Cleft Lip And Cleft Palate: What To Expect

Finding out that your (unborn) baby has a clept lip, a cleft palate, or a cleft lip and palate can be terrifying. Don't panic, though: orofacial clefts are very treatable these days, with one surgical procedure or a series. With treatment, cleft lip and palate can be repaired very well, enabling your baby to function without feeding or speech difficulties. 

What Are Orofacial Clefts?

The first trimester of pregnancy is a period of great changes — a baby develops more rapidly during this time than at any other point of pregnancy. The head starts to form around the fifth or six week. Tissues that started off at the sides begin moving towards the center, forming the mouth, lips, upper jaw, and nose. They normally fuse completely. If this doesn't happen, a gap — or "cleft" — remains, and the baby is born with an orofacial cleft.

A cleft lip is a split in the upper lip, which can be mild or severe, running all the way up to the nose. A cleft palate refers to a split in the roof of the mouth. Again, the split may be minor or severe. Babies born with a cleft lip and palate will be affected by both these conditions, which can be unilateral or bilateral. 

Research suggests that risk factors include smoking, drinking, using certain medications, not taking folic acid, and being overweight during the very early weeks of pregnancy. However, that doesn't mean you need to start asking yourself what you did wrong the moment your baby is diagnosed with a cleft lip and palate. Orofacial clefts have a very strong genetic component, which can be passed on by the mother or the father. Boys have a higher risk than girls, and babies of Latin American, Asian and Native American are also more frequently affected. 

When Are Orofacial Clefts Diagnosed?

The immediately apparent physical characteristics of cleft lip and cleft palate mean that the conditions are very easily spotted at birth, and no special tests are required to verify the diagnosis of orofacial cleft. As technology advances, cleft lip and palate are also noticed on routine ultrasound scans more and more frequently. Cleft lip or cleft lip and palate are easier to see on these scans, and they may be identified as early as the 13th week of pregnancy. 

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Stand-alone cleft palates are harder to spot, as they are limited to the oral cavity, but they too are sometimes diagnosed through ultrasound. Where orofacial cleft is spotted on an ultrasound scan, an amniocentesis may be recommended to rule out genetic conditions that also cause orofacial clefts. 

My Baby Has Cleft Lip And Cleft Palate: What Now?

How Does A Cleft Lip And Palate Affect A Baby?

The challenges a baby with an orofacial cleft will face depend on the severity of the cleft, whether the lip, the palate, or both are affected, and whether the cleft affects one or two sides. 

Difficulty feeding is one of the most obvious concerns. While those babies who were born with mild cleft lips usually don't encounter any challenges, those with more severe cleft lips and those with cleft palates will have trouble suckling. As the baby gets older and starts to speak, cleft palate also poses apparent challenges — the palate, or roof of the mouth, is used to produce many sounds, and toddlers with untreated cleft palate will face speech difficulties. 

Since cleft lip and cleft palate causes a rift in the mouth and lip, dental malocclusions can be expected and teeth that are exposed to air constantly due to a cleft lip are more vulnerable to decay. Surprisingly, babies with orofacial clefts are also at a higher risk of developing ear infections and hearing difficulties. 

Finally, but certainly not least importantly, a cleft lip and palate can lead to severe social isolation. Other children may be afraid of kids with untreated cleft lip and palate, and adults can shun these children as well. All these complications of orofacial clefts make it very clear how important it is to repair the condition as soon as possible, wherever parents have access to medical care.

When Can Cleft Lip And Palate Be Repaired?

Early treatment of cleft lip and palate has several distinct advantages. To start off with, early treatment offers better functioning and asthetic results. Repairing cleft lip and palate before the child starts interacting with other children socially will also help prevent bullying and shunning. 

Cleft lip correction surgery involves making incisions on both sides of the cleft, from the nose down to the lip. The surgical team will take care to create an appearance that is as normal as possible, including constructing philtral ridges (those "mountain-like" ridges that lead from the nose to the lip), and repairing any nasal deformities. 

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When these procedures are performed by experienced surgeons, cleft lip and palate surgery has excellent results. Along with correcting orofacial clefts, the child may also require treatment for ear damage and the services of an orthodontist to help with proper alignment of the teeth.