Cleft lips and/or palates are the most common congenital facial malformations. They occur due to a failure of the embryonic buds to fuse during the early weeks of embryogenesis.
A cleft lip and/or palate, also known as a cleft lip, is a facial malformation characterized by an opening in the upper lip that can extend to the palate. The cleft can affect one side of the lip, both sides, or be central. While a cleft lip is often diagnosed during a morphological ultrasound, a cleft palate is not easily visible on ultrasound.
Different forms of clefts
The extent and severity of clefts can vary from newborn to newborn. They can range from a slight indentation to a complete cleft extending from the lip to the back of the palate. Depending on their location, clefts can have different names.
Cleft lip
A cleft lip can be mild (a slightly split lip) or extend up to the nose, even reaching the gums. In this case, it is called a cleft lip and alveolus. It can also be associated with a cleft palate.
Cleft palate
A cleft palate refers to a fissure in the palate that can extend to the complete absence of the palate, resulting in communication between the nasal cavity and the mouth.
Causes of clefts
The causes of cleft lip and/or palate are multifactorial. External factors such as certain medications, alcohol consumption, and folate deficiency have been reported. The incidence is higher when a family member has a cleft. This malformation can be associated with a syndrome in 10 to 15% of children.
Symptoms to watch for
When a cleft lip and palate is diagnosed, there is a low risk of developing polyhydramnios, characterized by an excessive amount of amniotic fluid. If a pregnant woman is not immune to chickenpox, she should avoid contact with individuals who have the disease, as they are highly contagious.
It is important to note that a person with chickenpox is already contagious two days before the appearance of the rash. If a pregnant woman has been in contact with a contagious person, she should contact her doctor as soon as possible. Early preventive treatments can reduce the risk of infection.
Treatment for cleft lips and palates
Early treatment
Early treatment, tailored to the specific anomalies, may involve special nipples (to facilitate feeding), appliances (to close the cleft and enable suction), special bottles, or a gingivoplastic orthosis. The frequent episodes of acute otitis media should be detected and treated.
Definitive treatment
The definitive treatment is surgical closure. However, the ideal timing for surgery, which can affect premaxillary growth centers, is still debated. For cleft palates, a two-stage procedure is often performed. Cleft lips, nasolabial clefts, and velar clefts are repaired in infants (at 3 to 6 months of age). The residual cleft in the bony palate is repaired at 15 to 18 months of age. Surgery can lead to significant improvement, but in cases of major deformities or inadequate treatment, the patient may have residual nasal speech, aesthetic impairment, and a tendency for regurgitation.
Dental and orthodontic treatment, speech therapy, and genetic counseling are recommended.
