Cleft lip and Palate

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In the United States, cleft lip and palate is the fourth most common birth defects, affecting one in every 1,000 babies each year. According to the CDC, when a baby's lip or mouth does not develop properly or closes fully during pregnancy, it is known as cleft lip and palate. Orofacial clefts are the general term for these birth defects. A baby may have a cleft lip, a cleft palate, or both at birth.

The lip develops between the fourth and seventh weeks of pregnancy. The tissue that makes up the lip does not fully join before birth, resulting in a cleft lip. Therefore, the upper lip develops an opening. This can impact either one (unilateral) or both (bilateral) sides of the mouth, and it can be complete, which means that cleft extends all the way up into the nose, or incomplete does not extend all the way up into the nose.

The roof of the mouth (palate) is formed between the sixth and ninth weeks of pregnancy .A cleft palate happens if the tissue that makes up the roof of the mouth does not join together completely during pregnancy. A cleft palate can affect the soft palate or the hard palate (the bony part).

Nutrition is especially important for infants born with cleft lip and palate. These children require infection resistance, stamina for surgery, and the nutrients required to heal after surgery. The vast majority of children born with a cleft lip or palate go on to live normal lives. The most of affected children will not have any other serious medical problems, and treatment can usually improve the appearance of the face as well as feeding and speech problems.

Causes and Risk Factors

A definite cause is not found in many babies but Researchers believe that the majority of cases of cleft lip and cleft palate are caused by a combination of genetic and environmental factors, such as what the mother comes into contact with in her environment, what she eats or drinks, or certain medications she uses during pregnancy. 

Recently, reported some risk factors for having a baby with an orofacial cleft:

  • Diabetes― Women who have diabetes prior to pregnancy are at a higher risk.

  • Taking certain medicines in early pregnancy, such as some anti-seizure medications and steroid tablets

  • Smoking― Women who smoke while pregnant will have an orofacial cleft more likely than others.

  • Obesity during pregnancy.

 

Diagnosis

A cleft lip is usually detected during a mid-pregnancy anomaly scan, which is performed between 18 and 21 weeks of pregnancy. If a cleft lip or palate is not detected on the scan, it is usually diagnosed shortly after birth or during the newborn physical examination performed within 72 hours of birth.


 

Symptoms

Males are more likely than females to have a cleft lip and palate. Females are more likely to have cleft palate without cleft lip. At birth, a split (cleft) in the lip or palate is usually obvious. Depending on the type and severity of the cleft, children with cleft lip and/or cleft palate face a variety of challenges. 

For example, they are vulnerable to a variety of health complications, including malnutrition, which can result in morbidity and failure to thrive. They are also at a high risk of laryngeal penetration and aspiration, both of which can result in pneumonia. Other complications related to cleft lip and palate include:

  1. Difficulty feeding.

  2. Feeding is one of the most pressing concerns after birth. Babies must be able to form a vacuum inside their mouths in order to feed effectively, and they must be able to position their tongue properly in order to form a good seal with their mouth. While most babies with cleft lip can breast-feed, a cleft palate may make sucking difficult.

 

   3.Ear infections and hearing loss. 

     Babies with cleft palate are especially at risk of build-up of fluid in their ears and hearing loss.

   4. Dental problems. 

      If the cleft extends through the upper gum, tooth development may be affected including a greater number          of cavities as well as missing, extra, malformed or displaced teeth.

    5. Speech difficulties. 

        Because the palate is used in forming sounds, a cleft palate can affect the development of normal speech. 

    6. social, emotional and behavioral problems

        Due to differences in appearance and the stress of intensive medical care.

 

Prevention

Cleft lip and cleft palate in the baby can't always be prevented. However, you can do things to reduce the chance of your baby's birth defects:

 

  • Get a preconception checkup.

  • Take prenatal vitamins such as folic acid.

  • Don't use tobacco or alcohol and maintain healthy weight before pregnancy

  • You may need to stop taking some medications or switch to one that’s safer during pregnancy

  • Protect yourself from infections, vaccinations help protect you from certain infections

 

Infants with cleft lip and palate need immediate treatment. There was a significant reduction in failure-to-thrive rates for children with cleft palate after an early intervention feeding program was introduced.