Cleft Lip and Palate
What is a cleft?
A cleft lip, or a cleft palate, is a failure of the lip or palate to grow properly during development in the womb. This means the palate or lip will not form as one piece while the fetus is still developing in the uterus. Sometimes, with the aid of an MRI or ultrasound, a cleft can be detected before birth. Clefts are common and may be present in as many as one in every 2,000 births. This makes clefts one of the most frequently seen of all birth defects. A ‘unilateral’ cleft is a ‘cut-like’ opening seen in one side of the palate or lip. A ‘bilateral’ cleft forms on both sides of the palate or on both sides of the face.
A unilateral cleft lip is a defect found on one side of the face.
What are the causes of clefts?
There is little knowledge, and much guessing, as to what causes a cleft. Some thoughts on this include:
Possible genetic causes.
Some medications may be the cause, including anti-epileptic drugs such as topiramate, antiviral drugs (including some drugs taken by the mother for HIV), and amoxicillin, all taken while the fetus is developing. More research needs to be done in this field.
Use of alcohol and smoking during pregnancy may also be a causative factor.
What challenges does the child face?
The child struggles with speech development.
Difficulty in eating and swallowing.
Risk of developmental problems (improper growth) of the palate.
Dental problems are common in children with cleft palates including poorly aligned bite and a prominent (sticking out) of the lower teeth known in dental terms as a ‘class III bite’ (class three bite).
Treatment for cleft palate
Clefts represent a great challenge to babies and their care givers. A cleft palate hinders a baby’s ability to suck formula or milk and later to eat soft foods. Almost always, normal sucking is almost impossible with cleft palates. Special feeders, including the ‘Habermann feeder’ (see image) or ‘Medela special feeder’ will prove useful. These feeders is to teach the baby to bite the nipple in order to draw out liquid as opposed to ‘sucking’ on the nipple.
Typical removable denture with large acrylic palate to cover the cleft.
The skin of the palate is stretched to cover the cleft and stitched for healing.
Treatment might begin as early as a few months of age, and sometimes multiple treatments are necessary. It is sometimes suggested to try and delay surgery until an age when the child is fully grown. Despite risks that come with the surgery such as incomplete palate growth, doctors sometimes recommend early treatment to ensure normal speech development. It is important to discuss all these issues before deciding on surgery at a young age.
For those cases where a family chooses not to have surgery for a cleft palate, the alternative is to have a plastic removable device made. This is similar to a removable partial denture (see above image). This device is designed to fully cover the opening of the cleft in the palate thereby allowing the patient to comfortably drink and eat. The device is taken out and cleaned at night. These devices are made for children prior to surgery or for adults who are waiting for, or refuse, surgery.