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Cleft Lip

Treatment for oral clefting

Oral clefting (cleft lip or cleft palate), occurs in early pregnancy when the lip and / or palate tissues of the fetus do not grow together. A cleft lip has a narrow opening or gap in the skin of the upper lip that continues to the base of the nose. A cleft palate is an opening between the roof of the mouth and the nasal cavity. A child can be born with a cleft lip, a cleft palate or both. All fetuses in the womb have an opening in the upper lip and the roof of the mouth while the mouth is forming, but structures typically fuse together during the first trimester of pregnancy. When this fuse does not take place, a baby is left with an oral cleft.

Though doctors do not know the exact cause of cleft lips and palates, both genetic and environmental factors are believed to be large contributing factors. According to the Mayo Clinic, both the mother and father can pass on the genes that cause clefting, either as an isolated defect or as part of a syndrome that includes clefting as one of its signs. It is believed that in some cases, babies are passed a gene that make them at higher risk of developing a cleft, and then an environmental trigger actually causes the cleft to occur. If a pregnant woman is exposed to these environmental triggers, it increases the chance of clefting to occur. Such triggers are:

  • Cigarette smoke
  • Alcohol
  • Certain medications
  • Illicit drugs
  • Certain viruses
  • Nutritional deficiencies in the mother

Having a family history of cleft palate or cleft lip also puts the baby at a higher risk for developing one. Clefts are more common in Native Americans and children of Hispanic and Asian descent, while children of African descent are the least likely to have them. Males are twice as likely as females to have cleft lip, but females are about twice as likely to have a cleft palate.

There are many complications related to oral clefting, such as being more susceptible to colds, hearing loss and speech defects. Numerous dental problems also plague children with clefts, such as cavities and missing, extra, malformed or displaced teeth. Ear infections are also common due to Eustachian tubes not draining fluid away from the middle ear properly. The simple process of feeding also becomes a challenge when an infant is born with clefts. Improper sucking due to a misshaped mouth and accidentally taking milk up into the nasal cavity due to a cleft palate are expected obstacles.

Oral Clefting Surgery

Thankfully, the medical field has done much work in perfecting oral clefting surgeries. Surgery to repair a cleft lip should ideally be done between birth and three months and cleft palate repair done by one year of age. Follow-up surgeries then occur between age two and the late teen years.

To repair cleft lip, a surgeon will make an incision on each side of the cleft, and then the two sides of the lip are sutured together. Some cleft lip repairs require two surgeries, roughly a month apart, and may require a short hospital stay.

Surgery to repair a cleft palate entails taking tissue from either side of the mouth to rebuild the palate. This surgery is more involved and requires two or three nights in the hospital, with night one spent in the intensive care unit.

Parents that have had one baby born with a cleft are probably concerned that subsequent children would suffer the same fate. With genetic counseling, you can better determine how real that risk is. The simple task of taking a prenatal vitamin with the full serving of folic acid is one way to help prevent a cleft from forming.

If your baby is shown to have a cleft lip or palate, there is help available. Set up a plan with a surgeon before the baby is even born – it's the best way to ensure the optimal future for your child.

By Amelia Bines

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