Cleft lip and palate:
Cleft lip and cleft palate are facial and oral malformations that occur very early in pregnancy, while the baby is developing inside the mother.
Clefting results when there is not enough tissue in the mouth or lip area, and the tissue that is available does not join together properly.This separation often extends beyond the base of the nose and includes the bones of the upper jaw and/or upper gum.
A cleft palate is a split or opening in the roof of the mouth. A cleft palate can involve the hard palate (the bony front portion of the roof of the mouth), and/or the soft palate (the soft back portion of the roof of the mouth).Cleft lip and cleft palate can occur on one or both sides of the mouth.
The occurrence of clefts, are due to a combination of genetic and environmental factors. There appears to be a greater chance of clefting in a newborn if a sibling, parent, or relative has had the problem.Another potential cause may be related to a medication a mother may have taken during her pregnancy.Cleft lip and cleft palate may also occur as a result of exposure to viruses or chemicals while the foetus is developing in the womb.
Problems associated with cleft lip and palate:
- Eating problems: With a separation or opening in the palate, food and liquids can pass from the mouth back through the nose.
- Ear infections/hearing loss: Children with cleft palate are at increased risk of ear infections since they are more prone to fluid build-up in the middle ear. If left untreated, ear infections can cause hearing loss.
- Speech problems: Children with cleft lip or cleft palate may also have trouble speaking. The voice may take on a nasal sound, and the speech may be difficult to understand
- Dental Problems: Children with cleft palate often have an alveolar ridge defect. A defect in the alveolus can cause improper positioning of teeth, alveolar bone from forming and also can prevent eruption of permanent teeth.
Treatment of cleft lip and palate:
The treatment of cleft palate involves a multidisciplinary approach. The members of a cleft lip and palate team typically include:
- Plastic surgeon to evaluate and perform necessary surgeries on the lip and/or palate
- An otolaryngologist (an ear, nose, and throat doctor) to evaluate hearing problems and consider treatment options for hearing problems
- An oral surgeon to reposition segments of the upper jaw when needed, to improve function and appearance and to repair the cleft of the gum
- An orthodontist to straighten and reposition teeth
- A dentist to perform routine dental care
- A prosthodontist to make artificial teeth and dental appliances to improve the appearance and to meet functional requirements for eating and speaking
- A speech therapist to work with the child to improve speech
- An audiologist (a specialist in communication disorders stemming from a hearing impairment); to assess and monitor hearing
The health care team works together to develop a plan of care to meet the individual needs of each patient. Treatment usually begins in infancy and often continues through early adulthood.
· Surgical care:
A cleft lip may require one or two surgeries depending on the extent of the repair needed. The initial surgery is usually performed by the time a baby is 3 months old.
Repair of a cleft palate often requires multiple surgeries over the course of 18 years. The first surgery to repair the palate usually occurs when the baby is between 6 and 12 months old. Children with a cleft palate may also need a bone graft when they are about 8 years old to fill in the upper gum line so that it can support permanent teeth and stabilize the upper jaw. About 20% of children with cleft palate require further surgeries to help improve their speech.Once the permanent teeth grow in, braces are often needed to straighten the teeth.Additional surgeries may be performed to improve the appearance of the lip and nose.
Orthodontic care:
- A first orthodontic appointment may be scheduled before the child has any teeth. The purpose of this appointment is to assess facial growth, especially jaw development. After teeth erupt, an orthodontist can further assess a child's short and long-term dental needs. After the permanent teeth erupt, orthodontic treatment can be applied to align the teeth.
Prosthodontic care:
- A prosthodontist is a member of the cleft palate team. He or she may make a dental bridge to replace missing teeth or make special appliances called "speech bulbs" or "palatal lifts" to help close the nose from the mouth so that speech sounds more normal. The prosthodontist coordinates treatment with the oral or plastic surgeon and with the speech pathologist.