Description

Cleft lip and cleft palate are openings or splits in the upper lip, the roof of the mouth (palate) or both. Cleft lip and cleft palate occur when an unborn baby's face and mouth are developing and the upper lip and the palate is not completely closed.

Cleft lip and cleft palate are among the most common birth defects. These birth defects can occur alone or together. Sometimes a syndrome that can cause birth defects. But often the cause is not known.

Having a baby born with a cleft can be upsetting, but the treatment can correct the cleft lip and cleft palate. After a series of surgeries, the lips and the palate of work as they should and the baby looks so much better. Usually, only a light scar occurs.

Symptoms

Generally, a split (cleft) in the lip or the roof of the mouth (palate) can be seen immediately at birth. It can be detected before birth, during a prenatal ultrasound. Cleft lip and cleft palate can be seen as:

  • A fissure in the lip and palate that affects one or both sides of the face.
  • A fissure in the lip that appears as only a small notch in the lip or extends from the lips through the top of the gums and the palate at the bottom of the nose.
  • A crack in the roof of the mouth that does not affect how the face looks.

Less often, a fissure occurs only in the muscles of the soft palate, which are at the back of the mouth, and covered by the mouth's lining. This is called a submucous cleft of the palate. This type of crack can not be seen at birth and may not be diagnosed until later when the signs arise, such as:

  • Having a hard time feeding.
  • Nasal speaking voice.
  • Constant ear infections.
  • Rarely, having a hard time swallowing. Liquids or foods that may come out of the nose.

When to see a doctor

Cleft lip and cleft palate can be seen at birth or can be found on the ultrasound before the birth. Your health care professional may initiate the coordination of care in that moment. If your baby has symptoms of a submucous cleft of the palate, make an appointment with your child's health care professional.

Causes

Cleft lip and cleft palate occur when tissues in the baby's face and mouth do not stay together well before birth. Generally, the tissues that make up the lip and the palate come together in the first weeks of pregnancy. But in babies with cleft lip and cleft palate, they never come together or they only come together until the middle, leaving an opening.

Both genes and the environment can cause cases of cleft lip and cleft palate. But in many of the infants, the cause is not known.

The mother or the father can pass on genes that cause clefting, either alone or as part of a genetic syndrome that includes a cleft lip or cleft palate as one of its signs. In some cases, the babies inherit a gene that makes them more prone to getting a slit, and the combination with environmental factors, which causes the split to occur.

Risk factors

Various factors may make it more likely that a baby receives a cleft lip and cleft palate, including:

  • The history of the family. Parents with a family history of cleft lip or cleft palate may be at greater risk of having a baby with a cleft.
  • Exposure to certain substances during pregnancy. Cleft lip and cleft palate may be more likely to occur in pregnant women who use tobacco, drink alcohol or take certain medicines.
  • Not getting certain vitamins during pregnancy. For example, not having enough folate in the body during the first trimester of pregnancy may increase the risk of cleft lip and cleft palate.

Men are more likely to have a cleft lip with or without cleft palate. Cleft palate without cleft lip is more common in women. In the united states, the cleft lip and cleft palate are more common in people of Native American or Asian heritage and least common in african american heritage.

Complications

Children with cleft lip with or without cleft palate are facing several challenges, depending on the type and severity of the crack, including:

  • Having a hard time feeding. One of the concerns immediately after birth, is the food. While the majority of babies with cleft lip can breast-feed, a cleft palate can make it difficult to suck.
  • Ear infections and hearing loss. Babies with cleft palate are especially at risk of developing fluid in the middle ear and loss of hearing.
  • Dental problems. If the cleft extends through the top of the gums, the teeth may not develop properly.
  • Having a hard time with the speech. Due to that the babies use the palate to form the sounds, a cleft palate can affect the normal development of speech. Also, the language can have a nasal sound.
  • The challenges of coping with a medical condition. Children with cleft palate may face social, emotional and behavioral problems due to the differences in the appearance and the stress of medical care.

Prevention

After a baby is born with a cleft, the parents may be concerned about if they will have another child with the same condition. While many of the cases of cleft lip and cleft palate can't be prevented, think about these steps to reduce the risk:

  • Consider the possibility of genetic counselling. If you have a family history of cleft lip and cleft palate, tell your health care professional before you get pregnant. Your health care professional may refer you to a genetic counselor who can help you to calculate the risk of having children with cleft lip and cleft palate.
  • Take prenatal vitamins. If you are planning to become pregnant soon, ask your healthcare provider if you should take prenatal vitamins. These contain important vitamins and minerals you and your baby need.
  • Do not use tobacco or alcohol. Use of alcohol or tobacco during pregnancy increases the risk of having a baby with health problems at birth.

