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Cleft Lip & Cleft Palate

Overview

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Cleft Lip is a condition where there is an opening or gap in the upper lip that can extend into the nose. It occurs when the tissue that forms the lip doesn’t fully come together during fetal development. Cleft Palate is a condition where there is an opening or gap in the roof of the mouth (palate) that can extend into the nasal cavity. It occurs when the tissue that forms the roof of the mouth doesn’t fully fuse during fetal development. Both conditions can occur together, and their severity can range from a small notch in the lip to a large gap that extends through the gums and palate.

It occurs when the tissue that forms the lip doesn’t fully come together during fetal development. Cleft Palate is a condition where there is an opening or gap in the roof of the mouth (palate) that can extend into the nasal cavity. It occurs when the tissue that forms the roof of the mouth doesn’t fully fuse during fetal development.

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Symptoms

Cleft Lip:

  • Visible gap or split in the upper lip.
  • Sometimes extends into the nose.
  • Difficulty feeding due to the inability to create a proper seal.

Cleft Palate:

  • Opening in the roof of the mouth.
  • Problems with feeding and swallowing.
  • Nasal speech or voice quality changes.
  • Frequent ear infections and possible hearing loss due to fluid in the middle ear.
  • Difficulty with speech development and articulation.
Complications
  • Feeding Difficulties: Babies with cleft lip or palate may have trouble breastfeeding or bottle-feeding effectively.
  • Speech and Language Delays: Problems with articulation and speech development can occur if the cleft is not repaired.
  • Hearing Problems: Increased risk of ear infections and hearing loss due to fluid accumulation in the middle ear.
  • Dental Issues: Misaligned teeth and problems with tooth development may arise.
  • Social and Emotional Impact: Children may face psychological challenges related to appearance and self-esteem.
Causes
  • Genetics: Family history of cleft lip or palate can increase the likelihood of these conditions.
  • Environmental Factors: Certain factors during pregnancy, such as smoking, alcohol consumption, or exposure to certain medications, can contribute to the development of clefts.
  • Nutritional Deficiencies: Lack of essential nutrients, particularly folic acid, during pregnancy may play a role.
  • Combination of Factors: It is often a combination of genetic and environmental factors that lead to the formation of a cleft.
Prevention
  • Prenatal Care: Regular prenatal visits and screening to monitor and manage health during pregnancy.
  • Healthy Lifestyle: Avoiding alcohol, smoking, and certain medications during pregnancy.
  • Nutritional Supplements: Taking prenatal vitamins with folic acid to help reduce the risk of birth defects.
  • Genetic Counseling: For families with a history of clefts or other congenital conditions, genetic counseling may provide information on risks and preventive measures.
Risk Factors
  • Family History: A family history of cleft lip or palate increases the risk.
  • Maternal Health: Certain maternal health conditions and lifestyle factors (e.g., smoking, alcohol use) can contribute.
  • Gender: Cleft lips are more common in males, while cleft palates are more common in females.
  • Ethnicity: Higher prevalence is observed in certain ethnic groups, such as those of Asian or Native American descent.
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How is it treated?

Surgical Repair:

  • Cleft Lip Repair: Usually performed between 3 and 6 months of age to close the gap in the lip and improve appearance and function.
  • Cleft Palate Repair: Typically performed between 9 and 18 months of age to close the gap in the palate and improve feeding and speech development.
  • Speech Therapy: To address speech and language development issues, often starting early in childhood.
  • Orthodontics and Dental Care: To address dental issues and ensure proper alignment of teeth as the child grows.
  • Hearing Assessment: Regular hearing tests and possible interventions for ear infections or hearing loss.
  • Psychosocial Support: Counseling and support for the child and family to address emotional and social impacts.
  • Early intervention and a multidisciplinary approach involving pediatricians, surgeons, speech therapists, and other specialists are crucial for optimal management of cleft lip and cleft palate. Regular follow-ups and tailored care plans help ensure the best possible outcomes for affected individuals.
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How is it Diagnosed?

Cleft lip and cleft palate are congenital deformities that can be diagnosed prenatally or shortly after birth. In many cases, a cleft lip—with or without cleft palate—is detected during a routine prenatal ultrasound, typically around the 18th to 20th week of pregnancy. High-resolution 2D and 3D ultrasound imaging can reveal a visible split in the upper lip. However, isolated cleft palate may be more challenging to detect prenatally, as it lies inside the mouth and may not be visible in standard scans.

After birth, a physical examination is usually sufficient to confirm the diagnosis. A visible gap in the lip or the roof of the mouth (hard or soft palate) is typically observed. The severity and extent of the cleft are assessed, which is important for planning treatment and surgical repair.

    Further diagnostic assessments may include:

  • Feeding evaluation, as infants with cleft palate often have difficulty feeding.
  • Audiological assessment, since middle ear problems and hearing loss are common.
  • Speech and language evaluation, especially for cleft palate cases.
  • Genetic testing, particularly if the cleft is part of a syndrome involving other abnormalities.
  • A multidisciplinary team including a pediatrician, plastic surgeon, ENT specialist, audiologist, and speech therapist is typically involved in the evaluation and treatment planning to ensure holistic care.

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