Cleft lip and cleft palate (CLCP) or orofacial clefts are splits or openings on the mouth's roof or the upper lip or both mouths' roof and upper lip. Failure of the facial structures to fully develop completely in unborn babies gives rise to cleft lip and cleft palate (CLCP) or orofacial clefts.

A cleft lip and cleft palate (CLCP) or orofacial cleft is one of the birth defects that are common. Despite the fact that it is an isolated birth defect on its own it is also associated with syndromes or genetic conditions that are inherited.

Cleft Lip and Cleft Palate (CLCP) or Orofacial Clefts

It can be upsetting to have a baby with a cleft but correction of cleft lip and cleft palate (CLCP) or orofacial clefts is attainable. Normal function can be restored in most children through surgeries and normal appearance achieved with minimal scarring.

What is a Cleft Palate?

An opening or a split on the mouth's roof is called a cleft palate. The mouths roof at the front which is horny (the hard palate) or the soft portion at the mouth's roof (the soft palate) may be affected with the cleft palate.

Cleft Palate And Cleft Lip Are Common To What Extend?

Out of every 1,000 babies annually in the United States, cleft lip and cleft palate (CLCP) or orofacial clefts affects one or two of the new-borns. This ranks this condition as a major defect of birth. Asian, Native American and Latino children are the most commonly affected with clefts.

Is Cleft Lip and Cleft Palate (CLCP) or Orofacial Clefts Inherited?

The role played by hereditary factors in cleft lip and cleft palate situation is small. Approximately one in every three new-borns with cleft palate or lip might be having a relative with similar or the same condition or a genetic or chromosomal condition that is associated.

What Causes Cleft Lip?

In the course of development in the womb, the structures forming the upper palate or lip fail to come together properly and it gives rise to a cleft palate or lip.

The cause is unknown in most cases, but it is perceived to be the combination of environmental (external) and genetic (internal) factors.

Classification of Cleft Lip and Cleft Palate (CLCP) or Orofacial Clefts

Cleft lip and cleft palate (CLCP) or orofacial clefts occurrence can be during the same time or independently from each other. The description and classification of cleft palate and cleft lip often uses the terms below in describing cleft in precision.

Cleft Palate's Classification

The categorisation of cleft palate is based on the position that it affects whether soft, hard or both palates.

  • The mouth's front roof is called the hard palate.
  • The mouth's back roof is called the soft palate. The uvula's affection is included in this description.

Cleft Lip's Classification

The severity and the location of the cleft lip are used to classify:

  • Unilateral (affecting one side of the one's lip). One nostril will be lower and tilted than its counterpart due to the effect of unilateral cleft.
  • Bilateral (on the lip's both sides). The nose will be shorter and broader than it is, normally in cases of bilateral cleft.
  • Complete. (Reaches up to the nose)
  • Incomplete (does not go up to the nose)

Causes of Cleft Lip and Cleft Palate (CLCP) or Orofacial Clefts

Failure of the mouth and face tissues to fuse in a proper manner causes cleft lip and cleft palate (CLCP) or orofacial clefts. During the second and the third month is the duration which tissues forming the palate and lip fuses normally. A cleft (opening) is left due to failure of the fusion of the tissues to take place in babies with cleft palate and cleft lip.

Environmental and genetic interaction has been perceived by researchers to be the cause, of cleft lip and cleft palate (CLCP) or orofacial clefts in most cases that occur. A definite cause is majority of babies has not been discovered.

Cleft genes can be passed by the father or the mother. Signs of cleft lip and cleft palate (CLCP) or orofacial clefts will either be passed in part or alone as a form of a genetic syndrome on its own. Genes that exposes children to clefts vulnerabilities can also be inherited and a cleft occurrence can be triggered by the surrounding environmental condition.

Causes of Cleft Lip and Cleft Palate (CLCP) or Orofacial Clefts in Pregnancy

Cleft Lip: The fourth to seventh week is the time that the lip forms in babies during pregnancy. Failure of the tissues making up the lip to join completely prior to birth results in a cleft lip. An opening at the upper lip will result. The opening can be large and it reaches the nose from the lip or it can be a slit that is small. Either sides or one side of the lip can have a cleft or at the middle, which rarely occurs. A cleft palate can occur in children having a cleft lip.

Cleft Palate: The 6th to the 9th week of being pregnant is when the palate (mouth's roof) is formed. Failure of the tissues making up the mouth's roof to join completely, leads to a cleft palate during pregnancy. The back and the front palate's parts can be open in some babies. While in some, part of the palate is open.

Signs and Symptoms of Cleft Lip and Cleft Palate (CLCP) or Orofacial Clefts

During birth a cleft (split) in the palate or lip is identifiable immediately. The appearance of cleft lip and cleft palate include:

  • A cleft (split) on the palate or the lip is usually identified immediately at birth. A cleft in the lip or palate can appear as:
  • A split in the mouth's roof (palate) and a split in the lip that might be affecting both sides of the face and one side.
  • A lip cleft that might be appearing as a small notch only and might be extending to the palate and the upper gum even to the bottom of the nose, from down the lip.