Diagnosis

Most cases of cleft lip and cleft palate are seen immediately at birth, so special, the tests are not necessary. Cleft lip and cleft palate are often seen on ultrasound before the baby is born.

Ultrasound before birth

A prenatal ultrasound is a test that uses sound waves to create images of the development of the unborn baby. When the study of images, a health care professional can see the differences in facial structures.

Health professionals can use the ultrasound to find the cleft lip, beginning around the 13th week of pregnancy. Sometimes a professional of the health can be found cleft lip above the use of 3D ultrasound techniques. As the baby is still in development, it can be easier to diagnose a cleft lip. Cleft palate that occurs alone it is difficult to see using ultrasound.

If an ultrasound is a cleft lip or cleft palate, parents can meet with specialists to start planning for the care before the birth.

Genetic counseling

If the cleft lip or cleft palate is found before birth, your health care professional is often recommended to meet with a genetic counselor. If a genetic syndrome is suspected due to the prenatal ultrasound shows a slit, your healthcare provider can offer a procedure to take a sample of amniotic fluid from the uterus. This is called amniocentesis. The fluid test can show whether the fetus has inherited a genetic syndrome that can cause other health problems at birth.

Health professionals tend to offer genetic consultation to all parents who have a child born with a cleft lip or cleft palate. During genetic counseling, the results of any genetic test are discussed, including what caused the cleft lip or cleft palate, if the future of the children may be at risk of being born with a cleft lip or cleft palate, and if more evidence is needed. A medical geneticist can decide on the right of the test. But the cause of cleft lip and cleft palate, most of the times you will not know.

Treatment

The goals of treatment of cleft lip and cleft palate are to make it easier for a child to eat, speak and listen, and to achieve a typical aspect of the face.

For the care of children with cleft lip and cleft palate, often requires a team of health professionals, including:

  • Surgeons who specialize in the repair, such as plastic surgeons or ear, nose and throat doctors (Ents).
  • Oral surgeons.
  • Otolaryngologists, also called otolaryngologists or ent.
  • The pediatricians.
  • The pediatric dentists.
  • The nutrition or lactation consultants.
  • Pediatric sleep medicine specialists.
  • The orthodontists.
  • Nurses.
  • Ear or the hearing of experts.
  • Speech therapists and pathologists.
  • Genetic counselors.
  • The social workers.
  • The psychologists.
  • Nurse practitioners or physician assistants.

The treatment involves surgery to repair the cleft lip and cleft palate, and therapies to make any related to best conditions.

Surgery

The surgery to correct the cleft lip and cleft palate based on your child's situation. From the cleft of the repair, your health care professional may recommend a follow-up surgeries to make the speech better or do the lip and the nose look better.

Health professionals tend to do surgeries in this order:

  • Cleft lip repair — between 3 and 6 months of age.
  • Cleft palate repair by 9 to 18 months (usually around 1 year) or before if possible. This surgery occurs after repair of cleft lip.
  • Follow-up surgeries — between age 2 and the end of adolescence.

Cleft lip and cleft palate surgery is performed in a hospital. Your child will get medicine to go to sleep and not feel pain or be awake during the surgery. Surgeons use a variety of techniques and procedures for the repair of cleft lip and cleft palate, the reconstruction of the affected areas, and prevent or treat complications related to the.

In general, the procedures may include:

  • Cleft lip repair. To close the gap in the lip, the surgeon makes cuts in both sides of the cleft, and create flaps of tissue. Then, the surgeon may suture these flaps together, including the muscles of the lip. The repair should create a more usual lip appearance, structure and function. Nasal repair, if necessary, is usually done at the same time.
  • Cleft palate repair. Surgeons may use a variety of procedures to close the separation and rebuild the roof of the mouth (hard and soft palate), depending on the situation of your child. The surgeon makes cuts in both sides of the cleft, and placed the tissue and muscles. Then, the surgeon sutures in the repair closed.
  • Ear tube surgery. For children with cleft palate, surgeons can place tubes in the ears to reduce the risk of the constant of the fluid in the ear can lead to hearing loss. Ear tube surgery involves the placement of small coil in the form of tubes in the eardrum to create an opening to prevent the accumulation of fluid.
  • Surgery to improve the appearance. A child may need more surgeries to make the mouth, the lips and the nose look better.

