About Facial Deformities

Cleft Lip/Cleft Palate

What is cleft lip and/or cleft palate?

Cleft lip (CL) can be an isolated event or can be found in conjunction with a cleft palate (CP). In general, the condition refers to a separation of the parts or segments of the lip or roof of the mouth, which are usually joined together during the early weeks of development of an unborn child. Cleft lip is a separation of the two sides of the lip and often includes the bones of the maxilla and/or the upper gum. Cleft palate is an opening in the roof of the mouth. It occurs when the two sides of the palate do not fuse as the unborn baby develops.

Cleft lip (CL) can occur on its own or in conjunction with a cleft palate (CP). In general, the condition describes a separation of the parts or segments of the lip or roof of the mouth, which are usually joined together during the early weeks of an unborn child's development. Cleft lip is a separation of the two sides of the lip and often includes the bones of the maxilla (skull) and/or the upper gum. Cleft palate is an opening in the roof of the mouth. It occurs when the two sides of the palate do not join together as the unborn baby develops.

Clefts that involve the lip and the palate are more significant because they can affect feeding, weight gain, middle ear function, speech and facial growth. Each of these issues may be noted at different ages, i.e., difficulty feeding and middle ear dysfunction are infant and early childhood issues. Speech difficulties present themselves when the child reaches approximately two years of age. Repair of these problems is not only important medically (e.g., they impede the child's ability to swallow), but also cosmetically and emotionally, since the child's speech and physical appearance is impaired, which could prevent acceptance by peers.

How often do cleft lip and cleft palate occur?

CLP (cleft lip together with cleft palate) occurs in 2.1 in every 1,000 births among Asian children; 1 in 1,000 births among Caucasians; and 0.41 in 1,000 births among blacks.

• Isolated CP occurs with a frequency of 0.5 in 1,000 births among all races.
• Isolated CL accounts for 21 percent of all cleft disorders; isolated CP accounts for 33 percent of all cleft disorders; and CLP accounts for 46 percent of all cleft disorders. (According to surveys conducted by scientists Fraser and Calan)
• Isolated CP occurs more frequently in females; CLP occurs more frequently in males.

What causes cleft lip and/or cleft palate?

Cleft deformities often occur without any previous family history. The primary cause of CLP is believed to be a genetic mutation. Whether the defect is inherited is still under investigation. Among the factors that are known to increase the risk of a child's developing CLP are smoking or drinking by the mother during pregnancy. On the other hand, the mother's intake of folic acid and vitamin B6 are believed to reduce the risk of CLP. It is possible to diagnose CLP by ultrasound examination late in the first trimester or early in the second trimester of pregnancy.

What surgical solutions are available for cleft lip and cleft palate?

Children with CLP are often not treated surgically until their faces are fully grown. Since CLP is accompanied by other defects—central nervous system malformations, club foot, and cardiac abnormalities—around 30 percent of the time—a team approach to treatment is often needed. Pediatricians, speech pathologists, orthodontists, prosthodontists, oral surgeons, cardiologists, neurosurgeons, and plastic surgeons come together to design state-of-the-art programs that will address the complex needs of each child.

The two factors that are considered in cleft palate repair are speech production and facial growth. Since no single treatment plan works equally well for all patients, each case must be individually evaluated before the method of repair is determined. Surgical variables include the type of flap chosen to repair the cleft, molding of the segments of the palate both before and after surgery, and bone grafting. Also, the timing of corrective surgery should be tailored to the child's needs in hopes of enhancing speech production and facial growth. Research continues on in utero cleft repair. Though it has been performed successfully in animal models, in humans the procedure has been shown to stimulate preterm labor and loss of the fetus.

What kinds of non-surgical care are available for children with cleft deformities?

Speech pathologists and dietitians participate in each affected child's care to ensure that specific issues such as feeding difficulties and speech problems are corrected and that normal development occurs. Otolaryngologists help the approximately 90 percent of these children with cleft palate who have middle ear problems. This coordinated approach to care improves the child's overall well-being—his or her appearance, eating, oromotor, and language skills become as normal as possible before starting school and the likelihood of a healthier, happier future.

How do cleft deformities affect a child?

Cleft deformities that involve the lip and the palate are more significant because they can affect feeding, weight gain, middle ear function, speech, and facial growth. Each of these issues is most closely associated with a certain age. For example, feeding difficulties and middle ear dysfunction are infant and early childhood issues, while speech problems are of special concern when the child reaches approximately two years of age. Treatment for these problems is important both medically (even a child's ability to swallow may be affected) and emotionally, since a child with impaired speech and physical appearance may experience the pain of rejection by peers.