Cleft Lip and Cleft Palate
Cleft lip is a gap or split in the upper lip and this is due to the failure of fusion of the median nasal and maxillary mesodermal processes accomplished 35 days postconception.
Cleft palate is an opening or split in the roof of the mouth. This is due to the failure of the fusion of the midline palatal shelves usually accomplished 56-58 days postconception. Cleft lip with or without cleft palate is more frequent among males, whereas cleft palate alone is more frequent among females.
Genetic factors have very strong influence in the etiology of cleft lip with or without cleft palate, and maybe associated with chromosomal aberrations such as D and E trisomies.
Environmental factors such as maternal smoking and maternal obesity and maternal dietary deficiencies have also been cited as possible causes of the defect. Drugs such as Phenytoin, Sodium valproate, Topiramate and Methotrexate are associated with oral clefts. Maternal age more than 35 years old has an increased risk for oral clefts.
There are 5 types of cleft lip and these are:
- Unilateral – when it involves the philtrum on one side
- Bilateral – when it involves the philtrum on both sides
- Complete – when it extends all the way to the nostril
- Incomplete – when it does not extend into the nostril
- Isolated – cleft lip without a cleft palate.
On the other hand, cleft palate has 4 types and these are: - Complete- extends from the alveolus (gum line) all the way through the back of the palate
- Incomplete – does not extend all the way through the hard and soft palates
- Isolated – cleft palate without a cleft lip
- Submucous – a cleft In the muscles of the soft palate in the posterior roof of the mouth that is covered by a thin layer of mucosa.
The challenges in these conditions are feeding issues, dental and orthodontic problems, speech and language difficulties, hearing impairment and social and self- esteem issues. So in the management of the problem a multidisciplinary team is needed.
Feeding should be done in an upright position using soft nipples. In some cases, feeding may have to be by gavage or medicine dropper. Cleft lip repair has a rule of 10 which means the weight of the baby should be at least 10 pounds, with a hemoglobin level of 10g/dal and the age is at least 10 weeks old. Operation should be performed by a plastic surgeon at the age of 1-2 months for correction of a cleft lip , provided the infant is gaining weight and is free of any infection. Surgery for cleft palate varies from case to case. The best time for surgery maybe from 6 months to 2 years of age.