Cleft Lip and Palate – Causes and Treatment

Cleft lip and palate is a common birth defect characterized by congenital malformation of the upper lip and roof of the mouth which occurs very early in pregnancy. Clefting results when there is not enough tissue in the mouth or lip area, resulting in improper joining of the available tissue. A cleft lip appears as a separation of the two sides of the upper lip and appears as a narrow opening or gap in the skin of the upper lip. A cleft palate occurs if the tissue that makes up the roof of the mouth does not join together completely, leaving the palate open.

Causes

The actual causes of cleft lip and palate are not known and researchers believe it may be due to genetic and environmental factors. The top lip and/or roof of the mouth of the fetus are disrupted, which is usually believed to be the result of one or more of the following factors:

  • Defective genes
  • Vitamin deficiency
  • Viral illness
  • Alcohol consumption
  • Cigarette smoking
  • Family history
  • Medications during pregnancy
  • Exposure of the fetus to chemicals

Cleft Lip and Palate Surgery

The surgeon will recommend cleft repair surgery in the early stages of infancy – when the baby is between 6 and 12 months old. In addition to surgical repair of the cleft, the treatment may include speech rehabilitation, surgery to improve cosmetic appearance, and dental correction.

Before surgery, some children may require some sort of orthodontic treatment such as nasal alveolar molding or NAM in order to guide the growth of the mouth in the right direction. This is usually a lengthy process which mainly involves realigning the upper jaw’s cleft segments. The cleft lip edges are brought closer to allow precise cleft repair and correction of nose deformities.

This process begins with the creation of an upper jaw mold created using maxillary impressions and use of the mold to construct an acrylic plate. The plate is then fitted in the child’s mouth. Adjustments are made on a weekly basis to correctly align the growing bone. The jaw alignment is followed by significant lip alignment improvement, after which nasal correction is initiated. A stent is placed from the plate extending to the nostril and the nasal tip is elevated. Finally, the lining of the nose is stretched, bringing about more accurate aesthetic nasal repair. The duration of the nasal alveolar molding procedure will vary based on the severity of the condition.

Following treatment, most children will have a normal appearance with minimal scarring and normal speech. A board-certified plastic surgeon with vast experience in this field can provide effective treatment for cleft lip and palate. In reliable AAAASF-accredited surgical centers, expert craniofacial surgeons work with a team of specialists that would include an orthodontist, a pediatric plastic surgery nurse, a speech pathologist, an otolaryngologist (ENT), a dietician, an audiologist, and an oral surgeon. Such a coordinated approach will help in resolving these congenital defects and enhance the child’s ability to function, grow normally and lead a healthy life.