Cleft lip and Palate

Cleft lip and palate are congenital (birth) defects affecting 1 in every 700 live births. The word 'Cleft' means a split or gap. Cleft lip is condition where there is a split in the lip, usually upper lip. Cleft palate is seen inside the mouth and on the roof or palate.

The exact cause of cleft lip and palate is not known. Some believe it could be due to genetics and environmental factors. There are great chances of a baby being born with cleft if either of their parent or sibling have one too. Another possible cause might be certain medications that are taken during pregnancy. In certain conditions it can be a part of another syndrome.

Cleft lip and palate can be diagnosed during prenatal check-up through ultrasounds. If undiagnosed at this stage, a physical examination of mouth, nose and palate of new born can help in diagnosis.

Cleft lip and palates usually occur together or sometimes individually. Cleft lip is more commonly seen on left side and more in females. The associated problems depend on the severity of clefting. Generally the problems faced by these children are till their adolescent ages.

  • Eating/feeding problem: due to cleft, there is difficulty in formation of proper seal to contain the food in mouth. There is regurgitation of liquids through nose.
  • Ear infections/hearing difficulties: more prone to middle ear infections due to fluid accumulation in these patients. If left untreated it can lead to permanent hearing loss.
  • Speech problems: these patients have difficulty in pronouncing certain words and usually have a nasal twang due to cleft of palate.
  • Dental problems: they are more prone to dental caries, missing tooth, abnormal tooth shape/size and a small dental arch/jaw. In addition they also have clefts of alveolus or tooth bone.

Treatment of cleft patients involves multi-disciplinary approach. From the time of birth till their adolescents various speciality doctors are involved. These include Neonatologists, Paediatrician, Oral and maxillofacial surgeons, Plastic surgeons, Orthodontists, Prosthodontists, General dentists, Speech therapists & Pathologists, ENT surgeons, Nutritionists, Audiologists and a Social worker.

These patients are treated at different stages in life from birth through childhood to adolescence. These patients require multiple surgeries.

At 3-6 months cleft lip is repaired; cleft palate is repaired at 1-1 ½ years of age, cleft of bone is treated at age of 11-14 years; the brackets/braces treatment is started at adolescents and jaw surgeries are carried out at 15-18 years; finally any nose problems or scar corrections are done after 18 years.

These surgeries are dictated at different stages of growth and development keeping in mind the normal growth spurts of the child.

Cleft is more commonly seen in the lower socio-economic groups, probably because of lack awareness for treatment. In India, some people consider it to be a stigma of the poor. Which is untrue, as cleft lip and palate defects may be seen equally in all socioeconomic groups. Early detection and prompt treatment is needed. Proper education of the parent and/or relative of child is of utmost importance. Counselling plays a vital role. Making them to understand that it is not a taboo and can happen to anyone; emotionally supporting the child helps immensely. Various NGO are presently available for identifying and bringing together such patients for the treatment.

Last updated on 23 November, 2018.

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