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cleft_lip/palate

CONTENTS:
What is a cleft lip and cleft palate?
What are the causes of cleft?
What are the problems associated with clefts?
How to feed a baby with cleft?
At what age can the surgical correction be done?
What are the Surgical Corrections?
What are the Complications?
What are the DENTAL problems associated with clefts?
What is the need for Orthodontic Treatment?
Some Facts about Clefts.

cleft lip and cleft palate What is a cleft lip and cleft palate?
Cleft means 'split' or 'separation'. Cleft lip and/or palate are one of the more common birth defects. It occurs in approximately one in 700 births. Cleft occurs more often among the Asian populations and less often among Blacks. However, it does occur among people of every race.
During early pregnancy separate areas of the face develop individually at different periods and then join together. If some parts do not join properly the result is a cleft, the type and severity of which can vary.
A cleft lip is a condition that creates an opening in the upper lip between the mouth and nose. It looks as though there is a split in the lip (hare lip). It can range from a slight notch in the coloured portion of the lip to complete separation in one or both sides of the lip extending up and into the nose. A cleft on one side of the face is called a unilateral cleft, and a cleft that occurs on both sides is called a bilateral cleft.

cleft lip and cleft palate          cleft lip and cleft palate
A cleft in the gum may occur in association with a cleft lip. This may range from a small notch in the gum to a complete division of the gum into separate parts.
A cleft palate occurs when the roof of the mouth has not joined completely. The back of the roof of the mouth (palate) is called the soft palate and the front is known as the hard palate. A cleft palate can range from just an opening at the back of the soft palate to a nearly complete separation of the roof of the mouth (soft and hard palate). Bilateral cleft palate means that there is a cleft on both sides of the nasal septum, i.e., the palatal shelves don't connect with the nasal septum on either side. On a practical basis, bilateral cleft palates can be a little wider or there can be not much difference in appearance.
cleft lip and cleft palate     cleft lip and cleft palate
cleft_lip/palate

What are the causes of cleft?
A cleft occurs when something interrupts the normal development of the face. The face develops in the 4 - 8th week of pregnancy. The facial structures are formed from three planes (nasal, palatal, lip). Each migrating towards a meeting point in the middle of the face. The lip is formed by the obicularis muscle. The two lateral halves are joined in the middle at the philitrum lines. If you rub your finger above your top lip, you will feel those two ridges. Those are in fact the "cleft scars" of a non cleft-affected person. Those tissues naturally join by the fourth week of pregnancy, if they don't, a cleft lip results.
       The palate is formed out of the structure that begins as the tongue. Between the fourth and the eighth weeks of gestation, the tongue drops down and the palatal segments moves from the sides to the middle, ultimately fusing in the center. Run your tongue across your hard palate from side to side and you will feel the seam where the two sides fused.
       Everyone began life with a cleft. For 699 out of 700 of us, the cleft fuses before birth. For that one in 700, it fails to fuse. So we are not talking about something that happens so much as something that fails to happen. If the tissues of the lip and/or the palate fail to fuse at the proper time (4th to 8th weeks of gestation) for some reason or another, a cleft is formed.

There are lots of theories given for the non-union of these halves, but the actual cause is largely unknown. Many factors contribute to the cleft condition ---- heredity, congenital, pre-natal nutrition, drug exposure, environmental factors, syndromes, etc.

Parents should not search for reasons to blame themselves for "causing" a cleft lip or cleft palate, because it is not their fault. Many factors can contribute to anyone having a child with cleft, and may not have left the parents with much choice. Cleft lip and cleft palate occur early in a pregnancy (the face develops in the fourth to the eighth week of pregnancy) often before a mother is aware that she is pregnant.

cleft_lip/palate

What are the problems associated with clefts?

