What is a cleft of the lip and/or the palate
Cleft lipA cleft lip is a failure of fusion of the upper lip, which can be incomplete or complete (opening the nostril into the mouth) and on one or both sides. The shape of the nostril is also changed by the cleft.
Cleft palateA cleft palate is a separation in the palate, which can be only a separation of the muscles with a normal mucosal lining, but poor function (submucous cleft palate), a separation of the posterior palate (incomplete cleft palate), or a complete separation of the palate.
Cleft lip and palateIs the association of a cleft separating the lip and the palate on one or both sides
Why does a cleft occurClefts are very common anomalies, occurring about 1 in 700 children.
The lip and the palate are fully formed in the first trimester of pregnancy. Anything interfering with the normal fusion of the parts forming the lip and the palate will cause the cleft.
Many factors may contribute to the clefts, both environmental (i.e. some prescription drugs) and familial. The majority of patients with a cleft do not have anyone in the family with the same problem.
The majority of patients with a cleft do not have any other problem, however in some patients there may be other medical problems.
Feeding a child with a cleftA child with a cleft can have initially some difficulties feeding. Most children with a cleft lip can be breast fed. In children with a cleft palate this can be more difficult. To help the baby with a cleft feed, a palatal (feeding) plate can be used, as well as a specific feeder, if needed.
Because of the cleft in the palate the baby will swallow more air and it is important to have her/him burp more frequently to avoid the sensation of having a full stomach. It is generally preferable to feed the baby holding her/him up at 45°, almost sitting.
The physician/surgeon caring for your child will provide you with all the appropriate assistance on how to successfully feed your child.
HearingChildren with a cleft palate may have ear problems. A small conduit connects the middle ear to the throat (Eustachian tube), allowing the fluid in the middle ear to exit in the throat. This tube may not function well in children with a cleft palate and cause fluid to accumulate in the middle ear, causing decreased hearing and increasing the risk for infection, especially in very young children. For this reason it may be necessary to insert ventilation tubes in the eardrums, to allow the fluid to exit and improve the hearing.
Normal hearing is fundamental for the development of normal speech.
SpeechUnrepaired clefts of the palate do not allow closing the air passage toward the nose and therefore cause speech problems. Cleft palate surgery reconstructs the normal anatomy providing the base for normal speech development.
Speech evaluations will be regularly performed and many patients will benefit from speech therapy after the surgery.
Some patients may require another surgery to further improve the speech.
Teeth and orthodonticsFor some patients an orthodontic plate may be required to correct the position of the separated upper jaw.
Depending on the cleft type the child can have missing or smaller teeth. A regular dental follow-up is required as for every child.
Most cleft patients will have teeth requiring re-alignment, and will therefore require orthodontic treatment.