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Orofacial clefts, specifically cleft lip/palate, is one of the most common head and neck birth defects. Clefts affect roughly 1 in 700 children worldwide.
Oral clefts appear as splits or openings in the upper lip, palate (roof of the mouth), or both. The splits cause gaps and defects in the affected areas. They are also usually associated with a nose deformity on the same side.
Half of all clefts involve both the lip and palate. A cleft that only affects the palate is a less common birth defect.
In the U.S., cleft lip/palates are most common in Native Americans, Asians, and Latinos. African Americans have the lowest risk of developing orofacial clefts.
Serious medical and dental conditions typically occur in children who have cleft lips and/or palates, including:
Cleft lips can either be complete or incomplete, which means the splits may or may not extend to the nose. They can also develop on one side (unilateral) or on both sides (bilateral) of the upper lip.
There are a few types of cleft lips:
Clefts that develop on one side of the upper lip and do not extend into the nose.
Clefts that develop on one side of the upper lip and extend into the nose.
Clefts that appear on both sides of the upper lip, but do not extend into the nose.
Clefts that appear on both sides of the upper lip and extend into the nose.
Similar to cleft lips, cleft palates can either be complete or incomplete, which means the splits may involve the primary (front) palate, secondary (back) palate, or both.
There are a few types of cleft palates:
Clefts that develop in the soft palate (back of the mouth).
Clefts that develop in the soft and hard palate on one side of the mouth. The splits extend past the lips and into the nose.
Clefts that develop in the soft and hard palate on one side of the mouth. The splits extend past the lips and into the nose.
Clefts that develop in the soft and hard palate on both sides of the mouth. The splits extend past the lips and into the nose.
A submucous cleft palate affects the palate and uvula, which is the teardrop-shaped tissue that hangs in the back of your throat. The soft palate and uvula work together to prevent food from going up your nose.
Someone with a submucous cleft palate has a cleft underneath the mucous membrane. This type of cleft is "hidden" and will not be noticeable until the baby is born. It develops in about 1 in 1,200 babies.
Clefts are birth defects, which means they form in the womb. Common reasons a child may develop a cleft lip and/or palate include:
Common medical conditions associated with cleft lip and palate include:
Children who are born with a cleft lip, palate, or both require multiple phases of treatment starting from birth and into early adulthood (18+ years old).
Treatment typically includes adhesions, repairs, surgeries, bone grafts, and orthodontic treatment.
Cleft lip and palate repairs are performed by a plastic surgeon, pediatric otolaryngologist, or an oral and maxillofacial surgeon with extensive training in pediatric craniomaxillofacial surgery. In addition, there are a few phases of treatment throughout childhood, depending on the child’s needs:
From birth, children with a cleft lip and palate require pre-surgical infant orthopedics (PSIO). In particular, this procedure reshapes nasal and alveolar segments before cleft lip surgery.
A cleft lip is repaired between 3 and 6 months of age. A nasolabial (lip) adhesion may also be necessary before repairing the cleft lip to reduce tension and speed up the recovery process.
Cleft palate repairs are completed between 9 and 18 months of age, typically around age 1.
Early palate repair allows for better speech development. Repairing the defect early creates more scar tissue and may lead to improper growth of the mouth, improper bite, and poor facial esthetics.
Orthodontic treatment is typically necessary later on to correct these issues. If palate repair is completed after 18 months of age, speech can be negatively impacted.
Velopharyngeal insufficiency (VPI) occurs when the soft palate does not close tightly against the back of the mouth, which leads to abnormal speech and/or hypernasality.
Velopharyngeal surgery is completed around 3 years of age if a child’s speech does not improve.
After a cleft lip and palate repair, a surgeon performs alveolar bone graft surgery a few years later.
In short, the surgery adds bone to the gum ridge in children born with clefts. In addition, the bone graft must be completed as a child begins to lose their baby teeth and before permanent teeth grow in.
As baby teeth fall out and permanent teeth grow in (mixed dentition phase), the first round of orthodontic treatment takes place. Orthodontic treatment aligns the roof of the mouth, fixes crossbites, creates space for erupting permanent teeth, and treats impacted teeth.
By age 13, all permanent teeth have erupted. An additional phase of orthodontic treatment may also be necessary to align teeth and fix any dental abnormalities.
Orthognathic surgery is an operation that corrects the alignment of the jaws. It may be necessary after the cleft lip repair, bone graft surgery, and orthodontic treatment.
Ways to help prevent cleft lip during pregnancy include:
What a mother drinks and eats during pregnancy may cause a cleft lip/palate. Certain medications, as well as environmental factors, can also contribute to the development of craniofacial anomalies.
One study found that cleft lip and cleft palate may be linked to low folic acid intake, in addition to abusing alcohol and smoking, while pregnant.
A baby's mouth and nose develop between the 5th and 12th weeks in a mother’s womb. A primary cleft palate will form during early pregnancy, between the 4th and 7th weeks. A secondary cleft palate will develop between the 8th and 12th weeks of pregnancy.
A cleft lip is easier to detect in an ultrasound than a cleft palate that occurs alone. In many cases, a cleft lip will appear in an ultrasound around 13 weeks (after the baby's nose and mouth fully develop).
Most babies who have cleft lips and cleft palates can still breastfeed. Cleft palates, however, often make sucking more difficult.
Vitamin B and folic acid deficiencies during pregnancy are linked to cleft lip and palate in babies.
Genetics may play some role in the development of cleft lips/palates.
If your child has a cleft lip and palate, treatment will be separated into several surgeries. The first surgery corrects the cleft lip, while the second surgery repairs the cleft palate. Other surgeries may be required as well, depending on the severity of the condition.
Cleft lips/palates can't always be prevented. However, since cleft palates can be caused by folic acid deficiencies during pregnancy, mothers are encouraged to take folic acid supplements (400 micrograms a day).
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