cleft lip and palate

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CLEFT LIP & CLEFT PALATE

Cleft lip and cleft palate are facial and oral malformations that occur very early in pregnancy, while the baby is developing inside the mother. Clefting results when there is not enough tissue in the mouth or lip area, and the tissue that is available does not join together properly.

  • A cleft lip is a physical split or separation of the two sides of the upper lip and appears as a narrow opening or gap in the skin of the upper lip. This separation often extends beyond the base of the nose and includes the bones of the upper jaw and/or upper gum.
  • A cleft palate is a split or opening in the roof of the mouth.
  • Cleft lip and cleft palate can occur on one or both sides of the mouth. Because the lip and the palate develop separately, it is possible to have a cleft lip without a cleft palate, a cleft palate without a cleft lip, or both together.

What Causes a Cleft Lip and Cleft Palate?

In most cases, the cause of cleft lip and cleft palate is unknown. Most scientists believe clefts are due to a combination of genetic and environmental factors. There appears to be a greater chance of clefting in a newborn if a sibling, parent, or relative has had the problem.

Another potential cause may be related to a medication a mother may have taken during her pregnancy. Cleft lip and cleft palate may also occur as a result of exposure to viruses or chemicals while the fetus is developing in the womb.

What Problems Are Associated With Cleft Lip and/or Palate?

  • Eating problems. With a separation or opening in the palate, food and liquids can pass from the mouth back through the nose.
  • Ear infections/hearing loss.Children with cleft palate are at increased risk of ear infections since they are more prone to fluid build-up in the middle ear. If left untreated, ear infections can cause hearing loss.
  • Speech problems. Children with cleft lip or cleft palate may also have trouble speaking. These children’s voices don’t carry well, the voice may take on a nasal sound, and the speech may be difficult to understand. Not all children have these problems and surgery may fix these problems entirely for some.
  • Dental Problems. Children with clefts are more prone to a larger than average number of cavities and often have missing, extra, malformed, or displaced teeth requiring dental and orthodontic treatments. In addition, children with cleft palate often have an alveolar ridge defect. These problems can usually be repaired through oral surgery.

Who Treats Children With Cleft Lip and/or Palate?

The health care team works together to develop a plan of care to meet the individual needs of each patient. Treatment usually begins in infancy and often continues through early adulthood.

  • An OMF surgeon to reposition segments of the upper jaw when needed, to improve function and appearance and to repair the cleft of the gum
  • An orthodontist to straighten and reposition teeth
  • A dentist to perform routine dental care
  • A prosthodontist to make artificial teeth and dental appliances to improve the appearance and to meet functional requirements for eating and speaking
  • A speech therapist to work with the child to improve speech.

What’s the Treatment for Cleft Lip and Cleft Palate?

A cleft lip may require one or two surgeries depending on the extent of the repair needed. The initial surgery is usually performed by the time a baby is 3 months old.

Repair of a cleft palate often requires multiple surgeries till the age of 18 years. The first surgery to repair the palate usually occurs when the baby is between 6 and 12 months old. The initial surgery creates a functional palate, reduces the chances that fluid will develop in the middle ears, and aids in the proper development of the teeth and facial bones. Children with a cleft palate may also need a bone graft when they are about 8 years old to fill in the upper gum line so that it can support permanent teeth and stabilize the upper jaw. About 20% of children with a cleft palate require further surgeries to help improve their speech. Once the permanent teeth grow in, braces are often needed to straighten the teeth.

Additional surgeries may be performed to improve the appearance of the lip and nose, close openings between the mouth and nose, help breathing, and stabilize and realign the jaw. Final repairs of the scars left by the initial surgery will probably not be performed until adolescence, when the facial structure is more fully developed.

What Is the Outlook for Children With Cleft Lip and/or Cleft Palate?

Although treatment for a cleft lip and/or cleft palate may extend over several years and require several surgeries depending upon the involvement, most children affected by this condition can achieve near normal appearance, speech, and eating.

Dental Care for Children With Cleft Lips and/or Palates

Generally, the preventive and restorative dental care needs of children with clefts are the same as for other children. However, children with cleft lip and cleft palate may have special problems related to missing, malformed, or malpositioned teeth that require close monitoring.

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