Cleft Lip and Palate
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Cleft Lip and Palate

This article is designed to be a brief introduction to the condition Cleft Lip and Cleft Palate, and this article distinguishes between them. The medical infomation is of medical school standard, and this article is an excellent revision bite for all medical and surgical students, however can still be understood by anybody of any scientific background.

Inheritance pattern

The occurrence in the general population of Cleft Lip and Palate is 1 in 750 people. People of Asian descent are more likely to have the condition (1 in 500) and occurrence is lower in the African community (1 in 1000). Cleft Palate occurs in 1 in 2000 people. Women are more likely to develop a cleft palate, whereas men are more likely to have a cleft lip.

75% of all people born with a Cleft Lip or Palate have had no history of the affliction in their family history. However, there are some genetic links, and if one child is born with a cleft lip the chance of a subsequent child being born with either is raised to a 4% chance. If one child has a cleft palate however the risk only rises to 2%. If both a parent and another sibling were born with a cleft lip, the chance of a future child being born with it rises to a 15% chance.

Clinical Issues

A cleft lip does not impede speech, or feeding, however people see it as an aesthetic problem. A cleft however causes 4 major problems

  • Feeding – The presentation of the malformed palate prevents the child from using suction when eating, as they are not able to form a closed system, as air escapes through their nose. Both bottle feeding and breast feeding cannot be used as a method of nutrition for these children. There are 2 specific types of bottles that have been developed specifically for these children; these use a pumping system to pump milk into the child’s mouth, without them needing to use suction.
  • Middle Ear Infections- Children with a cleft palate have a raised chance of developing ear infections as the muscles which regulate opening and closing of one of the tubes in the middle ear are contained within the palate, and are deformed. This causes fluids to accumulate within the middle ear, leading to a higher risk of infection. Even once the palate has been fixed children born with cleft palate will suffer middle ear problems throughout their lives.
  • Speech- As children with a cleft palate are unable to close their mouth and nose, they develop hyper-nasal speech. This prevents the children pronouncing sounds like ‘em’, ‘en’ and ‘ing’ as these come through the nose.
  • Mid-Face Hypoplasia- The growth plates around the palate are always stunted in their growth, which leads to mid-face hypoplasia, and an under bite.

Cleft Lip Repair

A Cleft lip repair surgery is typically performed when the child is 3 to 4 months old, as at this age children can be more safely anaesthetized. If the gums of the child are badly displaced the surgery may be delayed so that the palate may be orthopedically repaired. This is done using a plate which is adjusted weekly, meaning a better cleft lip repair surgery can be performed.

Cleft Palate Repair

A Cleft palate is normally repaired when the child is between 9 and 12 months old. The earlier the repair is carried out, the better the speech of the child as they grow, however repairing too early can affect the facial growth of the child.

Secondary Surgeries a Child may require

10% of cleft palate surgeries will not completely fix the speech in the child, and these children may need a pharyngeal flap, which can be fixed in a second surgery. Other children may still have a deformed nose, requiring a rhinoplasty, or nose job. Some children may require speech therapy to help with their speech, even after the surgery in completed.

When the child is 6 or 7, if they have a hole in their gum (alveolus), this can then be surgically repaired as it is important to wait for adult teeth to begin to grow in the mouth.

Complications at Birth

Some children with an isolated cleft palate (the cleft palate is not linked to any other syndrome) may have trouble breathing when they are born. Pierre Robin Sequence is formed of Glosocytosis (a big tongue), Retronathic mandible and airway obstruction. When children present with this the tongue falls back into their throat, obstructing the airway and causing difficulty breathing. If a child with a cleft palate has trouble breathing it is possible they have Pierre Robin Sequence and opening the airway should be an immediate concern.

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