Articles

Is Cleft Of Lip And Palate Treatable

By Mr. Cose C Abraham : Speech And Language Pathologist

Oral- facial clefts are birth defects in which the tissues of the mouth or lip don't form properly during fetal development. In the United States, clefts occur in 1 in 700 to 1,000 births, making it the one of the most common major birth defects.

The good news is that both cleft lip and cleft palate are treatable birth defects. Most kids who are born with these conditions can have reconstructive surgery within the first 12 to 18 months of life to correct the defect and significantly improve facial appearance.

What Is Oral Clefting?

Oral clefting occurs when the tissues of the lip and/or palate of a foetus don't grow together early in pregnancy. Children with clefts often don't have enough tissue in their mouths and the tissue they do have isn't fused together properly to form the roof of their mouths.

A cleft lip appears as a narrow opening or gap in the skin of the upper lip that extends all the way to the base of the nose. A cleft palate is an opening between the roof of the mouth and the nasal cavity. Some children have clefts that extend through both the front and rear part of the palates, while others have only partial clefting.

There are generally three different kinds of clefts:

* cleft lip without a cleft palate
* cleft palate without a cleft lip
* cleft lip and cleft palate together

In addition, clefts can occur on one side of the mouth (unilateral clefting) or on both sides of the mouth (bilateral clefting).

More than boys girls have a cleft lip, while more girls have cleft palate without a cleft lip.

What Causes Oral Clefting?

Doctors don't know exactly why a baby develops cleft lip or cleft palate, but believe it may be a combination of genetic (inherited) and environmental factors (such as certain drugs, illnesses, and the use of alcohol or tobacco while a woman is pregnant). The risk may be higher for kids whose sibling or parents have a cleft or who have a history of clefting in their families. Both mothers and fathers can pass on a gene or genes that cause cleft palate or cleft lip.

Complications Related to Oral Clefting

A child with a cleft lip or palate tends to be more susceptible to colds, hearing loss, and speech defects. Dental problems - such as missing, extra, malformed or displaced teeth and cavities - also are common in children born with cleft palate.

Many children with clefts are especially vulnerable to ear infections because their Eustachian Tubes don't drain fluid properly from the middle ear into the throat. Fluid accumulates, pressure builds in the ears and infection may set in. For this reason, a child with cleft lip or palate may have special tubes surgically inserted into his or her ears at the time of the first re constructive surgery.

Feeding can be another complication for an infant with a cleft lip or palate. A cleft lip can make it more difficult for a child to suck on a nipple, while a cleft palate may cause formula or breast milk to be accidentally taken up into the nasal cavity. Special nipples and other devices can help make feeding easier, you will probably be given information on how to use them and where to buy them before you take your baby home from the hospital. And in some cases, a child with a cleft lip or palate may need to wear a prosthetic palate called an obturator to help him or her eat properly.

If you're experiencing problems with feeding, your doctor may be able to offer other suggestions or feeding aids to help you and your baby.

Treating Clefts

The good news is that there have been many medical advancements in the treatment of oral clefting. Re constructive surgery can repair cleft lips and palates, and in severe cases, plastic surgery can address specific appearance-related concerns.

A child with oral clefting will need to see a variety of specialists who will work together as a team to treat the condition. Treatment usually begins in the first few months of an infant's life, depending on the health of the infant and the extent of the cleft.

Members of a child's cleft lip and palate treatment team usually include:

* a Geneticist
* a Plastic Surgeon
* an Ear, Nose, and Throat Physician (Otolaryngologist)
* an Oral Surgeon
* an Orthodontist
* a Dentist
* a Speech Pathologist (often called a Speech Therapist)
* an audiologist
* a Nurse Coordinator
* a Social Worker and/or Psychologist

Speech Therapy

A child with oral clefting may have trouble speaking - the clefting can make the voice nasal and difficult to understand. Some will find that surgery fixes the problem completely.

Catching speech problems early can be a key part of solving them. It's a good idea to take your child to a speech therapist between the ages of 18 months and 2 years. Many speech therapists like to talk with parents at least once during the child's first 6 months to provide an overview of the treatment and suggest specific language- and speech-stimulation games to play with the baby.

Shortly after the initial surgery is completed, the speech pathologist will see your child for a complete assessment. The therapist will evaluate your child's developing communication skills by assessing the number of sounds he or she makes and the actual words your child tries to use, and by observing interaction and play behaviour

This analysis helps determine what, if any, speech exercises your child needs and if further surgery is required. The speech pathologist will often continue to work with your child through additional surgeries. Many children who have clefts work with a speech therapist throughout their school years.