A cleft in the mouth's roof that is not affecting the face's appearance is present. It is rare for submucous cleft palate (cleft affecting the soft palate) to occur. This is the rear of the mouth and the lining of the mouth covers it. It is hard to notice this kind of cleft and diagnosis might not be availed until much later following the development of signs. Submucous cleft palate's signs and symptoms are:

  • Feeding difficulty.
  • Swallowing difficulty with high potential of food or liquids coming out through the nose.
  • Chronic ear infection.
  • Nasal speaking voice.

Risk Factors for Cleft Lip and Cleft Palate (CLCP) or Orofacial Clefts

The likelihood of development of CLCP by the baby may be increased by several factors including:

  • Higher risk of bearing a baby having a cleft affects parents with a history of cleft lip and cleft palate (CLCP) or orofacial clefts in their family.
  • Cleft lip and cleft palate (CLCP) or orofacial clefts in the United States are common in African-Americans and Native Americans reportedly.
  • The likelihood of a male baby having a cleft lip is twice while having or not having a cleft palate. In females cleft palate with no cleft lip is higher in female.
  • Certain exposure to substances during pregnancy. Women who are taking certain medication, taking alcohol and smoking cigarette are prone to give birth to babies with cleft lip and cleft palate (CLCP) or orofacial clefts.
  • Having diabetes. Babies with a cleft lip and no cleft palate are at high risk of being born by women diagnosed of diabetes prior to pregnancy according to some evidence.
  • Obesity during pregnancy. Cleft lip and cleft palate (CLCP) or orofacial clefts can occur in children born by mother who are obese when they are pregnant, according to some evidence.

Complications in Cleft Lip and Cleft Palate (CLCP) or Orofacial Clefts

Several complications are possible with cleft lip and cleft palate (CLCP) or orofacial clefts .The severity and the type of the cleft will determine the variety of the challenges that children with cleft lip while having a split palate or not.

  • Feeding difficulty. Feeding after birth is the immediate concern. Sucking while with a cleft palate will be hard for a breast feeding child despite the fact that they can, with only a cleft lip.
  • Loss of hearing after hearing infection. Risk of developing fluid which will lead to hear loss is high in babies with a cleft palate.
  • Dental problems. The development of tooth can be affected if the extend of the cleft reaches the upper gum.
  • Speech difficulty. Cleft palate affects normal-speech due to the fact that sound formation takes place in the palate. The speech will be sounding too nasal.
  • Medical condition's challenges to cope. The stress of the medical care that is intensive, problems with behaviour due to differing appearance, emotional and social problems are the problems likely to be faced by children with clefts.

Tests to Diagnose Cleft Lip and Cleft Palate (CLCP) or Orofacial Clefts

Special test in order to diagnose are rarely needed in cleft lip and cleft palate (CLCP) or orofacial clefts because most cases are noticed immediately at birth. Cleft lip and cleft palate (CLCP) or orofacial clefts are increasingly seen on ultrasound while the baby has not been born.

Ultrasound Exam Prior to Birth to Detect Cleft Lip and Cleft Palate (CLCP) or Orofacial Clefts

The picture of a foetus that is developing is created using sound waves when conducting a prenatal ultrasound test. Difference in the structure of the face can be detected by the doctor during analysis.

At around the thirteenth week is when ultrasound to detect cleft can be conducted. Accurate cleft diagnosis of the foetus can be done as it is still developing. Is more difficult to use ultrasound to see a cleft palate occurring alone.

Amniocentesis (amniotic fluid from the uterus) can be offered to be taken by your doctor if a cleft is shown by a prenatal ultrasound. Inheritance of genetic syndrome and its potential of causing other birth defects can be indicated through the fluid test. The cause of cleft lip and cleft palate (CLCP) or orofacial clefts is not known anyway.

Treatment for Cleft Lip and Cleft Palate (CLCP) or Orofacial Clefts

The ability to eat, hear normally appear normal in the face and to speak are the aims of treating any child with cleft lip and cleft palate (CLCP) or orofacial clefts. A team of experts and doctors are involved in caring for children with a cleft lip and cleft palate (CLCP) or orofacial clefts which include:

  • ENTs/ otolaryngologist (ear, nose and throat physicians.)
  • Oral surgeons
  • Paediatricians
  • ENTs or plastic surgeons (surgeons specializing in the repair of clefts.)
  • Orthodontist
  • Paediatric dentist
  • Nurses
  • Speech therapist
  • Social workers
  • Genetic counsellors
  • Psychologist
  • Hearing or auditory specialist

The defect is surgically repaired and any other related condition is sorted by therapist during treatment.

Surgery for Cleft Lip and Cleft Palate (CLCP) or Orofacial Clefts

The particular situation of your child will determine the surgery needed to be corrected for cleft lip and cleft palate (CLCP) or orofacial clefts. The improvement of speech and nose and lip appearance might be enhanced with further follow-up surgeries recommended by your doctor after the initial repair of the cleft.

