Cleft lip and palate
Cleft lip and/or palate are the most common birth defects of the mouth. Cleft lip occurs when the two structures or processes that make up the lip do not fuse completely before birth.
According to a study conducted by the National Institute of Dental and Craniofacial Research, 7 in 1000 children are born with a cleft lip and palate deformity. This means that there are millions who need help but can’t access or afford it. While it’s still unclear what causes children to develop deformities, some believe it’s caused due to poor Vitamin B and folic acid levels in the mother. These deformities, experts believe could be wiped out if mothers take these vitamins before conception but that seems unlikely where nutrition for women isn’t really a priority.
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Dr Shishir Aggarwal, Senior Consultant, Plastic Surgery, Delhi based Sri Balaji Action Medical Institute says, ‘Cleft Palate is a form of facial malformations that occur in a baby during the pregnancy stages. It is caused when an opening in the roof of the mouth fails to fuse during the first few months of pregnancy when the embryo starts to develop. Generally, this opening in the palate allows communication between the nasal passages and the mouth.
The majority of cleft palate cases are believed to be caused by an interface of genetic and environmental factors. Although a definite cause hasn’t been discovered yet, genes inherited from both the parents cause this condition.
In some cases, although babies inherit a gene that increases their risk of developing a cleft defect, the condition will be manifested only when gene is activated by an environmental trigger. Also, exposure to certain substances during pregnancy like smoking cigarettes, drinking alcohol and taking certain drugs can result in their babies developing a cleft palate. Read about 5 ways smoking during pregnancy can harm your baby.
Apart from this, lack of proper nutrition and deficiency of folic acid and vitamin B-complex in pregnant women causes birth defects in their children. Here are 8 reasons why you need folic acid.
According to Dr Aggarwal, ‘There are several factors that are likely to increase the baby’s chances of developing a cleft palate such as –
- Family history: Parents with a family history of cleft lip and palate have a high risk of having a baby with this birth defect.
- Race: Cleft lip and palate is most common in American, Indian and Asian children, whereas African children hardly acquire this problem.
- Sex: Males are twice likely to develop a cleft lip with or without cleft palate, whereas a cleft palate without cleft lip is common in females.
- Obese mothers: Babies born to obese mothers may have increased risk of acquiring a cleft palate.’
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Usually, a cleft lip and palate is identifiable at birth and may affect one or both sides of the face. It might appear as a small notch in the lip that extends through upper gum into the bottom of the nasal septum. However, in some cases cleft occurs at the back of the mouth (which in turn is covered by mouth lining). In this type of cleft lip and palate, you might experience signs such as difficulty in swallowing, speaking (nasal voice) and high risk of ear infections.
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A cleft palate is normally diagnosed by an ultrasound done during pregnancy (before the baby is born) to detect whether the unborn child suffers from any birth defects. In this way, doctors are able to detect an abnormality in the facial structures by analyzing the pictures.
Read about ultrasounds during pregnancy – everything you need to know.
Dr Aggarwal explains, ‘In the recent past, there have been numerous advancements in the field of cleft palate surgery. Currently, cleft palate surgery is done with better, soft palate lengthening techniques so that velopharyngeal space (which creates space behind the palate and aid in proper speaking and swallowing of food) is narrowed with better soft palate movement. With advanced diagnostic video-endoscopy techniques it is easy to assess velopharyngeal incompetency (caused due to improper closing of the soft palate muscle present in the mouth thereby interfering with speech).’
Also, post surgical operation, patients are recommended to undergo speech training with a speech therapist so that nasal twang is corrected. Apart from this, advancement in maxillofacial surgery (used to treat defects in the mouth, jaws, neck and face) and orthodontics aid in better and effective treatment of cleft lip and palate. In maxillofacial surgery, maxillary segments are improved by osteotomy (a surgical operation that involves cutting a bone to fix an injury or facial appearance) to correct mid face retrution. Whereas, other dental implants such as secondary bone grafting and orthodontic treatment helps to bring the teeth in proper alignment.
Read more about why is a fetal echocardiography necessary?
Cleft lip and palate cause various problems along with interfering with your day-to-day activities such as -
- Cleft lip and cleft palate can cause problems with sucking, swallowing, speech and socialization.
- There could be a risk of aspiration (food going from the mouth to the nose and/or respiratory tract).
- Teeth may be missing, deformed or displaced. This could cause adjoining teeth to move into the space causing improper bite, irregular gaps between teeth and difficulty in chewing.
- Soft tissue folds and irregularities in the palate or roof of the mouth can increase the risk of gum disease.
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‘Although it is not possible to prevent the cases of a cleft palate, parents should follow some of the key steps to lower the risk of their kids from suffering with this condition. Here are few tips you need to consider,’ says Dr Aggarwal.
Read about 8 drinks or beverages to avoid during pregnancy.
The content has been verified by
Dr Shishir Aggarwal
, Senior Consultant, Plastic Surgery, Delhi based Sri Balaji Action Medical Institute.