What is it about ?
Cleft lip and / or palate is a birth defect. The cause is generally not known, but genetic factors are believed to be involved as well as negative external influences (such as smoking and drinking alcohol during pregnancy).
Among children with a cleft lip or palate, 15% have a split lip on the left or right or both sides, with or without extension to the dental arch. The outside of the nose can also be affected. In 25%, the cleft also affects the hard palate and the soft palate. In 60% (so in most), the cleft affects only the soft palate, but it often extends to the hard palate.
These abnormalities can impact the function of the middle ear, language development, diet (less suction force and reflux through the nose via the cleft palate), the shape of the dental arch and nose, and thrust. of the upper canine. In 15 to 40% of cases, the child also has other birth defects, most often in the limbs or heart. The malformation is often part of a syndrome.
What is its frequency?
One to two in 1,000 newborns have a cleft lip, with or without a cleft tooth arch and cleft palate. It is the most common congenital malformation of the face. One in 2,000 babies has only a cleft palate.
How to recognize them?
These abnormalities are often already observed during pregnancy during an ultrasound or, at the latest, in the maternity ward at birth. The malformation may be limited or extensive.
What can you do ?
It is a congenital malformation; we don’t have control over it. Expectant mothers should stop smoking and drinking alcohol.
What can your doctor do?
The treatment is always multidisciplinary, that is to say that the child is taken care of in a specialized center by a team of different care providers. In this case, they are doctors specializing in plastic surgery, maxillofacial surgery and ENT (nose-throat-ear), an orthodontist, a speech therapist and a nursing team.
The cleft lip is operated around the age of 4 months. The cleft palate is corrected around the age of 9 to 10 months with a view to normal language development. A slot in the dental arch is closed with a piece of bone that is removed from the hip when the child is 9 or 10 years old. For surgical (cosmetic) corrections of the upper (and lower) jaw, nose and lip, it is best to wait until the growth is complete.
There are often abnormalities of the teeth in terms of their size, shape and number. This can have an impact on the position of the teeth relative to each other and on their alignment. The orthodontist can correct the malposition of the teeth. When the child is finished growing, missing or deformed teeth can be replaced with artificial teeth.
It is possible that the muscles of the palate located near the Eustachian tube (connection between the middle ear and the pharynx) are not functioning properly due to the cleft palate. This creates negative pressure in the middle ear, which causes fluid to build up (otitis media). The person hears less well. Transtympanic drains (“diabolos”) can be placed when the palate is closed, or earlier if indicated. After the palate is closed, ear problems usually go away. Children with otitis media are followed until it is certain that their ears have healed.
If it is believed that the cleft palate is part of a syndrome, the child is referred to a specialist in human genetics.
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