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Cleft Lip and Palate

“Smile and the world smiles with you”, perhaps a phrase that is very unfortunate for a child born with a cleft lip or palate. It indeed does take fewer muscles to smile than to frown, but for a child with this condition, smiling is difficult .The first 3 month of pregnancy is when the formation of the face takes place and it is around this time that these abnormalities occur.

What is a cleft?

A cleft forms when the skin, muscles and bones from one side of the face do not merge with their counterparts on the other side of the face. Cleft lip is a gap between the skin and muscles in the upper lip, this may also in certain cases extend to the region where the nose ends. Cleft palate on the other hand is a gap in the roof of the mouth resulting in an opening between the roof of the mouth and the nasal cavity. Both a cleft lip and a cleft palate may involve either one side of the lip (unilateral) or both sides (bilateral).

A cleft can be of various types .A child may be diagnosed with only an independent cleft lip or a cleft palate, or both together. Each of these conditions can occur on one or both sides of the face. A cleft lip where there is some skin intact between the lip and the nose is known as an incomplete cleft lip, while a complete cleft lip is when the gap between the lips extends through the entire length of the lip to the floor of the nose. Both cleft lip and palate can be detected in an ultrasound during pregnancy; a cleft lip can be detected as early as the 12th week of pregnancy.

Causes of a Cleft Lip and Palate

A cleft results when the lip and the palate do not merge properly before birth, why it happens though is not really known. Researchers agree that a cleft is caused by a combination of genetic and environmental factors - “The child may inherit a gene that makes the development of a cleft possible, but unless certain environmental factors are present the possibility will not become a reality.”

Lack of the vitamin B9 and folic acid at the time of conception and during pregnancy can cause a cleft lip, cleft palate and other birth defects. Expecting mothers are therefore expected to take folic acid supplements from 1 month before pregnancy to the end of the first trimester. There are a few drugs though that interfere with the body’s use of folic acid and can increase the risk of a variety of birth defects including cleft lip and palate, if taken during pregnancy. These drugs include those taken to treat epilepsy like phenytoin and Phenobarbital among others. Maternal alcohol abuse and smoking have also been indicated to increase the risk of clefts.

Management of a Cleft Lip and Palate

This medical condition is usually treated by a multidisciplinary team of doctors consisting of a plastic surgeon, maxillo–facial surgeon, orthodontist, ENT surgeon, Speech therapist, psychologist and a geneticist.

The best time to treat a cleft lip is to operate on the child when s/he is between 3 to 6 months of age and weighs at least 5kgs. This surgery is usually conducted under general anaesthesia as it help makes the process pain free. In some types of clefts, such as the complete ones, delay in surgery could result in the gap becoming wider.

The cleft palate surgery though is carried out only once the child begins to speak, which is usually around the age of 1. It is essential for the child to weigh around 10kgs by this time. Delay in palate repair results in the child developing faulty speech along with a nasal tone in the voice. This becomes more and more difficult to correct as the child grows older.

Children with a complete cleft of the lip and palate involving the alveolus (bony tissue which holds the teeth and is covered by the gums) will require bone grafting. It is a surgical procedure in which a piece of bone is taken from another part of the body and packed into the area of the missing bone, so that it can hold a tooth in the future. A final surgery particularly around the nose is then required at the age of 18 , when the face has completely grown.

Cleft Lip and Palate is a completely treatable condition. The right surgery at the right age by the right surgeon will give the child a second chance at life, this time with a brighter smile and a new hope.

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