Cleft Palate And Cleft Lip
Common Birth Defects Which Occur In Pregnancy

Birth Defect Guide Photos of Cleft Lip

Cleft Lip Picture

Complete Unilateral And Bilateral Cleft Lip.

Cleft Palate And Cleft Lip

Contents

What Is A Cleft Palate And Cleft Lip?
How Common Are They?
What Are The Causes And Risk Factors?
How Is It Diagnosed?
How Is It Treated?
What Problems Do Babies With Clefts Have?
How Much Will Treatment Cost?


Cleft Palate Picture

Guide To Defects
Birth Defects

What Is A Cleft Palate And Cleft Lip?

A cleft is a split that occurs in the lip and/or mouth palate. It is present when a baby is born which means it is a birth defect. It forms in the first trimester of pregnancy when either the lip (or palate) fails to completely develop and fuse together. A baby born with a cleft lip will have an opening in the upper lip. The opening can be a small slit or it can be large and deep enough to extend as far as the nostrils. The slit can occur on either (or both) sides of the lip or on rare occasions in the middle. A middle defect is sometimes referred to as a harelip, because of the person's supposed resemblance to a rabbit. Doctors prefer not to use this term deeming it insensitive. A cleft palate usually occurs during weeks 6 to 9 of pregnancy. This is where the roof of the mouth does not join together and a gap occurs which can extend from the back of the mouth to just behind the teeth. About 30 percent of orofacial clefts (the medical term for both conditions) are accompanied by other problems such as partial deafness. Although most clefts are correctable with surgery, some babies will require complex dental surgery and speech therapy as they get older.

How Common Are Clefts?

According to the Centers for Disease Control and Prevention (CDC) over 2,600 babies are born every year in the U.S. with cleft palates, while about 4,400 are born with a cleft lip (with or without cleft palate). Other interesting statistics, provided by the World Health Organization (WHO), include:

Western Countries incidence rates:

• Children born with both CL/CP: 1 per 1000 births.
• CL/CP: Occurs more frequently in males.
• CL/CP: 75 percent of all cases have a left sided defect.
• Babies born with just CP: 1 per 2000 births.
• CP: Occurs more frequently in females.
• CP: Highest incidence rate can be found in Australia, Finland and Scotland.

What Are The Causes And Risk Factors?

Genetics

As with many birth defects, the causes of orofacial clefts are still unknown and are probably multifactorial. For this reason the CDC has launched a massive U.S. wide National Birth Defects Prevention Study to try and understand the risk factors and causes of birth defects better. As with other defects, such as spina bifida, the causes of clefts are probably a combination of both genetic and environmental factors. The condition appears to run in families. In August 2011 it was announced in the New England Journal of Medicine that genetic testing was now possible. Researchers have developed a genetic test which can help parents who already have a child with an 'isolated' form of either cleft or lip palate to predict their chances of recurrence in the next child. Scientists have isolated a gene called IRF6 which was found to play a role in Van der Woude Syndrome, a condition where babies born with clefts are also born with other birth defects. The gene appears to play an important role in the early formation of skin, lips, the palate and genitalia. Any mutations in the parent’s genes increased their offspring’s chances of developing defects. Concerned parents should talk to a genetic advisor for more information.

Environmental

Possible environmental factors could include the consumption of alcohol in early pregnancy as well as smoking. Certain drugs such as anticonvulsants (taken most commonly for epilepsy or depression) and corticosteroids if taken while pregnant may be another cause. Before quitting any necessary medications however always discuss this with your doctor first. They may suggest a safer alternative to use during pregnancy.

Women who start their prenatal care by preparing for pregnancy before conception can reduce their overall risk of birth defects. Steps include following a healthy diet, taking a multivitamin with folic acid (400 micrograms) and quitting smoking. A 2007 study by the National Institute of Environmental Health Sciences found that women who took folic acid and multivitamin supplements 2 months prior to conception reduced the incidence of clefts in their babies by 33 percent. Keeping any existing medical conditions under check is also important as studies show that women with a pre-existing diabetes diagnosis had greater chances of having children with clefts.

How Is It Diagnosed?

