Cleft lip | Causes of cleft lip

A fissure in the upper lip that is due to failure of the left and right sides of the foetal lip tissue to fuse, an event that should take place by 35 days of foetal age. Cleft lip can be on one side only or on both sides. Because failure of lip fusion can impair the subsequent closure of the palatal shelves, cleft lip often occurs in association with cleft palate. It is one of the most common physical birth defects, and it can be corrected with surgery.

Who Gets Cleft Lip and Cleft Palate?

Cleft lip, with or without cleft palate, affects one in 700 babies annually, and is the fourth most common birth defect in the U.S.

Compared with girls, twice as many boys have a cleft lip, both with and without a cleft palate. However, compared with boys, twice as many girls have cleft palate without a cleft lip.

Causes a Cleft Lip

In most cases, the cause of cleft lip and cleft palate is unknown. These conditions cannot be prevented. Most scientists believe clefts are due to a combination of genetic and environmental factors. There appears to be a greater chance of clefting in a new-born if a sibling, parent, or relative has had the problem.

Another potential cause may be related to a medication a mother may have taken during her pregnancy. Some drugs may cause cleft lip and cleft palate. Among them: anti-seizure/anticonvulsant drugs, acne drugs containing Accutane, and methotrexate, a drug commonly used for treating cancer, arthritis, and psoriasis.

Cleft lip and cleft palate may also occur as a result of exposure to viruses or chemicals while the foetus is developing in the womb.

In other situations, cleft lip and cleft palate may be part of another medical condition.

What Problems Are Associated With Cleft Lip and/or Palate?

  • Eating problems. With a separation or opening in the palate, food and liquids can pass from the mouth back through the nose. Fortunately, specially designed baby bottles and nipples that help keep fluids flowing downward toward the stomach are available.

Ear infections/hearing loss. Children with cleft palate are at increased risk of ear infections since they are more prone to fluid build-up in the middle ear. If left untreated, ear infections can cause hearing loss.

Speech problems. Children with cleft lip or cleft palate may also have trouble speaking. These children’s voices don’t carry well, the voice may take on a nasal sound, and the speech may be difficult to understand.

Dental Problems. Children with clefts are more prone to a larger than average number of cavities and often have missing, extra, malformed, or displaced teethrequiring dental and orthodontic treatments.

Who Treats Children With Cleft Lip and/or Palate?

Due to the number of oral health and medical problems associated with a cleft lip or cleft palate, a team of doctors and other specialists is usually involved in the care of these children. Members of a cleft lip and palate team typically include:

  • Plastic surgeon to evaluate and perform necessary surgeries on the lip and/or palate
  • An otolaryngologist (an ear, nose, and throat doctor) to evaluate hearing problems and consider treatment options for hearing problems
  • An oral surgeon to reposition segments of the upper jaw when needed, to improve function and appearance and to repair the cleft of the gum
  • An orthodontist to straighten and reposition teeth
  • A dentist to perform routine dental care
  • A prosthodontist to make artificial teeth and dental appliances to improve the appearance and to meet functional requirements for eating and speaking
  • A speech pathologist to assess speech and feeding problems
  • A speech therapist to work with the child to improve speech
  • An audiologist (a specialist in communication disorders stemming from a hearing impairment); to assess and monitor hearing
  • A nurse coordinator to provide ongoing supervision of the child’s health
  • A social worker/psychologist to support the family and assess any adjustment problems

Paediatric Occupational Therapy

As stated in the Cleft Palate-Craniofacial Journal, the speech problems and facial differences associated with a cleft lip and palate have environmental impacts on the child, which could affect his behavior, including his social skills, self-control, and interactions with his parents. As such, a team of healthcare professionals often have to work together for effective treatment. In addition to the speech therapist, the team may also include a surgeon, an orthodontist, a psychologist, and an occupational therapist.

In particular, occupational therapists may help a child deal with Sensory Processing Disorder (SPD), formerly known as sensory integration dysfunction. For a child with cleft palate, sensory integration problems stem from the discomfort that comes with eating, which is a highly sensorial activity. Sensory integration deficits often lead to anxiety, frustration, emotional fits, and obsessive behaviors like chewing fingernails. As stated in the SPD Foundations website, paediatric occupational therapy introduces your child to a sensory-rich environment that helps develop the right responses to sensation, which enables him to act in a more functional manner.

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