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What is cleft lip/cleft palate?
Cleft lip/cleft palate are congenital developmental abnormalities of the face in which the roof of the mouth, the dental arch and the lips do not join properly. A cleft is defined as a division in the body's natural structure, regularly formed before birth. When only the soft tissues of the face are involved, it is likely referring to cleft lip. Cleft lip is a small gap or an indentation in the lip (partial or incomplete cleft) or continues into the nose (complete cleft). Lip cleft can occur as one sided (unilateral) or two sided (bilateral). Cleft palate is a large gap (complete) or small hole (incomplete) in the roof of the mouth and may involve both hard and soft palates.
Unilateral incomplete
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Unilateral complete
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Bilateral complete
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Incomplete cleft
palate
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Unilateral complete
lip and palate
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Bilateral complete
lip and palate
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What is the incidence of cleft lip/cleft palate?
The overall incidence of the cleft palate with or without cleft lip is 1 in 1000 live births. Cleft palate is more prevalent in the racial populations of the American Indians and least common in African Americans. Among total cleft cases, 20% are isolated cleft lip, 50% are cleft lip and palate, and 30% are cleft palate only.
What are the consequences of cleft lip/cleft palate?
Cleft lip/ cleft palate may cause problems with the infant regarding feeding, ear problems, speech as well as socialization process associated with development. In addition, cleft patients my require medical management . Children with cleft palate (with or without cleft lip) have difficulty obtaining enough introral pressure for sucking and extracting liquid from a nipple. In addition, food/ liquids may go up the infants nose and cause choking. Almost all cleft patient will have some type of ear infections. The eustacian tubes and external ear canals may be angled or tortuous, leading to food or other contamination of a part of the body that is normally self cleaning. Finally, most cleft patients also have difficulty with speech, specifically
the pronunciation of specific vowels. Both the lips and palate have important roles in speech because air going
into the nasal cavity gives speech a hypernasal tone.
What is the team approach to treating cleft lip/cleft palate?
Multiple specialists make up the team that works together to improve the quality of life for cleft lip/ cleft palate patients. Normally, an otolaryngologist, an oral and maxillofacial surgeon, a plastic surgeon, an orthodontist, a nutritionist and a speech pathologist are members of this team.
How is an alveolar cleft in a cleft lip/cleft palate person repaired by an oral and maxillofacial surgeon?
Alveolar bone repair is an integral part of repairing palatal clefts and this procedure is performed by an oral and maxillofacial surgeon. This surgery is initially performed when the patient is 8 to 12 years old when the canine teeth are beginning to develop. The procedure involves placing bone into the defect of the alveolar cleft as well the closure of the communication from the nose to palatal tissues. The bone is usually taken from the hip or tibia and sometimes mixed with artificial bone. This procedure is done in operating room setting with general anesthesia.
How do cleft lip/cleft palate affect the person’s facial and dental development later in life?
Many people with cleft lip/palate often have upper jaw restriction later in life. Their palates often have a narrower and, they have an underdeveloped dental arch and abnormal height. This condition often causes the person to develop a significant underbite. When the person is around 16 to 19 years, a surgery to correct jaw deformities is often performed . See orthognathic surgery.
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