Cleft lip and cleft palate are two common developmental disorders that occur during pregnancy. They are facial and oral disorders that occur within the first trimester of the baby’s formation in the mother’s womb.
Generally, clefts or clefting occurs when the amount of tissue is not enough to cover the lip or mouth region. Likewise, it may be as a result of the inability of the tissues to properly join together to form a covering for the lips or the mouth.
When a baby is seen to be born with a large hole in the upper lip of the mouth, the child can be said to have a cleft lip. Cleft lip occurs when there is a visible physical split on the upper lip.
Sometimes, it can appear as the presence of a narrow gap on the upper lip, which may often extend to the base of the nose and may include the bones found at the upper gum or the upper jaw.
On the other hand, if the lip is formed correctly, but there is an opening on the hard palate(the roof) of the mouth or an opportunity on the soft palate which is the soft area around just behind the hard palate (at the back of the mouth), then the child is said to have cleft palate.
A cleft palate can occur on both sides of the mouth, but in most cases, it is seen to affect just one part of the mouth. One common question people ask is if it is possible to develop both at the same time.
Although the palate and the lip develop at different times, however, their development is closely related, and as such, it is possible to have one without another.
This means that it is possible to develop cleft palate without developing a cleft lip, and it is also possible to develop cleft lip without developing a cleft palate. Also, it is entirely possible to have deformities in both the palate and the lip.
Clefts have been seen to be a fairly common disease as it affects one in 700 babies every year. According to research, this deformity has been seen to be the fourth most common congenital disabilities to affect children in the U.S. It has also been observed that this deformity affects Asians and native Americans than Africans and Indians.
Also, in terms of sex, boys are often much more with cleft palate than girls, while girls have been seen to develop cleft lip often much more than boys.
What are the causes of cleft lip and cleft palate?
Generally, cleft lip and cleft palate occur as a result of the inability of the tissues of the lip to fuse properly as well as the failure of the tissues of both the hard and soft palate to blend properly. However, what causes this inability is still unknown.
Usually, these tissues are meant to fuse properly in the first trimester of pregnancy, generally within the second and third months. However, when this fusion doesn’t occur, it leaves behind a large gap known as a cleft.
There have been speculations among researchers and doctors attributing the causes of cleft palate and cleft lip to genetic as well as environmental factors.
Researchers say that it is entirely possible for either the mother or the father of the child to pass on the gene that results in clefting to the child.
For some children, they may have the gene of clefting; however, it may never manifest due to the child’s environment. However, for children who exhibit this deformity, it has shown that a large number of them had the gene, as well as contributing factors from the environment, resulted in the manifestation of the gene.
One other cause that seems to be a contributing factor to the development of this deformity is the kind of drugs and medications taken by the mother while she was pregnant. Some medications, as well as drugs, have the capacity to cause this deformity.
Drugs such as some anti-seizure drugs, anti-convulsants, drugs that are used for acne, which may contain Accutane and methotrexate as well as medicines which are used for treating cancer and arthritis have been considered to be harmful to use during pregnancy.
This is because when used during pregnancy, they have the tendency of causing cleft lip and cleft palate.
Also, children who have relatives or family members who have once had the deformity have a higher chance of developing this condition. If the child is exposed to harmful substances (such as chemicals) as well as some viruses, the child might come out with this deformity.
There are some children who develop cleft lip and palate as a result of an underlying sickness or medical condition.
Symptoms of cleft lip and cleft palate
Usually, cleft lip and cleft palate are two visible deformities that generally appear at birth. There are, however, several presentations of this disease, and they include:
- A split in the hard palate(roof) of the mouth as well as a division of the lip, which may affect both sides of the face or just one side.
- A split on the lip which may appear as only a slight tear in the lip or might extend upwards to the base of the nose.
- A tear in the roof of the mouth which may not quickly appear on the face.
Sometimes, the tear may occur on the soft palate, which is that part of the mouth that is just behind the tongue. It is also known as the submucous cleft, and an epithelium lines it.
This type of cleft, which is known as the submucous cleft palate often time is missed at birth, and this is due to the location of the cleft. The cleft may go on until the child is older before it is detected.
However, there are some signs that are generally associated with children who have a cleft in their soft palate, and these symptoms include:
- The intense difficulty of the child to swallow and as such breastfeeding will become a problem.
- Difficulty in taking in liquids as it has the potential of it coming out through the nose.
- Ear infections that tend to be chronic.
- Nasal speaking voice.
Risk factors
There are certain factors that tend to increase a child’s chances of developing a cleft palate and cleft lip. These factors include:
1. Family History of the disease
If there is a family history of cleft palate or cleft lip, then the chance of the baby developing a cleft increases to a more considerable extent.
2. Exposure or the use of certain drugs and substances during pregnancy
Women who smoke, drink alcohol, take hard drugs as well as take certain medications can increase their babies’ chances of developing cleft lip and cleft palate.
3. Women who have diabetic and pregnant
According to research, some pieces of evidence have pointed out that women who have diabetes before or during pregnancy may increase the baby’s chances of developing cleft palate and cleft lip.
4. Obesity
Being obese during pregnancy can cause a lot of complications to the baby, and one of such complications include the possible development of the cleft palate and cleft lip.
Complications associated with the development of cleft
Babies who have cleft lip and cleft palate are prone to facing a lot of challenges until treatment is carried out. Some of these complications include:
1. Severe difficulty in feeding
One of the most difficult complications a child who has cleft stands to face is the difficulty I’m feeding. The children who have cleft palate tend to have more problems as it is difficult for them to suckle.
However, babies who have a cleft lip can still suckle but may find it difficult to swallow.
2. Ear infections may lead to hearing loss
Babies who have cleft palate may often have the tendency of having fluid in their middle ear, and this can result in them losing their hearing either temporarily or permanently depending on the severity of the infection.
3. Dental problems
In some children, the cleft can extend through the upper gum up to the bridge of the nose. Once this occurs, the child may experience difficulties in the growth of their tooth.
4. Speech problems
Generally, the palate is involved in the production of individual sounds. Once a child has a cleft palate, it may be difficult for the child to articulate some words, and as such normal speech will become impaired, leading to speech disorders.
Treatment
A cleft lip is often treated when a child is about three months old with initial surgery. Depending on the extent of the damage, the number of operations may be one or more than one.
Cleft palate, on the other hand, will require quite a number of surgeries for 18years. The first surgery is often done when the baby is about 6months old, and it is corrective surgery.
Children who have cleft palate may require the use of a bone graft in order to fill the upper gum line so that it can support the development of teeth.
