip or palate, and it can be especially difficult for infants to breastfeed because the gaps prevent them from latching and sucking properly. However, there are special bottles and fabricated palates that can help an infant eat normally until the initial correction surgery can be performed.
Children with cleft lips and palates are prone to ear infections, which is typically alleviated by inserting tubes into the ears to alleviate pressure and help prevent a buildup of fluid. In addition, these children also tend to have difficulty hearing and speaking. Slurred or lisped speech and difficulty articulating letters and words are the most common speech problems, which are caused both by the malformation of the lip or palate as well as additional malformation of the teeth and jaws. While additional surgeries can help correct issues with the teeth, mouth and jaw that are and make it easier to speak and hear, a good speech therapist and speech pathologist are instrumental in helping your child speak and communicate more easily, which will help them succeed in school and build strong, healthy relationships with his or her peers.
If you child has a cleft lip or palate, make sure you pay extra attention to cleaning the teeth in infancy and childhood, and begin to schedule orthodontist visits as soon as the teeth develop. It’s typical for these children to have issues with the alignment of their teeth and jaws, so early intervention and careful monitoring by an orthodontist will help catch and treat problems early.
It can often be very emotionally difficult for children to go through surgeries and experience being physically different from other children. It is therefore very likely that your child can benefit from seeing a therapist, who can help him or her deal with any complicated emotions or fears that have arisen due to the medical treatments. Additionally, a therapist can help navigate and manage any difficulties integrating into a school environment, which may be difficult for children who speak or look differently from most other children. Comforting your child and making them feel loved and understood is more important than anything else, and ensuring they have the proper support network in place will help them feel more normal and build their self-esteem.
Although there are many treatment options for children with cleft lips and palates, it is still a complex malformation that can be difficult for parents and children to deal with. It’s important to build a strong relationship with your child’s dental and medical team in order to ensure the best possible care physically and emotionally, and to continuously check in with your child to make sure they are doing well emotionally. Your child’s health and well-being is paramount, and we want to make sure your child always smiles brightly from inside and outside.