Cleft Lip & Palate
During early pregnancy, separate areas of the face develop individually and then join together, including the left and right sides of the roof of the mouth and lips. If some parts do not join properly, sections remain separate and the result is a cleft. If the separation occurs in the upper lip, the child is said to have a cleft lip.
A completely formed lip is important not only for a normal facial appearance but also for eating and to form certain sounds made during speech. A cleft lip is a condition that creates an opening in the upper lip between the mouth and nose. It looks as though there is a split in the lip. It can range from a slight notch in the colored portion of the lip to complete separation in one or both sides of the lip extending up into the nose. A cleft on one side is called a unilateral cleft. If a cleft occurs on both sides, it is called a bilateral cleft.
A cleft in the gum may occur in association with a cleft lip. This may range from a small notch in the gum (dental ridge) to a complete division of the gum into separate parts. A similar defect in the roof of the mouth is called a cleft palate.
The palate is the roof of your mouth. It is made of bone and muscle and is covered by a thin, wet skin that forms the red covering inside the mouth. You can feel your own palate by running your tongue over the top of your mouth. Its purpose is to separate your nose from your mouth. The palate has an extremely important role during speech because when you talk, it prevents air from blowing out of your nose instead of your mouth. The palate is also very important when eating. It prevents food and liquids from going up into the nose.
Like a cleft lip, a cleft palate occurs in early pregnancy when separate areas of the face develop individually but do not join together properly. When a cleft palate occurs there is an opening in the roof of the mouth. The back of the palate is called the soft palate and the front is known as the hard palate. A cleft palate can range from just an opening at the back of the soft palate to a nearly complete separation of the roof of the mouth (soft and hard palate).
Since the lip and palate develop separately, it is possible for a child to be born with a cleft lip, cleft palate, or both. Cleft defects occur in about one out of every 800 births.
A dental-alveolar cleft is a separation in the tooth-bearing portion of the upper jaw. Usually this is associated with a cleft lip and/or palate.
Children born with any of these conditions usually need the skills of several professionals to manage the problems associated with the defects such as feeding, speech, hearing and psychological development. In most cases, surgery is recommended at some point.
Cleft Lip Treatment
Cleft lip surgery is usually performed when the child is between the ages of 3-6 months. The goal of surgery is to close the separation, restore muscle function, and provide a normal shape to the mouth and upper lip. The nostril deformity may be improved as a result of the procedure but may require subsequent surgery.
Cleft Palate Treatment
A cleft palate is initially treated with surgery when the child is between the ages of 6-18 months. This depends upon the individual child’s situation. For example, if the child has other associated health problems, it is likely that the surgery will be delayed.
The major goals of surgery are to:
- Close the gap or hole between the roof of the mouth and the nose.
- Reconnect the muscles that make the palate work.
- Make the repaired palate long enough so that the palate can perform its function properly.
There are many different techniques that surgeons will use to accomplish these goals. The choice of techniques may vary between surgeons and should be discussed between the parents and the surgeon prior to surgery.
Dental-Alveolar Cleft Treatment
The cleft dental-alveolus is generally repaired between the ages of 6-12 years when the cuspid teeth begin to develop. The procedure involves placement of bone, usually from the hip, into the bony defect, and closure of the communication from the nose to the gum tissue in three layers. It may also be performed in teenagers and adults as an individual procedure or combined with corrective jaw surgery. Usually the skills of a pediatric dentist, orthodontist and an oral and maxillofacial surgeon are utilized to manage this aspect of cleft repair.