Many many years ago when a child was born with  cleft lip or cleft palate it was considered as an evil power or a bad omen.Many children in the past have been killed or abandoned by their family to save themselves from the social stigma.

   But now with increasing literacy rates,awareness and medical facilities the scene has changed completely today.So lets have an idea about what is cleft lip/palate,what causes it and how can it be treated.

Clef is a gap ,fissure or crack.

Cleft lip and palate are congenital deformities(i.e.they are present  right from birth)caused due to disturbance during growth and development of embryo.

They most commonly affect the upper lip,hard palate,soft palate.very rarely eyes and nose also get  affected.

In  India the incidence of cleft lip and palate in regional population is 1:639.cleft lip deformity is more common in males while cleft palate is more common in females.

As lip and palate develop separately there can be only cleft lip or only cleft palate or both together.

Causes of cleft lip and palate

The embryological development of face occurs between 4- 8 weeks of gestation(i.e. during the first trimester of pregnancy)

Underlying are the factors that increase the risk of cleft lip and palate during the first trimester-

• Viral infection
• Exposure to radiation
• Stress
• Excessive use of antibiotics,steroids,insulin,antiepileptic drugs,anti cancer drugs,psoriasis
• Vitamin A and B deficiency
• Anaemia
• Excessive consumption of alcohol
• Excessive tobacco chewing/smoking
• Age of the  mother i.e. older the mother great the chances of such congenital defects
• Consanguineous marriage(i.e. to marry a person who is blood related)
• Family history also plays an important role
• It could be also a part of some other underlying medical condition

Associated problems with cleft lip and palate

• In significant cleft lip case nostril defect is present.This can be a mild nostril asymmetry or a deformity of the nasal septum(nasal bone)
• There is lack of underlying bone support at the base of the nose.
• Since the mandible(lower jaw) id underdeveloped)tongue falls back causing aur way obstruction in new born child.
• Cleft palate increases the chance of fluid accumulation in middle ear leading to ear infection followed by loss of hearing
• Hearing impairment affects speech further
• Palate is required for swallowing ,sucking and speech.In a cleft palate patient necessary negative pressure required for sucking is absent.So the baby finds difficulty in suckling.Breast feeding/ bottle feeding is not easy.
• Consonant sounds(p,b,t,d,k,g)cannot be pronounced clearly by the child.
• Abnormal tongue position makes speech difficult
• The development of jaw,primary and permanent teeth are retarded.
• This may lead to congenitally missing teeth or extra teeth.
• In many cases crowding or displacement of permanent teeth are seen
• Teeth that are present might are deformed
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General care to be taken during feeding

Specially designed nipples having elongated and bigger opening can be used to overcome the problem.

Breast milk can be expressed and fed with a spoon.

Spoon feeding is preferred as it is more hygienic.

Child is susceptible to nasal regurgitation during feeding so do not feed the child in lying down position.Raise the head of the child to approximately 45 degree.

There is excessive air swallowing while feeding therefore frequent burping Is a must

Several years of speech therapy is required for acceptable speech so speech problems should be tackled first to develop normal speech.

Once the date of surgery is decided avoid breast/bottle feeding. Put the child on spoon feeding at least 1 week in advance to let him get adjusted.

The objective of the treatment

• Early management of cleft lip/palate is necessary to correct the defect surgically so as to give the child acceptable facial aesthetics.
• To facilitate speech.
• To correct dental anomalies (problems)so that there is normal chewing, speech, and aesthetics.

For a complete treatment of cleft palate, a team of doctors is mandatory in order to solve all the medical, dental, surgical, and psychological issues.

Team of doctors include plastic surgeon,ENT surgeon,plastic surgeon,orthodontist,oral and maxillofacial surgeon,speech therapist,prosthodontist,paediatrcian,child psychiatrist.

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Management of cleft lip

• Surgery of cleft lip repair varies from 48 hours of life to 6 months of age.
• In countries like India where neonatal care is below the ideal standard surgeons prefer the rule of 10 i.e. 10 weeks of age with 10 gm of Hb and 10 pounds of weight.
• However nowa nowadays emphasis is placed on early repair. As early as 5­-7 days after birth.
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Conclusion

When a child is born with cleft lip/palate it becomes very difficult for the parents to accept the situation.But parents must understand that like its difficult for you its equally difficult  for the child.The child usually gets a feeling of inferiority.They avoid mingling with people or going in public.You have to reassure the child that he/she  is no less than other people.You and your doctor together can help the child in overcoming this difficult phase.