Complications of Cleft Lip and Cleft Palate

A cleft is a separation in the upper lip or palate (roof of the mouth). It is a congenital defect. This happens because these parts could not join during the development happening during pregnancy. These defects are also known as “orofacial clefts”. A cleft lip and palate is the most common facial birth defect across the globe.

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What is a cleft lip?

An opening formed in the upper lip during the development phase is known as cleft lip. Normally, the lip is formed in 4th to 7th week of pregnancy. During the developmental phase, the cells and the tissues grow towards the center of the face and join to make the facial features. A cleft lip happens when this joining process does not take place. It can take place on either side of the lip or in the middle.

What is a cleft palate?

The palate i.e the roof of the mouth is formed between the 6th and 9th weeks of pregnancy. A cleft palate occurs the tissues of the mouth fail to join during the developmental phase.

Causes of cleft lip and cleft palate

The exact causes of cleft lip and cleft palate are unknown. The cases are generally congenital as the problem originates during the pregnancy. However, as per some researches, most of the cases can be associated with the following factors:

• Similar genetic information in the parents (one or both)

• Smoking or alcohol consumption during pregnancy

• Obesity during pregnancy

• Deficiency of folic acid during pregnancy

• Intake of medications like anti-seizure drugs and steroids in early pregnancy.

• In rare cases, certain birth defects like 22q11 deletion syndrome also known as a velocardiofacial syndrome and Pierre Robin sequence can also lead to the condition.

Complications or problems faced in children with cleft lip and palate

This condition is not just an aesthetic issue, there are numerous functional complications that occur in a child with this illness:

Feeding problems - Children with cleft palate have an opening between the mouth and the nasal passage. The children cannot be breastfed or take anything from the normal milk bottles.

Hearing difficulty - In children with cleft palate, there an increased fluid build-up in the middle ear due to which there are more chances of infection. The ear infections if not treated timely, can also cause hearing loss.  

Dental problems - Incomplete development in the cleft lip and palate also hampers the proper development of dental structures like teeth and alveolus. An alveolus is the bony part of the gum that holds and anchors the teeth. Children with an alveolar ridge defect are more prone to:

• Displacement, tipping or rotation of permanent teeth

• Non-eruption of permanent teeth

• Improper development of the alveolar ridge

Speech problems - Children with cleft palate and cleft lip tend to have an unclear voice with nasal sounds.

Diagnosis

The cleft lip can be diagnosed in the mid-pregnancy week (18th - 21st ) by an ultrasound. However, complex cases might not show up in the routine ultrasound. The cleft palate is usually diagnosed after the birth or within 72 hours from the birth. In such cases, the child is referred to a specialist who explains the parents all possible treatment options and about counseling sessions the child as he/she grows up.

Treatment

The treatment for cleft lip and cleft palate have two types of goals:

• Functional treatment

• Surgery

Functional treatment includes supporting several difficulties faced by the child. These include,

• To ensure proper feeding specially designed baby bottles and nipples to help to keep the fluids flowing down to the stomach. Also, children are made to wear specialized plates for the palate that cover the cleft and act as a barrier, preventing the food from falling into the nasal passage.

• To prevent frequent ear infections, specialized tubes inserted in the eardrums to aid drainage of fluid. Also, hearing power must be checked regularly.

• Children with speech problems should consult a speech doctor called the pathologist to resolve the speech difficulties.

Surgeries

• Cleft palate repair surgery - The procedure involves the closure of the separation and rebuilding the roof of the mouth including soft palate and hard palate. The surgery involves an incision on both sides of the cleft and reposition of the tissues on the cleft followed by the sutures.
• Cleft lip repair surgery - To close the cleft lip, incisions are made on both sides of the cleft and flaps of tissue are created. The flaps are then stitched together. The surgery is performed carefully as the lip should look normal in appearance, structure, and function.
• Multiple oral surgeries to repair dental issues.

Due to advancement in the healthcare sector, several new inventions have been made to treat and repair such genetic defects. However, according to some of the best ENT surgeons in India, the most important factor is to provide regular counseling to the child to help them feel confident about him/herself.