Two developmental defects that occur during the first trimester of pregnancy are the cleft palate and the cleft lip: These oral and facial malformations are frequently referred to as ‘clefting.’ Clefting can occur on one side or both sides of the mouth; however, since the palate and the lip develop separately, a baby may be born with just one of these defects or both of them.
What is the difference between a cleft palate and a cleft lip?
A cleft palate refers to an opening or split in the roof of the mouth. This malformation can involve the soft back portion (soft palate) and/or the bony front portion (hard palate) of the roof of the mouth.
A cleft lip refers to a physical gap between the two sides of the baby’s upper lip. This gap frequently extends past the base of the nose and often affects the bones of the upper gum and/or upper jaw.
What causes clefting?
Clefting occurs when there is an inadequate amount of tissue in the lip and/or mouth area, and the tissue that does exist neglects to come together properly (fuse). Each year, one in 700 babies are born with some form of clefting.
In the majority of cases, the cause of clefting is unknown; however, scientists do believe that a combination of environmental and genetic factors play a role in causing these malformations. If a family member (sibling, parent or other blood relative) has a cleft palate or a cleft lip, the likelihood of a baby being born with this malformation increases. Clefting may also occur when the developing fetus is exposed to chemicals, viruses and/or medications.
Some of the medications believed to cause clefting include:
- acne medications that contain Accutane;
- medications like Topamax that are used to treat migraine headaches;
- anticonvulsant/anti-Seizure medications; as well as
- methotrexate, which is a medication frequently used to treat psoriasis, arthritis and cancer.
Other activities during pregnancy that can lead to clefting include:
- consuming alcohol;
- smoking cigarettes (the effect e-cigarettes have on a fetus is currently unknown); as well as
- a lack of folic acid (during pregnancy and before conception).
Furthermore, clefting may occur due to another medical condition.
Are there any other factors that increase the likelihood of clefting?
- When compared to Caucasian children, clefting occurs more frequently in children who are of Latino, Native American or Asian descent.
- When compared to females, males are twice as likely to have a cleft lip (with and without a cleft palate).
- When compared to males, females are more likely to be born with a cleft palate malformation that is not associated with a cleft lip.
Diagnosing a cleft palate and a cleft lip.
Since obvious physical changes are present when a baby is born with a cleft palate and/or a cleft lip, accurately diagnosing these malformations is easy. A direct illuminated physical examination of the newborn’s nose, mouth and palate can confirm a clefting diagnosis.
Additionally, the examiner will use his or her finger to palpate the hard and soft regions of the palate to ensure a partial cleft is not present. A partial cleft occurs when skin covers a muscular or bony defect of the palate, essentially concealing the underlying tissue separation. In some instances, diagnostic testing is conducted to rule out or determine if there are other abnormalities that need to be addressed.
How is a cleft lip and a cleft palate treated?
On average, treating a cleft lip is less extensive than treating a cleft palate. An infant with a cleft lip may require a couple of surgeries, with the initial surgery being performed prior to the infant reaching 3 months of age.
Typically, to repair a cleft palate, multiple surgeries are performed throughout the course of his or her childhood:
- The first surgery is performed at some point between the ages of 6 and 12 months. During this initial surgery, a functional palate is created: This palate aids in the correct development of the facial bones and teeth, and reduces the likelihood of fluid developing in the middle ears.
- Additionally, when a child with a cleft palate turns 8 years old, he or she may need to have a bone graft. This bone graft is used to support the permanent teeth as well as to stabilize the child’s upper jaw. Approximately 20 percent of the children born with a cleft palate will need additional surgeries to improve their speech.
- After the permanent teeth have grown in, many of the children born with cleft palates will need braces to straighten their teeth. Furthermore, additional surgeries may be necessary to improve the appearance of his or her nose and lip, and/or to close openings that remain between the nose and the mouth. Surgical procedures can be used to improve his or her breathing, as well as to realign and stabilize the jaw.
- The resulting scars from the initial surgery will be addressed once the child’s facial structure is almost fully developed: Therefore, this surgery is usually performed at some point during adolescence.
If you or your child were born with an oral or facial malformation, contact Sedaros Oral Facial Surgery & Dental Implants in Melbourne, Fla., today to schedule an appointment with Dr. Steve A. Sedaros. Our phone number is 321.610.7868. If you would prefer to contact us online, please click here to be redirected to our contact form.