What is Cleft Palate?
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Also called cleft lip or rabbit lip, it is a physical division or separation of the two sides of the upper lip.
It can appear as a small opening or gap in the upper lip.
What is Cleft Palate and Cleft Lip (Rabbit Lip)? How is it treated?
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This separation often extends beyond the base of the nose and involves the bones of the upper jaw and/or upper gums.
A cleft palate is a cleft or opening in the roof of the mouth. A cleft palate can involve the hard palate (the bony front part of the roof of the mouth) and/or the soft palate (the soft back part of the roof of the mouth).
Cleft lip and cleft palate can occur on one or both sides of the mouth. Because the lip and palate develop separately, it is possible to have a cleft lip without a cleft palate, a cleft palate without a cleft lip, or both.
Who Could Have Cleft Lip and Cleft Palate?
Cleft lip, with or without cleft palate, affects one in 700 babies per year and is the fourth most common birth defect in Turkey.
Globally, cleft lip is more common in children of Asian, Latino or Native American descent. Compared to girls, twice as many boys have a cleft lip, both with and without cleft palate.
However, compared to boys, twice as many girls have a cleft palate without a cleft lip.
What Causes Cleft Lip and Cleft Palate?
In most cases, the cause of cleft lip and cleft palate is unknown. These conditions cannot be prevented.
Most scientists believe that clefts are caused by a combination of genetic and environmental factors.
The chance of a cleft lip or cleft palate in a newborn baby seems to be higher if a sibling, parent or relative has the problem.
Another possible cause may be related to a medication a mother may have taken during her pregnancy. Some medicines can cause cleft lip and cleft palate.
Cleft lip and cleft palate can also occur as a result of exposure to viruses or chemicals while the fetus is developing in the womb.
In other cases, cleft lip and cleft palate may be part of another medical condition.
How are Cleft Lip and Cleft Palate Diagnosed?
A cleft lip or cleft palate is easy to diagnose because the cleft causes very obvious physical changes.
Prenatal ultrasound can sometimes determine whether an unborn child has a cleft.
If a cleft is not detected on ultrasound before the baby is born, a physical examination of the mouth, nose and palate will confirm the presence of a cleft lip or cleft palate after birth.
Sometimes diagnostic tests can be performed to identify or exclude the presence of other abnormalities.
What Problems Are Associated with Cleft Lip and/or Palate
Eating problems:
With a separation or opening of the palate, food and liquids can pass from the mouth back through the nose.
Fortunately, specially designed bottles and pacifiers are available that help fluids flow down into the stomach.
Children with a cleft palate may need to wear a man-made palate to help them eat properly and ensure adequate nutrition until surgical treatment is available.
Ear infections / hearing loss:
Children with cleft palate are at higher risk of ear infections as they are more prone to fluid build-up in the middle ear.
If cleft palate is left untreated, ear infections can lead to hearing loss. To prevent this from happening, children with a cleft palate should usually have special tubes inserted into their eardrums to help drain fluid and their hearing should be checked once a year.
Speech problems:
Children with cleft lip or cleft palate may also have problems with speech. These children's voices do not carry well, the voice can take on a nasal sound and speech can be difficult to understand.
Not all children have these problems and surgery can completely solve them for some.
For others, a specialized doctor called a speech pathologist will work with the child to solve their speech difficulties.
Dental Problems:
Children with clefts are more prone to cavities in greater numbers than average and often have missing, extra, malformed or displaced teeth that require dental and orthodontic treatment.
In addition, children with cleft palate often have an alveolar protrusion.
Defect:
The alveolus is the bony upper gum that contains the teeth. A defect in the alveolus can displace, tilt or rotate the permanent teeth.
It can prevent the permanent teeth from showing and the alveolar ridge from forming. These problems can usually be repaired with oral surgery.
Who Treats Children with Cleft Lip and/or Palate?
Because of the number of oral health and medical problems associated with cleft lip or cleft palate, these children are often cared for by a team of doctors and other specialists.
