Cleft lip and palate is one of the most common birth defects of lip and mouth cavity. Cleft lip and cleft palate can be either alone or can be combined cleft lip and cleft palate with cleft alveolus. Cleft lip can be one side (unilateral) or both sides (Bilateral). All of these defects are known as ‘Orofacial Clefts’.
A slit or gap in lip from birth. Defect may be like a slight notch to a big gap. A child with cleft lip looks ugly and there may be speech problems also if gap is very big.
A slit or gap in Palate (roof of mouth) from birth. Defect may be like a slight notch in Uvula to a big gap in whole palate.
Cleft palate child suffer with feeding problem and thus malnourished. They also suffered with frequent ear infections, respiratory tract infections like pneumonia which may be life threatening, in later life speech problem – they can’t pronounced the words properly, their speech is not understandable. A child with cleft lip and palate can’t go to school properly as his/her speech is not understandable. They are socially neglected.
A slit or gap in Palate (roof of mouth) from birth. Defect may be like a slight notch in Uvula to a big gap in whole palate.
Cleft palate child suffer with feeding problem and thus malnourished. They also suffered with frequent ear infections, respiratory tract infections like pneumonia which may be life threatening, in later life speech problem – they can’t pronounced the words properly, their speech is not understandable. A child with cleft lip and palate can’t go to school properly as his/her speech is not understandable. They are socially neglected.
A slit or gap in alveolus (Gum) from birth. Defect may be like a slight notch in gum to a big gap. Defects in alveolus causes dental problems.
A slit or gap in any site of lip from birth which may involve wide area of face including nose, around eye. Defect may be like a slight notch to a big gap. A child with facial cleft looks uglier than simple cleft lip and there may be speech problems also if the gap is very big.
The external human face develops between the 4th and 6th week of embryonic development. The development of the face is completed by the 6th week.
Between the 6th and 8th week, the palate begins to develop. Consequently, this causes a distinction between the nasal and oral cavities. This development is completed by the 12th week.
The structures of the external face are derived from fusion of 5 structures :
Any defect in fusions of these five structures results in oro-facial cleft.
Cleft lip can be incomplete or complete cleft lip, unilateral cleft lip or bilateral cleft lip with or without cleft alveolus and or cleft palate. Cleft palate can be Isolated (without Cleft lip and alveolus) involving Uvula, Soft palate, Hard Palate.
Facial Cleft can occur in any aspect of face lower lip, Angle of moth, upper lip, Nose, around eye, lip up to around eye with or without involving nose.
The exact cause for this defect is often unknown. The probable causes are-
In many cultures worldwide a cleft lip or palate is thought to represent a sign of evil or wrong-doing on the part of the family or effect of something else like
Many parents may thus be affected with severe guilt.
But there is no connection of any birth defects with these. Parents did nothing wrong to cause the child’s birth defect.
We know ‘prevention is better than cure’. But in case birth defects there are no specific measures to prevent as the cause is not specific.
We may still take some measures which may reduce birth defects-
It is said ‘Misfortunes never come singly’. It is true in case of oro-facial clefts. There may be associated congenital heart diseases, defects in limbs, ear and other birth defects
To diagnose any birth defects, we have to check natural orifices of new born like Mouth cavity, Ear, Nose, Genitalia, Anal orifice. Cleft lip and facial clefts are externally visible defects.
We may do some investigations like Echocardiography, Complete Blood Count, BT, CT, CXR, etc. in suspected patients and for evaluation of fitness for operation.
Treatment is operation for any kinds of oro-facial clefts if patient is fit for operation. So, such baby should be under supervision of a cleft surgeon just from birth. Surgeon will guide the parents how to feed, how to take care of baby.
Lip: Treatment at an early age (If possible within one month of age) gives better result if child is fit for operation. But it can be repaired at any age. We usually do it at the age 3 months or more.
Palate: 6-12 months of age for best speech out come. But can operate in any age, there will be improvement of speech.
Cleft Nose repair and correction of Secondary deformities of Repaired Clefts: 4-5 years
Gum : Alveolar Bone Graft. 2-5 years (alloplastic Bone graft), 5-8 years (Autologus bone graft)
From the age of 3 years, but can be given earlier along with behavioral therapy if needed.
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4. https://www.clapa.com/
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Dr. Bijoy Krishna Das (B K Das) is an expert in the field of pediatric plastic surgery. He devotes himself to correct the physical deformities of children and adolescents.