The order of surgeries performed for cleft lip and cleft palate (CLCP) or orofacial clefts is this:

  • Cleft lip repair: not exceeding 12 months old.
  • Cleft palate repair: earlier than 18 moths or at that time.
  • Follow-up surgeries: at the age of two up to late teen years.

A hospital is where the surgery of cleft lip and cleft palate (CLCP) or orofacial clefts is taking place. General anaesthetic will be given to your child so as to prevent pain or awakening during the surgery. Different procedure and techniques are used in repairing cleft lip and cleft palate (CLCP) or orofacial clefts, reconstructing the areas affected and preventing and treating complications related.

Generally, procedures for cleft lip and cleft palate (CLCP) or orofacial clefts can include:

  • Cleft lip repair. For closing the separation of the lip, an incision is made by the surgeon on both of the cleft's side creating flaps of tissue. Stitching of the flaps is the next step. A structure, function and normal appearance of the lip is created by the repair. Nasal repair that might be needed is performed at that instance.
  • Cleft palate repair. Both the hard and the soft palate's separation (mouth's roof) can be rebuilt using various procedures depending on the situation of your child. The muscle and tissues are repositioned after the surgeon has made incisions on the clef's both sides. Stitching and closing the repair is the next step is stitching and closing.
  • Ear tube surgery. Chronic hear fluid which leads to hear loss can be prevented by placing ear tubes when a child with a cleft palate is six months old. Tinny bobbin-shaped tubes are placed in the eardrum which will be preventing the build-up of fluids due to its opening is what is done in an ear tube surgery.
  • Appearance reconstruction surgery. The appearance of your nose, mouth or lip might need additional surgeries so as to improve.

The ability of your child to eat, talk and breath, appearance and quality of life can improve significantly through surgery. Permanent or temporary to the blood vessels, nerves and structures, puckering of scars, poor healing and bleeding are the possible risks involved in a surgery.

Managing for the Complications

Complication accruing from cleft lip and cleft palate (CLCP) or orofacial clefts can need additional treatment as recommended by the doctor. Examples include:

  • Feeding strategies like using a special bottle feeder or nipple.
  • Correcting speaking therapy with speech therapy.
  • Teeth and bite orthodontic adjustment like having braces.
  • Oral health and tooth development monitoring form an early age by a paediatric dentist.
  • Ear infection monitoring and detections including the ear tubes.
  • Devises to aid or assist a child whose hearing has been lost.

Helping the child through therapy from a physiologist in order to cope with the stress emanating from medical procedures that are repeated or other concerns

Coping with Cleft Lip and Cleft Palate (CLCP) or Orofacial Clefts

Birth defects are not the expectation of any parent. Having a child with cleft lip and cleft palate (CLCP) or orofacial cleftscan ruin the excitement your excitement of giving life, a process that is emotionally demanding for your family in its entirety. The following coping tips should be kept in mind when you welcome a baby with cleft lip and cleft palate (CLCP) or orofacial clefts:

  • You do not have to blame yourself. Helping and supporting your child should be your main focus.
  • Accept the emotions. Feeling sad upset and overwhelmed is normal.
  • Seek support. Education, financial resources and community can be attained through the help of the social workers of your hospital.

Many ways can be used for supporting your child with cleft lip and cleft palate (CLCP) or orofacial clefts:

  • Do not see your child as a cleft but focus on him/her as a person.
  • Do not involve appearance when pointing out positive qualities of others.
  • Allow your child to make their own decisions so as to boost their confidence.
  • Confident body language should be encouraged like smiling and holding up the head with shoulders back.
  • Maintain communication lines open. In case of teasing in school they are in a position to tell you confidently.

Prevention of Cleft Lip and Cleft Palate (CLCP) or Orofacial Clefts

The worry of having another child with a cleft lip and cleft palate (CLCP) or orofacial clefts is the concern of many parents after the first instance. In order to lower the risks consider the following steps despite the fact that cleft can't be prevented.

  • Genetic counselling. Prior to becoming pregnant, inform your doctor of your family history of cleft. You can be referred to a genetic specialist for determination of your potential to bear children with cleft lip and cleft palate (CLCP) or orofacial clefts.
  • Prenatal vitamins. Confirm from your doctor if you can take prenatal vitamin when you want to get pregnant.
  • Avoid tobacco or alcohol. Bearing babies with birth defects is increased with cigarette smoke and alcohol intake.

Prognosis (Outlook) for Cleft Lip and Cleft Palate (CLCP) or Orofacial Clefts

Majority of babies have no healing problems in the condition of cleft lip and cleft palate (CLCP) or orofacial clefts. The appearance of your child post healing will depend on how severe the defect was. Fixing the scar from the wound of the surgery might require another surgery.

Orthodontist or a dentist might be required for children who had a cleft palate. Correction of the teeth as it comes might be needed.

Cleft palate is accompanied by hearing problems. Hearing test should be conducted and repeated overtime.

Speech problems can still be there after surgery. Muscle problem in the mouth's roof causes it. Your child will be helped by speech therapy.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: November 7, 2015

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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