The team treating cleft lip and palate should include the following specialists:
- Plastic surgeon to evaluate and perform necessary surgeries on the lips and/or palate
- An otolaryngologist (ear, nose and throat doctor) to assess hearing problems and evaluate treatment options for hearing problems
- An oral surgeon can reposition parts of the upper jaw as needed, to improve function and appearance, and repair cleft gums.
- An orthodontist to straighten and reposition teeth
- A dentist to provide routine dental care
- A prosthodontist who makes artificial teeth and dental appliances to improve appearance and meet functional requirements for eating and speaking
- A speech pathologist to assess speech and feeding problems
- A speech therapist to work with the child to improve speech
- An audiologist (specialist in communication disorders caused by hearing impairment); to assess and monitor hearing
- A nurse coordinator to provide constant supervision of the child's health
- A social worker/psychologist to support the family and assess any adjustment problems
- A geneticist to help parents and adult cleft palate patients understand their chances of having more children with these conditions
The healthcare team works together to develop a care plan to meet each patient's individual needs. Treatment for cleft palate usually begins in infancy and often continues into early adulthood.
What Do Children with Cleft Lip and/or Cleft Palate Look Like?
Although treatment for cleft lip and/or cleft palate can take several years and may require several surgeries depending on the involvement, most children affected by this condition can regain normal appearance, speech and eating.
How is Cleft Lip and Cleft Palate Treatment Performed?
Cleft lip may require one or two surgeries, depending on the extent of the repair needed. The first surgery is usually done when the baby is 3 months old.
Cleft palate repair usually requires multiple surgeries over 18 years. The first surgery for the palate usually takes place when the baby is 6 to 12 months old.
The first surgery creates a functional palate, reduces the chance of fluid in the middle ear and helps the teeth and facial bones develop properly.
Children with a cleft palate may also need a bone graft at about 8 years of age to fill in the upper gum line to support permanent teeth and stabilize the upper jaw.
About 20% of children with cleft palate require further surgery to improve their speech. Once permanent teeth have grown in, braces are often needed to straighten the teeth.
- Improving the appearance of the lips and nose,
- closing the openings between the mouth and nose,
- to help breathing,
- Additional surgeries may be performed to stabilize and realign the jaw.
Final repairs of the scars left by the initial surgery will probably not be done until adolescence, when the facial structure is fully developed.
Dental Care for Children with Cleft Lip and/or Palate
In general, children with clefts have the same needs for preventive and restorative dental care as other children.
However, children with cleft lip and cleft palate may have special problems with missing, malformed or misplaced teeth that require close monitoring.
Early dental care: Like other children, children born with cleft lip and cleft palate require proper cleaning, good nutrition and fluoride treatment to maintain healthy teeth.
Proper cleaning with a small, soft-bristled toothbrush should begin as soon as the teeth erupt. If a soft children's toothbrush does not clean the teeth adequately due to the altered shape of the mouth and teeth, a dental kit may be recommended by your dentist.
A dental is a soft, mouthwash-containing sponge on a handle that is used to drive the teeth.
Many dentists recommend that the first dental visit be scheduled at about 1 year of age, or earlier if there are special dental problems. Routine dental care can start at about 1 year of age.
Orthodontic care: The first orthodontic appointment can be made before the child's teeth erupt. The purpose of this appointment is to assess facial growth, especially the development of the jaw.
After teeth erupt, an orthodontist can further assess a child's short and long-term dental needs. After the permanent teeth erupt, orthodontic treatment can be used to align the teeth.
Prosthodontic care: A prosthodontist can create dental bridges to replace missing teeth or make special appliances called “speech bulbs” or “palate lifts” to help the nose close over the mouth so that speech sounds more normal.
The prosthodontist coordinates the treatment with an oral or plastic surgeon and speech pathologist.
These articles are written for informational purposes. You should consult your doctor to determine whether the procedure has been performed and the appropriate treatment for you.
