Pediatric Congenital Conditions Cleft Palate

A cleft lip is a disfiguring birth defect resulting in a gap in the tissue of the upper lip. A cleft palate is a related disorder in which the roof of the mouth has a fissure so that the mouth connects to the nasal cavities.

Cleft lip surgery is required to correct this cosmetic disfigurement. While several reconstruction surgeries may be necessary to correcting a cleft lip of palate, fortunately, surgery is effective in correcting most cases of cleft lip and/or palate.

Cleft Lip Anatomy

Depending on the severity of the cleft lip, the gap may be a small notch in the lip or a large gap extending to the nose. Children with cleft lips that extend to the nose may also suffer from stretched nostrils or flattened noses.

A cleft lip may be unilateral, referring to a gap that affects only one side of the mouth. Children will clefts on both sides of the mouth have bilateral cleft lips. Patients with bilateral cleft lips are more likely to have nasal tissue disfigurement and, consequently, require more extensive cleft lip surgery.

Cleft Palate Characteristics

A cleft palate is only noticeable when looking into a child’s mouth. The cleft palate is an opening in the top of the mouth that involves either the hard palate (the tissue that divides the mouth from the nasal structure), the soft palate (the tissue at the back of the mouth by the throat) or both.

Causes of a Cleft Lip

Although the exact causes of a cleft lip and cleft palate remain unknown, they are thought to come from a combination of factors. A few of the supposed causes include genetic propensity for clefting and maternal drug or alcohol abuse during pregnancy.

A family history of cleft lips or cleft palates increases the risk of a child suffering from this condition. Studies also support the theory that ethnicity and genetics play a role in cleft lip. While the overall incidence of clefting is one in every 2,500 births, certain ethnic groups have a higher risk of clefting:

  • African-Americans: one cleft lip per 2,000 births
  • Asian-Americans: one cleft per 1,000 births
  • Caucasians: one cleft lip per 1,000 births.

Gender also plays a role in the causes of cleft lips. While boys are more likely to have cleft lips than girls, girls are more likely to have cleft palates without cleft lips. Keep in mind, however, that it is possible for both sexes to be born with a cleft lip, a cleft palate or both.

Factors that contribute to an unhealthy pregnancy and, therefore, give rise to the possibility that a child will have a cleft lip or cleft palate include:

  • drinking alcohol
  • taking anticonvulsant medication or Vitamin A supplements (The anticonvulsant medication phenytoin increases the risk of a cleft lip by 10 times the baseline risk.)
  • smoking (Smoking while pregnant doubles the chances that the baby will be born with a cleft lip or palate).

Cleft Lip and Cleft Palate Complications

Disfigurement is the most obvious complication associated with children who suffer from cleft lips. Repair of a cleft lip is essential to prevent your child from suffering from teasing, self-image problems and even clinical depression. Other complications of a cleft lip include:

  • difficulty feeding
  • misaligned teeth
  • speech impairment
  • stretched nostrils or noses.

While a cleft palate is not as noticeable as a cleft lip, it tends to produce more complications. Children with cleft palate often experience feeding problems. For example, infants with cleft palate may regurgitate milk through their noses.

Special bottle nipples are available to help feed a baby with a cleft palate. A prosthetic palate called an obturator can also improve feeding until cleft palate surgery corrects the problem.

Along with trouble eating, cleft palate complications include the increased risk of ear infections, as cleft palate affects the development of the Eustachian tubes (the tubes that nasal and ear cavities to equalize ear pressure). With malformed Eustachian tubes, fluid accumulates in the tubes that usually drain fluid from the ears to the throat. Fluid can become infected, resulting in ear infections.

Other complications associated with a cleft palate include:

  • displaced or missing teeth
  • extra teeth
  • growth delays
  • hearing loss
  • nasal deformities
  • speech impairment
  • susceptibility to colds.

Children with a combined cleft lip and cleft palate may experience delayed upper jaw growth, in which the upper jaw does not match the growth of the lower Jaw. In these cases, surgical reconstruction is required to align the jaws.

Surgery for Cleft Lips and Cleft Palates

Usually performed on children three to nine months old, cleft lip surgery generally has positive outcomes. Like many other types of corrective surgery, the amount of surgery required depends on the severity of the case. Here is an outline of the various procedures that doctors use to correct clefting:

  • Cleft Lip Surgery: In procedures to correct cleft lips, doctors start by suturing together the two sides of the cleft lip and allowing it to heal. Further cleft lip reconstruction may include cosmetic surgery to reshape the lip and reduce surgical scarring. If the cleft lip extends to the nose, more surgery may be needed to reconstruct the nasal tissue.
  • Cleft Palate Surgery: Corrective surgery for cleft palates uses tissue from the sides of the cleft to reconstruct the palate. The goals of cleft palate surgery are to close the fissure and reduce the risk of ear infections. Similarly, it attempts to help facial bones to grow properly. Cleft palate surgery usually requires several operations.
  • Combined Clefting Surgery: Children who have a cleft lip and palate will need more surgery than patients who suffer from only one of the conditions. Along with the typical procedures associated with both cleft lip and cleft palate corrective surgeries, additional surgery to improve breathing and speech will be needed.Additional surgeries are scheduled six months apart to ensure time to heal between surgeries. The final surgeries that reduce surgical scarring are often left until the teen years when facial bones have matured. Emotional support and counseling may be needed to deal with self-esteem issues until surgery is complete.

Resources

KidsHealth (updated September 2005). Cleft Lip and Palate. Retrieved September 19, 2007 form the KidsHealth Web site: http://www.kidshealth.org/parent/medical/ears/cleft_lip_palate.html.

U.S. Library of Medicine (updated 22 October 2004). Cleft lip and palate. Retrieved June 5, 2005 from the NLM Web site: www.nlm.nih.gov/medlineplus/ency/article/001051.htm.