Cleft Lip and Cleft Palate

Cleft lip and cleft palate are birth defects that affect the upper lip and roof of the mouth. This happen when the tissue that forms the roof of the mouth and upper lip don't join before birth. The problem can range from a small notch in the lip to a groove that runs into the roof of the mouth and nose. This can affect the way the child's face looks. It can also lead to problems with eating, talking and ear infections. A cleft is a fissure or opening—a gap. It is the non- fusion of the body's natural structures that form before birth.

Cleft Palate

Sometimes the roof of the mouth does not completely close, leaving an opening that extends into the nasal cavity. The cleft may include either side of the cavity. The abnormality may be associated with cleft lip or other syndromes.

Cleft Lip

Incomplete formation of lips during foetal development leads to Cleft Lip abnormality. The extent varies from mild to severe. The clefts can be distinguished into unilateral clefts and bilateral clefts.

Associated Problems

• Feeding difficulties: The infant with the abnormality is unable to suck properly.
• Ear infections and hearing loss: Ear infections occur due to dysfunction of the tube that connects the middle ear and the throat. Recurrent infections lead to hearing loss.
• Speech and language delay: The deformity leads to reduced muscle function, thus affecting speech.
• Dental problems: Oligodontia, malaligned teeth causes crowding, rotations, spacing, poor hygiene maintenance leading caries, periodontal problems etc.

What causes cleft lip and cleft palate?

The exact cause of cleft lip and cleft palate is not completely understood. Cleft lip and/or cleft palate are caused by multiple genes inherited from both parents, as well as environmental factors that scientists have not yet fully understood.

Multifactorial inheritance is the type of hereditary pattern seen when there is more than one genetic factor involved and sometimes, when there are also environmental factors participating in the causation of a condition.

As genes are involved, the chance for a cleft lip and/or cleft palate to happen again in a family is increased, depending on how many people in the family have a cleft lip and/or cleft palate. If parents without clefts have a baby with a cleft, the chance for them to have another baby with a cleft ranges from 2 to 8 percent. If a parent has a cleft, but no their children are without cleft, the chance to have another baby with a cleft is 4 to 6 percent. If a parent and a child have a cleft, the chance is even greater for a future child to be born with a cleft. Genetic consultation is suggested.

Feeding my baby with cleft palate:

The most immediate concern for a baby with cleft palate is good nutrition. Sucking for children with a cleft palate is difficult because of the poorly formed roof of the mouth. Children with just a cleft lip (without a cleft palate) do not routinely have feeding difficulties. The following are suggestions to help aid in the feeding of your infant:

• Breastfeeding is allowed. It will take extra time and patience. Be open for alternatives if this is not providing adequate nutrition for your infant. You may still pump your breast and feed your infant breast milk through other techniques.
• Hold your infant in an upright position to help keep the food from coming out of the nose.
• Other feeding devices may be utilized. Consult with your child's physician for more information.
• Small, frequent feedings are recommended. This can be a frustrating and slow process, however, your infant will receive more calories and therefore, gain weight.
• There are many types of bottles and nipples on the market that can assist with feeding an infant with cleft palate. Consult your child's physician regarding which type is most appropriate for your child. The following are a few examples:
  • Syringes may be used in hospitals following cleft surgery and may also be used at home. Typically, a soft, rubber tube is attached on the end of the syringe, which is then placed in the infant's mouth.
  • In some cases, supplements may be added to breast milk or formula to help your infant meet his/her calorie needs. Consult your child's physician regarding other home devices (i.e., small paper cups) for feeding your child with a cleft palate.

The cleft abnormalities can be managed and corrected via a team approach. This team must comprise plastic/craniofacial surgeon, paediatrician, orthodontist, paediatric dentist, speech and language specialist, Otolaryngologist (ear-nose-throat specialist), audiologist (hearing specialist), genetic counsellor, nurse team coordinator and social worker.