  1. Chronic or recurring ear infections. The ears of a child with a cleft have a tendency to collect fluid because the Eustachian tubes, which connect the middle ear to the mouth, do not drain the fluids effectively. Pressure can build up and infection can occur. Children who suffer from a lot of untreated ear infections over a period of time may face the inevitability of permanent hearing loss.
  2. A child with a cleft will need speech therapy. The oral and nasal cavities are extremely important structures in the production of speech. Cleft-affected child have to learn how to make the same sounds as everyone else using a different oral and nasal structures.
  3. A child with a cleft may face some emotional challenges. If he or she is very self-conscious about the cleft scar or her speech, she may become introverted and her self-esteem may plummet. Children who were born with clefts may feel different from their peers and occasionally professional counseling may be needed to help the child identify her strengths and put the cleft scar into its proper perspective.
  4. If the alveolar ridge (bone) was disturbed by the cleft, the teeth in the cleft line may be totally absent, or so late in erupting that proper natural alignment is impossible. The need of orthodontic intervention is necessary to unlock impacted palatal segments and permit more normal growth. Some patients with cleft palates present a unique combination of both skeletal and dental abnormalities. Their dentition will require long periods of treatment with use of braces and/or appliances, and later may have to undergo Orthognathic surgery.
  5. It is also common for children born with clefts to have supernumerary (extra) teeth. Supernumerary teeth are usually located next to the cleft site. Some emerge into the oral cavity, while others may remain unerupted. The supernumerary may have to be removed to facilitate the treatment of the remaining dentition. Occasionally a tooth may be switched in position with another tooth (transposition), or the tooth in the line of the cleft will be absent (missing).
  6. Nasal deformities are often seen along with deformities of the jaw. Some common deformities of the nose are: deviated nasal septum, flared or constricted ala of the nose, saddle nose, hooked nose, asymmetrical nose etc.
  7. Deficient growth of lower jaw (mandible) and the nasal structures may cause difficulty in breathing. Difficulty in swallowing may also be seen. The growth of maxilla will also be retarded due to scar formed after surgical correction.
cleft_lip/palate

How to feed a baby with cleft?
All babies spend most of their early weeks feeding and sleeping. Feeding is a time for social interaction, the baby is most alert during this period and the mother and baby begin to get to know each other. Unless your baby has other problems you need not to be separated from your baby.
       In order to feed, babies need to form a vacuum inside the mouth. This is usually done by sealing the lips around the nipple or teat and closing off the back of the mouth with the soft palate. Babies with clefts may not be able to do this efficiently and need some extra help. Those with a small lower jaw (mandible) may at first have difficulty in coordinating swallowing and breathing. Ways of helping may include

It is important not to delay sucking unless there is a medical reason for doing so. Babies with clefts may swallow more air than normal during feeding, especially if the flow of milk is either too slow or too fast, and may show this by having a blue moustache, being extra sleepy or bringing up some of their feed. If this is so, stopping 2 or 3 times during the feed to burp the baby, or sitting the baby in a more upright position may be helpful.
       All babies can lose up to 10% of their birth weight but usually regain it in 2 - 3 weeks. Babies with cleft lip or cleft palate may take longer to gain weight. A baby having 5 - 6 wet nappies a day and regular motions, and looks healthy and alert, are the indications that he or she is being fed sufficiently.
       Every mother and baby is unique, so it is not possible to give hard and fast rules to follow. Some babies feed easily while others take more time to find a way that suits them, even if they have the same type of cleft. Try and give yourself time to sit comfortably and be relaxed. Make sure your baby is given enough time with one method of feeding before trying an alternative.
cleft_lip/palate
At what age can the surgical correction be done?
A child with cleft have to undergo 4 to 5 surgeries to correct the problem. It is important to note that every child is different. Some children may require more surgeries than others, while others may require less. This all depends on the severity of their cleft and how the child heals after the surgery is completed.
cleft_lip/palate

What are the Surgical Corrections?
What are the Complications?
What are the DENTAL problems associated with clefts?
What is the need for Orthodontic Treatment?
Some Facts about Clefts.

* Know your teeth * Know your Gums (Gingiva) * Eruption Dates * Six Golden Rules * Brushing\Flossing Technique * Wisdom tooth * Tooth Decay * Extraction * Dental Implant * Surgical Extraction * Orthognathic Surgery * Asymmetry of the face * Gummy Smile * Prognathism{Long Jaw} * Beggs\Straight wire{Orthodontia} * Bleaching{Tooth Whitening} * Habit Breaking * Interceptive Orthodontics * Discolouration\Veneers * Composite\Amalgam Fillings * Root Canal Treatment{RCT} * Crown{Porcelain\Castmetal} * Flap Surgery/Splinting * Bridges{Porcelain\Castmetal} * TMJ (Joint) Disorders * Bell's Palsy {Facial Paralysis} * Ankylosis{Difficulty in mouth opening} * Cleft Lip and Palate * Trigeminal Neuralgia * In a Lighter vein


This site is produced, designed and maintained by
Dr Antony George, Trichur Institute of Head And Neck Surgery (TIHANS),
Shornur Road,Trichur,Kerala-680001,India.
Ph: 0091-0487-335145, 335185
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copyright ŠAug 2000. No part of this website may be transmitted or reproduced in anyway. Every effort has been made to supply correct and accurate information, but I assume no responsibility for its use.

updated Aug2002.