The condition can sometimes be diagnosed during pregnancy through routine anatomy scan. If suspicions are aroused an MRI scan may be offered to the women which can give a more detailed image. After childbirth clefts are diagnosed by physical examination although they are normally clearly visible. Occasionally minor clefts such as bifid uvula and submucous cleft palate may not be diagnosed until later in life.

How Is It Treated?

Treatment and services for children born with orofacial clefts can vary depending on the severity of the defect, the presence of any other defects or syndromes and the child's age. Early referral to a cleft team is essential. This is a team of medical specialists including doctors, surgeons, geneticists and audiologists who are experts in managing such cases. Surgery to repair cleft lip is usually performed in the first few days after a baby is born or at about 3 months of age. The timing will depend on the surgeon who is performing the operation. The goal of the operation (image) is to close the gap in the lip and to place the scar along the natural skin curve. If the nose is off-balance this will be corrected too. Sometimes further surgery may be necessary to refine the appearance. Surgery for cleft palate is usually performed when the infant is 6 to 9 months of age. Depending on the extent and type of defect more than one operation may be necessary to finally close the gap and improve speech. If for any reason the infant is considered high risk for surgery the alternative is to wear a prosthetic aid which can block the opening. Depending on the child's needs, even after surgery further treatments and services may be required from a cleft team. These include:

• Surgeons such as oral/maxillofacial surgeons, plastic surgeons, craniofacial surgeons or neurosurgeons.
• Audiologist for testing hearing.
• Pediatric dentist or other dental specialists such as prosthodontists who makes prosthetic aids/devices for the mouth.
• Orthodontist who can align jaws and straighten teeth.
• Pediatrician to monitor the child’s overall health and development.
• Nurse to provide help and advice on feeding problems or other day to day issues.
• Geneticist who can screen parents for craniofacial syndromes and assess their risk of having further children with similar conditions.
• Otolaryngologist or ENT: Ear, Nose and Throat doctor.
• Speech/language pathologist who can assess speech problems, but also any physical feeding issues.
• Psychologist or other mental health specialist (to support the family and assess any adjustment problems);

Fortunately, as this can seem very daunting to any new parent, the Cleft Palate Foundation have compiled a list of teams throughout America and internationally. To contact them call: 1.800.24.CLEFT or visit their website at: www.cleftline.org/parents/about_team_care.

What Problems Do Babies With Clefts Have?

Hearing Problems

Babies born with both lip and cleft palates often suffer frequent ear infections which can lead to partial loss of hearing. This is because the Eustachian tubes within the ears do not drain effectively so fluid accumulates causing infections. If treated in early infancy, any hearing loss should not be permanent. For this reason it is important for all children born with this defect to have annual ear check-ups with an audiologist. If fluid buildup is detected this can be treated with medications and occasionally minor surgery. In persistent cases a doctor may insert a tiny tube into the eardrum to help prevent further fluid build ups.

Teeth

Most children born with clefts require orthodontic treatment between the ages of 13 and 18. They may be missing some teeth, or teeth may need to be repositioned using braces. Also some jaw or gum repair work may be needed. This work will usually be carried out over several years.

Feeding Difficulties

Babies born with cleft lips usually have little difficulty in normal feeding. However those born with cleft palates often do because the gap in the roof of their mouth makes sucking difficult. They may also have problems with choking on milk or the milk coming out their nose. For this reason a doctor will recommend special bottles and nipples which are designed for babies with this problem. Although breastfeeding will not be possible it is still beneficial for the baby to be fed breast milk. A nurse will show the mother how to pump her breasts before leaving hospital.

Speech

Most children with cleft lip have little if any difficulties with speech. Those with cleft palate may however take longer than other infants to speak. When they do, their words can sound nasal. Fortunately they normally catch up with their peers although it may require additional surgery when they are older and speech therapy.

How Much Will It All Cost?

The cost of cleft lip surgery alone is about $5,000, and this is often only the beginning. Between the cost of additional surgeries and specialist advice, over the years the total costs can run into hundreds of thousands of dollars. Fortunately health insurance firms will pay all or certainly part of the care. Additional financial support is also available through state and federal resources. Contact your state Department of Health or the Cleft Palate Foundation for further advice.

Read all about : clubfoot, another common birth defect.

Related Articles on Clefts

For more tests and pregnancy care, see the following:

Genetic Tests During Pregnancy
Prenatal Care Guide

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