What is Cleft
A congenital defect where the baby has improperly formed lip or mouth is concluded in the “orofacial deformities”. The two most common categories are:
Cleft lip – a condition in which the lip does not form entirely as the lip tissues fail to fuse or join fully before birth. It will appear either as a lip notch in mild cases or a huge opening/gap from lip to nose in severe cases.
Cleft palate – a condition in which the tissue of the mouth’s roof fails to develop or does not fuse fully during pregnancy. This opening leads through the nasal cavity. One or both sides of the palates can be involved.
If we look at the broader range, the cleft deformity is known to be more popular and affects children more frequently of Asian descent.
As far as gender is concerned, the surveys have shown that twofold as many boys as girls with a cleft lip are found, either they have a cleft palate or not. On the contrary, two times as many girls as boys are found with cleft palate without having a cleft lip.
What are the major causes of Cleft Lip and cleft Palate?
The cleft lip and cleft palate causes can vary depending on the mother and child’s development. Mostly, the cause is unknown but as science has evolved, the following reasons are considered significant.
- Genetic changes or Inheritance in a family – The genes inherited from both or any of the parents OR faulty genes development during conception are the major causes. The chances are high in newborns who already have a sibling or either parent with the cleft problem.
- External factors – Also called environmental factors, such as exposures to toxic matters, and viruses, OR the use of harmful medication during pregnancy can result in cleft deformities.
- Substance Abuse – Mother dealing with the issues of smoking, tobacco or nicotine use, and drug abuse during pregnancy can give birth to a baby with cleft palate or lip.
- OTC medication – As the doctors say, one of the significant reasons behind cleft is the use of excessive, harmful, or unprescribed medications during pregnancy. The highlighted ones include drugs used for seizures, acne, psoriasis, any kind of malignancy, and arthritis.
- Folic acid deficiency – Having a drastically low vitamin B9 in the pregnancy period can be another reason as it can affect a baby’s normal growth.
Ways to diagnose Cleft
Do you know why it is said that cleft lip and palate are easier to diagnose? Because both are physical deformities that can be observed with the use of various advanced apparatuses even before delivery.
- Ultrasound – The safest way for diagnosis before a baby is born is to perform a prenatal ultrasound that helps detect the deformity after the completion of 16 weeks into a pregnancy. The downside is that it only diagnoses 7% of the patients.
- Amniocentesis – In case of doubting prenatal ultrasound, a fluid test called amniocentesis is performed to confirm the diagnosis, in which a required amount of amniotic fluid is extracted from your uterus and evaluated whether the fetus is inborn a genetic disease or not.
- Visual and Physical examination – After birth, the doctor must conduct a detailed physical assessment and comprehensive visual examination of the newborn’s mouth, nose, and palate.
- Fetal MRI – It can help the doctor assess the level of deformity along with the involvement of the tissues (hard palate or soft palate).
Whether the newborn has a cleft lip, cleft palate, or both, he/she will face wide-ranging issues that will hinder her/his nutrition, daily life activities, and breathing. And, remember the complications rely on the severity and extent of the deformity.
Let us go through a few major technicalities that you must know if you are a medical student or have a baby with orofacial deformity.
Nutrition and feeding problems
Do you know what is the most immediate concern as soon as the baby comes into the world? FEEDING! Without nutrition, who can survive? No-one!
Babies with cleft lip relatively get better nutrition and can even be breastfed. Whereas, having a cleft palate makes the sucking problematic. The evident problem of children with cleft lip and palate is eating complications that includes:
- Swallowing difficulties
- Possibility of food items particularly liquids to come out through the nose
- Sucking problem is noticeable in patients with cleft palate
Chronic auricle infections
Children with cleft lip and palate are more prone to infections, particularly of the middle ear. And in the worst-case scenario, hearing loss can occur at a very young age. Well, the problem lies as it can reoccur and recurrent infections are more damaging.
The reason is the possible fluid build-up in the middle ear.
Another one of the most significant issues is delayed, disrupted, or improper tooth development. They might have an extra or missing tooth. Besides, teeth can be malformed, or displaced making the feeding tougher.
Have you ever interacted with a child with cleft lip or palate? If yes, then you must have noticed their nasal speaking voice.
As the palate is undeveloped, forming sound is a challenging task for children. The babies have typically delayed speed due to the unnecessary opening in the roof of the mouth and the lip. The reason behind this is the delayed muscle function. Besides, the speech will also be unclear and abnormal.
The particular alphabets that a child will find difficult to speak include p, b, t, d, k, g, f, v, s, z, sh, and ch.
Management for complications
For feeding problems
- Feed your expressed breast milk because breast milk acts as a protection against infections for the child
- Use specifically designed baby bottles with suitable nipples for better suction
- Pick a compatible man-made palate prosthetic in case of cleft palate
For hearing problems
- Hearing assessment must be performed periodically along with annual hearing tests to check the current status of the infection
- Consult your audiologist and get your child a special tube that could be installed along the eardrums to let the fluid drain
- Use customized hearing aid device
For dental problems
- Contact an experienced orthodontist for a checkup and treatment
- You might need oral surgery.
For speech problems
- Consult a skilled speech therapist or pathologist
- The severe condition may require surgery
Who can treat a child with Cleft lip and palate?
One thing you must keep in mind before you start your child’s treatment is that the results of the surgeries and therapies can differ in degree of effectiveness. In most cases, certain therapies are found to be highly useful but it might need EXTRA effort to make the child having cleft lip and palate lead a normal life.
Now, most of the parents are unaware of the therapies, surgeries, and treatments that could help their child get better in terms of eating, speaking, and hearing.
For your instant guidance, we are enlisting here a few of the significant professionals (doctors and experts) that will play an important role to bring your child back to a healthy life.
- Plastic surgeons
- Orthodontist or Oral surgeons
- Otolaryngologist or ENT for regular checkup of Ear, nose, and throat.
- A speech pathologist to evaluate the speech and feeding problems and will help you plan a cleft lip and palate treatment strategy.
- Audiologist for assessing hearing problems.
- Geneticists guide parents in understanding the reasons, causes, and possible complications of Cleft lip and palate. It will help them plan the next pregnancy with lowered chances of having a future child with cleft deformities.
- Psychologist to provide emotional and social support.