Cleft lip and palate are structural abnormalities that start during fetal development. As a baby develops in the womb, the structures that form the lips and roof of the mouth join. In some cases, this does not happen correctly, resulting in a cleft.
A cleft is a gap. It commonly affects the lip or the roof of the mouth, known as the palate. The extent of a cleft can vary widely. Some small clefts in the lip just look like an indentation, whereas others can extend to the nose. A cleft can be unilateral and affect one side of lip, or it can be bilateral and affect both sides.
COMPLICATIONS
Without treatment, a cleft lip/palate can lead to:
• Feeding difficulty
• Problems with dental development
• A higher risk of tooth infection
• Ear infection
• Possible hearing loss
• Unclear speech/speech that sound unusual
• Breathing difficulties
• A risk of aspiration/taking food into the lungs.
CAUSES
Doctors do not know precisely why some children are born with a cleft, but it happens when structures in the mouth do not form as they should while the skull is developing. The lip forms between the fourth and seventh week of pregnancy.
RISK FACTORS
In some cases, it may be due to certain changes in specific genes.
Other risk factors are associated with the pregnancy. A pregnant women can minimise the likelihood of a cleft affecting the baby by:
• refraining from smoking
• avoiding drinking alcohol
• working with a doctor to manage their weight safely, if they have obesity.
• Taking enough folic acid
• Avoiding certain medications during pregnancy such as steroids, antiseizure drugs
TREATMENT
Various treatment options are available:
For cleft lip, an infant will usually have surgery at the age of 3-5 months, but this will depend on various factors, such as the size of the infant and the presence of any other health conditions. There will be follow ups when they reach the age of 2-3 years to address any problems with speech or swallowing.
For cleft palate, possible interventions include
• Nasoalveolar molding
• Surgery usually within 6-12 months
• Further surgery if necessary as the child grows older
Types of surgery depends on the extent of the cleft.
The benefits of surgery include:
• Improving the appearance
• Allowing the teeth to develop
• Improving speech
• Reducing the risk of ear and hearing problem
• Helping with breathing in some cases
Cleft lip/palate can lead to difficulties with speech, feeding and hearing as well as an altered facial appearance. These challenges can affect a child’s confidence, self-image and social life. However, surgery is usually effective, and other therapies can help monitor and prevent issues with teeth, speech, hearing and feeding.
The condition can have a considerable impact on a child’s well-being in the early years, but the result after surgery is usually excellent, with most children going on to live a full and healthy life.
(The writer is resident dentist at Studio32, a chain of dental clinics in the State)