Some children with the most severe clefts of the lip and palate may need orthodontic treatment before surgery to bring the edges of the cleft more close. Generally, it involves nasoalveolar molding with an orthodontic appliance or special of the ribbon through the slit.

Nasoalveolar molding is not a surgery. It is a process that consists of applying the ribbon through the slit, and sometimes the devices that improve the shape of the nose. In patients with cleft palate, an additional prosthesis can be placed on the roof of the mouth to better align the structures of the upper jaw, also known as the upper jaw. Consultation with a specialist team early in the first 1 to 2 weeks after birth, it is important to determine if your child qualifies for nasoalveolar molding.

The surgery can improve your child's quality of life and your child to eat, breathe, and speak better. Possible risks of the surgery include bleeding, infection, poor wound healing, enlargement or raised scars, and short-or long-term damage to other structures.

Treatment of complications

Your health care professional may recommend a treatment for other structural and functional changes that the cleft lip and cleft palate causes, such as:

  • Feeding strategies, such as the use of a special of the nipple of the bottle or feeder.
  • Speech therapy to make it more easy to talk to.
  • Orthodontic adjustments to the teeth and the bite, such as having braces.
  • Monitoring by a pediatric dentist for tooth development and oral health from an early age.
  • Monitoring and treatment for ear infections, which can include tubes in the ears.
  • Monitoring of the hearing and provide hearing aids or other devices for a child with hearing loss.
  • Therapy with a psychologist to help the child deal with the stress of repeated medical procedures or other problems.

Regular screening and treatment for health problems is largely confined to the first two decades of life, but of a lifetime of monitoring may be needed depending on your child's individual health problems.

Coping and support

When the excitement of the new life we met with the stress of discovering that your baby has a cleft lip or cleft palate, the experience can be emotionally demanding for the whole family.

For parents and family

Time to welcome a baby with a cleft lip and cleft palate in your family, keep these coping tips in mind:

  • Do not blame yourself. Focus your energy on supporting and helping your child.
  • Accept your emotions. It is completely normal to feel sad, overwhelmed and upset.
  • Find support. Your hospital social worker can help you find the community and financial resources, education and family support groups.

For his son

You can support your child in many ways. For example:

  • Help your child to gain confidence. Build confidence body language, such as smiling and holding the head with the shoulders back. Encourage your child to take part in decisions about your medical care when at an appropriate age.
  • Let your child know that you are open to speak when necessary. If the teasing, the bullying or self-esteem problems arise, talk with you about it can help.
  • Meet with a mental health professional if necessary. This can help you and your child to learn how to manage.

Preparing for your appointment

If your child was diagnosed with cleft lip, cleft palate, or both, you need to consult the specialists that can help you create a treatment plan for your child. Here's some information to help you prepare and what to expect from your health care professional.

What you can do

Before your appointment:

  • Find out of any type of restrictions before an appointment. At the time of making the appointment, ask if there is something that you need to do before the appointment, as the limit of the diet of your baby.
  • Make a list of the symptoms that your baby is taking, including those that do not seem to be related to the reason for the appointment.
  • Think about bringing a family member or friend. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who comes with you may remember something that you missed or forgot.
  • Make a list of questions to ask your health care professional. A list of questions from most important to least important in case time runs out.

Some questions to ask your health care professional may include:

  • What my baby has a cleft lip, cleft palate, or both?
  • What made my baby with cleft lip or cleft palate?
  • What tests does my baby need?
  • What is the best treatment plan?
  • What are the alternatives to the treatment approach that you're suggesting?
  • Are there any restrictions that my baby needs to follow?
  • Should my baby to see a specialist?
  • Are there brochures or other printed material I can have? What sites do you recommend?
  • If I choose to have more children, there is a possibility that they may also have a cleft lip or cleft palate?

Do not hesitate to ask other questions.

What to expect from your doctor

Your healthcare provider will probably ask you several questions, such as:

  • Does your family have a history of cleft lip and cleft palate?
  • Does your child have problems, while power, such as nausea or breast milk until through the nose?
  • Does your child have any symptoms that worry you?
  • What, in any case, it seems that your baby's symptoms better or worse?

Preparing and hoping questions will help you make the most of your appointment time and allow you to cover any other items that you want to talk.

Symptoms and treatment of Cleft lip and cleft palate