Cleft Lip and Palate
Anomaly is a medical term which means ‘different from normal’. Congenital anomaly refers to such an irregularity which is present from birth. Cleft lip and palate are such abnormalities present from birth that affect the upper lip and the palate of mouth. They represent the most common of all the developmental anomalies affecting the head and neck region. Severities of the abnormalities may range from mild, moderate to severe forms occurring separately or in combination with other anomalies.
The frequency of occurrence of cleft lip with or without cleft palate is between 1:700 to 1:800 which means that a child is therefore born with a cleft somewhere in the world approximately every two and half minutes. There is no single cause for cleft lip and or cleft palate. Often there are many interrelated factors like a change in the genes, consanguineous marriage, viral infections during pregnancy, certain drugs taken during first few weeks of conception, etc.The condition is evident at birth as loss of continuity of the lip and or an open communication between nose and mouth. Affected infants present with so many problems other than the distorted aesthetics of the face which psychologically affects the parents and the beloved ones. But with the advancement in surgical field, even the severest form of cleft lip/palate can be treated very
effectively. Other than the appearance which is evident to anyone who sees the baby, it also suffers problems like missing teeth, extra teeth, abnormal shape, size and location of teeth, growth of middle of face affected, speech difficulties, hearing problems and sometimes even breathing problems especially while feeding. The most important of all is the self-estimated or externally inflictedpoor social image of the affected child. The mother often faces difficulty in breast feeding or bottle feeding. Because of the continuity of the nose with the mouth and lack of proper lip seal around the breast /feeding bottle, the fed contents are usually regurgitated and not swallowed by the baby. So it becomes a real mentally painful condition that, neither the mother is able to feed the baby, nor the baby is able to swallow.
With regular periodic gynecological consultation, the condition can be diagnosed before birth itself by doing an ultrasound test. Cleft lip and cleft palate is a complex problem which is best managed by a specially trained team of doctors known as cleft lip/palate team. The treatment starts at birth itself.
Reassurance is given to concerned parents by the counselor that, the child will definitely have a beautiful smile after completion of treatment. On day one itself, mother is taught by a specially trained nurse, the modified form of breast feeding which, later she herself will become used to within few days. The treatment basically aims at providing modified feeding habits, surgical closure of the cleft portion, plastic correction of the face, correction of abnormalities of teeth, improving the speech and most importantly improving the social life. Feeding plates made out of a type of plastic material by a prosthodontist is given to the mother to keep in the baby’s mouth while feeding, to prevent entering of food into airway which may lead to breathing difficulty. Surgery is usually carried out for lip correction by facial plastic surgeon, oral and maxillofacial surgeon, craniofacial surgeon in between 2nd to 3rd month of age provided, the baby is fit for surgery. Surgery for palate can be done either before 2 years or after 5 years.
A pedodontist and an orthodontist willtake care of the problems with the teeth. To improve the facial appearance a second surgery may also be needed in late childhood. The pronunciation of sounds like ‘p, b’ and ‘k, ng, h, t, d, s’ becomes difficult in patients with cleft lip and cleft palate respectively. Hence speech therapy is usually started in early childhood itself. Hearing problems if present can be corrected in late childhood with the help of ENT surgeon and audiologist. Periodic counseling is given to the patient and the family members and ensured that it is correctable condition, though the treatment continues for a longer period of timeuntil adolescence. The best part of the cleft lip and cleft palate treatment is the total improvement in the quality of life before the child reaches adulthood.
This article has been contributed by Captain(Dr) Saravanan SP, Dental Surgeon Cannanore(India).
