One of the most heart-breaking of all human afflictions is a baby or child born with a cleft lip or cleft palate. These so-called orofacial clefts are developmental defects that occur during pregnancy, and though cleft lip and cleft palate are related, they can occur independently of one another or simultaneously.
Children born with one or both defects are faced with the prospect of a multi-year sequence of treatment procedures. The parents of these children must be prepared to make this long journey with them. The more they know about the nature and treatment of cleft lip and cleft palate, the better they will be able to cope with it.
A cleft lip is a split in the upper lip that can involve the nose and portions of the upper jaw. A cleft palate is an opening in the roof of the mouth that can extend throughout the length of the palate. It creates a direct communication between the mouth and the nasal passages and can interfere with breathing, eating, drinking, and speaking.
These developmental defects are among the most common of all birth defects, and they occur in children of both sexes and all races. Statistically, cleft lip is more common in boys, but girls are more likely to have cleft palate.
Cleft lip and cleft palate result from the incomplete development of certain parts of the head during pregnancy. The right and left portions of the face and head normally join in the center during early development, but clefts occur when they fail to properly connect.
Stanford Children's Health reports that nearly 7,000 babies are born each year in the United States with one or both these abnormalities. It is fortunate that most of these children have no other birth defects and are otherwise healthy.
The cause of these defects is something of a mystery. They are impossible to prevent or predict and though they can sometimes be detected late in pregnancy with ultrasound, they are often not discovered until birth.
Some experts suggest that there is a genetic component to cleft lip and cleft palate, while others believe they could result from medications or substances the mother is exposed to during pregnancy. Certain medications used to treat epilepsy are especially suspect.
There is also strong evidence to suggest that mothers who smoke or have diabetes are more likely to have a baby with orofacial clefts. All these factors, as well as possible others, may play a part in the formation of orofacial defects.
Fortunately, many of the problems caused by cleft lip and cleft palate are treatable. They do, however, require the long-term involvement of providers from a multitude of specialties.
What is well known about cleft lip and cleft palate is that they pose serious problems for the child who has one or both conditions.
First and foremost, these include difficulty in eating, breathing, and speaking. These children also suffer a higher rate of ear infections, hearing loss, and they have a wide variety of dental-related problems.
Children suffering from these defects also understandably have self-esteem issues and often do not develop adequate social skills. This can result in a variety of psychological problems.
Most alarmingly, this condition can be fatal. In recent years, as many as 3,000 children worldwide succumbed to the effects of this congenital defect.
Fortunately, cleft lip and cleft palate are treatable. They do, however, require the long-term involvement of providers from a multitude of specialties. These can include surgeons and dentists; ear, nose, and throat specialists; and speech therapists and speech pathologists. Often included in the team are nurses, psychologists, geneticists, pediatricians, social workers, and other types of medical specialists the patient requires.
The treatment for cleft lip and cleft palate is extremely involved and lengthy. Depending on the severity of the defects, it can involve a series of surgical procedures, starting soon after birth and continuing throughout childhood and into early adulthood. The surgical approach is designed to close the separated soft tissues, and in the case of cleft palate, use bone grafting material, taken from the hip, rib, chin, or skull, to fill in the void in the palate and upper jaw.
Dental specialists, including orthodontists and prosthodontists, are often needed to help manage the positioning of the erupting teeth and fill in the spaces that can be present. One of the things that the prosthodontist might be called upon to do is to fabricate a special prosthesis for the patient to wear that will act as an artificial palate to separate the mouth from the nasal passages. These so-called speech bulbs or palatal lifts, when properly coordinated with a speech pathologist, can greatly improve the quality of speech.
The result of what often amounts to nearly two decades of specialized treatment is usually quite good. Children lucky enough to have access to the best possible treatment can usually achieve normal or nearly normal function and appearance.
The American Cleft Palate – Craniofacial Association recommends that a special interdisciplinary group of healthcare providers, known as a cleft and craniofacial team, take responsibility for coordinating the treatment of children suffering from these defects. These teams exist to ensure that everyone works together to provide the best care available. They are located throughout the United States, and in other countries as well. Those interested in finding and contacting the nearest team are encouraged to visit the Cleft and Craniofacial Teams and Centers website for more information.
Most children who receive appropriate treatment for their cleft lip and cleft palate manage to recover from the physical and psychological problems it causes and lead happy and productive lives. However, it is a long and tortuous road to complete recovery for both the child and the parents. Those families affected are encouraged to seek out support groups consisting of other families with children suffering from this condition.
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