Definition and Overview

A cleft lip and cleft palate, known technically as an orofacial cleft, is actually a group of various conditions that involve a ‘cleft” on the patient’s face. A patient can have a cleft lip or a cleft palate, or both at the same time. In the case of a cleft lip, the patient has a visible opening in the upper lip, which may extend up into his or her nose. Regardless of the number or location of the cleft in the upper lip—the patient can have one cleft on one side or right in the middle, or have one each on both sides—this is still known as a cleft lip.

A cleft palate, on the other hand, can be not easily seen just by looking at the patient with his or her mouth closed. The roof of the patient’s mouth has an opening that leads directly into his or her nose. A cleft lip and palate involves both the upper lip and roof of the mouth clefts occurring at the same time. It is possible for a patient to have just one of the two conditions, or both. This is because the palate and the lip of the foetus develop separately. Both conditions are considered birth defects, and in most cases, the cause is unknown.

This group of disorders can cause an infant, as well as the parents, various problems, such as difficulty in feeding and speech. Some patients also suffer from hearing problems and frequently occurring ear infections.

One out of 700 babies born every year are affected by cleft lip and cleft palate, and research shows that there is a higher number of infants with Native American, Latino, or Asian descent born with this defect. More male infants have a cleft lip while female infants tend to have a cleft palate without the more visible cleft lip.

The main treatment for these conditions is surgery, which should be performed early in the patient’s life.

Cause of Condition

The cause of cleft lip and cleft palate is unknown in most cases, which means that the occurrence of these conditions in infants cannot be prevented earlier. The cleft in the foetus’ lip or palate can be diagnosed earlier in the pregnancy, but there is nothing that can be done to cure it inside the womb.

Research shows that the occurrence of the conditions can be influenced by genetic factors. The development of the foetus’ face inside the womb is coordinated by various genetic and environmental factors, which makes a lot of room for malformations in facial features. During the first two months of pregnancy, the foetus’ head begins to form. When the tissues from the two sides of the lips and cheeks fail to meet in the middle, the cleft forms.

In some foetuses, the upper lips can meet and fuse together, but the palate will have a cleft in it. The tissues in the upper lift can have a visible physical split, without malformations in the palate. Also, both the upper lip and the palate can have malformations.

In some studies, researchers attribute the occurrence of these conditions to genetic factors—they discovered that cleft lips and palates run in families, with multiple siblings having the malformations if their parents or close relatives have it. They have also identified several genes responsible for the development of facial features.

According to genetic research into clefts, some syndromes can cause facial malformation in infants. For example, the Stickler’s Syndrome can cause cleft lips and palates, as well as myopia and joint pain. Van der Woude Syndrome and Loeys-Dietz Syndrome are also common genetic culprits.

Environmental factors can also be considered as possible causes of cleft lip and palate. Maternal hypoxia, or insufficient supply of oxygen in certain parts of the body (or even the whole body), can be linked to the conditions. Several activities performed while the mother is pregnant can also affect foetal development, such as alcohol abuse, smoking, and even undergoing treatment for hypertension. Research shows that exposure to pesticides, certain ingredients in food that the mother eats, vitamin intake, anticonvulsant drugs, illegal drug use, exposure to chemicals such as lead, and other such factors can affect the proper development of the foetus’ facial features.

Key Symptoms

Cleft lips are often more visible than cleft palates. The main symptom of a cleft lip is a very visible split or notch in the upper lip. The cleft can be on one side of the upper lips or down in the middle, as well as on both sides of the upper lip.

On the other hand, a cleft palate might not be easily visible upon a routine inspection of the child’s face. Symptoms include nasal-sounding speech (as the child’s palate is not whole to make for properly pronounced words), inability to suck in or blow out air, and milk coming out of the nose while the infant is feeding.

Infants suffering from a cleft palate also have an increased risk of ear infections since their condition allows for a fluid build-up in their middle ears.

Who to See and Types of Treatment Available

There are many medical professionals who can treat a cleft lip or a cleft palate. Plastic surgeons can evaluate, as well as perform, surgical procedures to correct the condition. If the infant has suffered from ear-related complications, an otolaryngologist or an audiologist can step in.

An oral surgeon, dentist, and an orthodontist can also contribute to the treatment of the patient. The oral surgeon is qualified to reposition upper jaw segments to improve both the function and appearance of that part of the face. Finally, a speech therapist can help in correcting the patient’s speech, if the surgery is performed after the child has learned to talk.

References:

  • Friedman O, Wang TD, Milczuk HA. Cleft lip and palate. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 4th ed. Philadelphia, Pa: Mosby Elsevier; 2005:chap 176.

  • Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Cleft lip and palate. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 307.

  • Tinanoff N. Cleft lip and palate. In: Kliegman, RM, Behrman RE, St. Geme III JW., Schor NF., Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 302.

  • Arosarena OA. Cleft lip and palate. Otolaryngol Clin North Am. 2007 Feb;40(1):27-60.

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