Roche A. Samy
Some 5,000 children (one out of every 700 births) are born with cleft lip or palate in the United States each year. “Cleft” describes a split where parts of the upper lip or palate (roof of the mouth) fail to grow together. Some have only cleft lip, also known as “harelip,” while more have only cleft palate. About 40 percent have both cleft lip and palate. The defect appears more often among Orientals and certain tribes of American Indians than among white Americans. It occurs less frequently among black Americans.
Figure 2
(figure available in print form)
Causes of Cleft Lip and Palate
There is no one cause for all clefts. Scientists believe that any number of factors such as drugs, disease, heredity, malnutrition, and adverse environment may act on each other to disturb normal growth. Many infants with cleft palate are premature and have other defects.
Heredity appears to play a role in about 25 percent of cases. In other 75 percent there is no family history of the defect, even among distant relatives. It is known that if both parents are normal and have a child with a cleft,the chances that subsequent babies will have a cleft increase progressively. If either parent has a cleft, there’s a four percent chance that their first baby will have a cleft, and the chances increase with each time they have an affected child.
Figure 3
(figure available in print form)
Cleft Lip Affecting Baby’s Face
Cleft lip may involve only one side of the upper lip or both. The split may be only in the upper lip, or may extend up into the nostril. Usually the split goes through the outer skin, muscles, and inside of the lip. Cleft palate may involve only the soft part of the palate toward the back of the throat, or it may extend forward through the hard palate.
Treatment of Cleft Lip and Palate
Treatment usually combines surgery, speech therapy, dental corrections and psychological help. Depending on the type of cleft and the infant’s general condition, corrective surgery can be started within the first few months. It may be a simple stitching together of the separated edges of the lip; or with a cleft palate, several operations may be necessary. Sometimes tissue grafts are needed. Temporary dental splints or plates are used to keep the upper jaws in proper alignment before and between operations. Braces may be needed later because teeth usually grow in crooked and some may remain impacted in the jaw.
Problems related to Cleft Lip and Palate
Feeding is the first problem to be overcome. Since a split in the roof of the mouth makes it difficult for a baby to suck, foods backs up through its nose and may cause choking. Parents are taught to feed the baby in an upright position, in small amounts, using a nipple with a large hole or syringe.
Defective speech is one of the most serious results of cleft palate and, to a lesser extent, cleft lip. Psychological problems may result from speech difficulties and the child’s unusual appearance before clefts are repaired,a nd require a professional counselor’s help. Clefts have no relation to mental ability or retardation.
Ear infections are common. Difficulty in swallowing affects air pressure around the inner ear, spreading infection directly through the nose to ear. Frequent or severe ear infections may lead to hearing loss.
Prevention of Cleft Lip and Palate
If there is any history of cleft palate or lip in the family, or a history of any other condition of which the cleft is a part, a genetic counselor can determine the chances for passing on the defect. Since certain drugs may influence structural growth, it is important for an obstetrician to know if the pregnant patient is taking such medications as anti-convulsant, sedatives, insulin, etc., or if she is on a special diet. Early and regular prenatal care and good health habits are important for prevention of many birth defects, but cannot guarantee that all babies will be normal.
