Cleft Lip & Cleft Palate for Parents
Cleft Lip and Cleft Palate are one of the most common congenital birth defects. It can be in most cases fixed with a few surgeries and minimal scarring to restore normal functioning in babies. Talk to your doctor about the options.
Keep reading to know more about the causes, symptoms, diagnosis, treatment and long term prognosis.
Causes
This happens when the orofacial tissues don't fuse completely during the development of the baby in the womb. The exact cause for this in most cases is unknown but in a few it is associated with genetic conditions or environmental factors. Research suggests that certain women may be at higher risk - drinking, smoking or on medications for any condition or lifestyle diseases like diabetes. The chances also increase if the previous baby or members of the family had a cleft lip or palate. For most part we are not sure as to why some babies get these defects.
Cleft Lip and Cleft Palate Difference:
When the tissue doesn't fuse completely at the lips or at palate or the roof of the mouth it causes these defects. Based on the extent of the defect Cleft Lip and Palate are further classified in to different types:
Forme Fruste Cleft Lip: One of the more subtle type of cleft lip which looks more like a slight indent.
Incomplete unilateral: Cleft lip is present only on one side of the lip and doesn't go all the way to the nose.
Complete Unilateral: Cleft lip happens on one side and goes all the way to the nose
Incomplete Bilateral: Cleft lip happens on either side of the lip but do not go all the way to the nose
Complete Bilateral: Cleft lip happens on either side of the lip and go all the way to the nose
Incomplete Cleft Palate: The tissue does not fuse completely at the back of the mouth or soft palate
Complete Cleft Palate: The tissue doesn't fuse completely at the back of the mouth soft palate and hard palate at the front
Submucous Cleft Palate: The soft palate muscles don't completely fuse but the skin or mucus membrane over it stays intact and also the uvula may be split in two, called a bifid uvula or cleft uvula.
Related: Congenital Heart Defects
Symptoms and Other Complications
In most cases the Cleft Lip and Palate are apparent at birth if missed during pregnancy ultrasound. While they may pose cosmetic concerns there are also a few symptoms and complications associated with these that need medical treatment
Feeding Difficulties: One of the most critical abilities that babies need to develop after birth is feeding. While many babies can still nurse with a cleft lip, they struggle to suckle with a cleft palate and hence need immediate interventions.
Recurrent Ear Infections and Hearing Loss: Babies with cleft palate are more prone to fluid build up in the middle ear due to a tube dysfunction that connect middle ear to throat. Frequent ear infections may lead to hearing loss.
Dental Issues: Cleft Lip and Palate may cause issues with the tooth development and alignment and increase the chances of tooth decay.
Speech Problems: Cleft Lip and Palate may cause speech delays and affect the clarity of speech as the muscles and palate play a role in the way words sound and one may end up sounding nasal.
Diagnosis
Most cases are diagnosed during pregnancy during ultrasound scans or right after birth when doctors do a thorough physical exam of the baby. While Cleft Lip is easy to identify and obvious, isolated cases of cleft palate may be detected only after birth and some like submucous cleft palates may go unnoticed even after birth until the baby presents signs of feeding difficulties, frequent ear infections or frequent vomiting through the nose.
Treatment
Cleft Lip baby surgery is usually done anytime between 3 and 6 months of age. Based on the severity the child may need one to two surgeries to completely correct the defect. The pink scare fades with time and becomes less noticeable.
Cleft Palate baby surgery is more complicated and based on the severity may need more than one surgery to correct the defect. As there is a higher chance of fluid build up in middle ear for babies with cleft palate the surgeries may also look at options like special tubes to help drain the fluid. The doctor performs the first surgery when the baby is around 12 to 18 months of age so that baby can tolerate the surgery and is also grown a bit to operate. Some babies need further surgeries to correct their speech and maybe even a bone graft for upper jaw gum line if the cleft impacts the permanent teeth development.
Long term Prognosis
Most babies will do very well after surgeries and go on to live normal adult lives. In severe cases the child may need multiple surgeries as they grow but eventually even they do well as they heal and grow. Cleft Lip and Palate in most cases is completely treatable and usually poses no other serious health issues unless it is associated with a genetic condition which may need specific evaluation and treatment as per the condition.