What Causes Cleft Lip And Palate In Newborns

After Surgery Will There Be A Cleft Lip Scar

As with any surgery, a small cleft lip scar will be visible. Your babys scar will fade over the years, although when they become adults 97% believe there is still a physical difference. If you look at pictures of mouths with cleft lips before and after surgery you will see that scarring is usually minimal.

What You Need To Know

• Cleft lip and cleft palate are among the most common congenital facial differences in children.
• These birth differences arise when the tissues and bone inside the mouth do not fuse properly, resulting in a space in the upper lip and/or palate.
• Both cleft lip and cleft palate surgeries are performed in the hospital under general anesthesia and usually require a stay of at least one night.

Whats The Treatment For Cleft Lip And Cleft Palate

A cleft lip may require one or two surgeries depending on the extent of the repair needed. The initial surgery is usually performed by the time a baby is 3 months old.

Repair of a cleft palate often requires multiple surgeries over the course of 18 years. The first surgery to repair the palate usually occurs when the baby is between 6 and 12 months old. The initial surgery creates a functional palate, reduces the chances that fluid will develop in the middle ears, and aids in the proper development of the teeth and facial bones.

Children with a cleft palate may also need a bone graft when they are about 8 years old to fill in the upper gum line so that it can support permanent teeth and stabilize the upper jaw. About 20% of children with a cleft palate require further surgeries to help improve their speech.

Once the permanent teeth grow in, braces are often needed to straighten the teeth.

Additional surgeries may be performed to improve the appearance of the lip and nose, close openings between the mouth and nose, help breathing, and stabilize and realign the jaw. Final repairs of the scars left by the initial surgery will probably not be performed until adolescence, when the facial structure is more fully developed.

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Treatment Of Oral Clefts

A mild cleft may not require treatment if it does not interfere with everyday activities and does not cause pain or discomfort to the child. However, some children with a more severe cleft may need surgery to correct their condition at an early age. Some may even require multiple surgeries for years to fix them completely.

Children with cleft lip and palate have a better chance of curing the condition if treated early, before six months of age. The sooner plastic surgery is performed on these babies, the better their chances for success will be down the road in treating any other complications that may arise. The surgery aims to correct appearance, speech problems, feeding issues, and other complications.

A plastic surgeon or a team that includes plastic surgeons, dentists, and ear-nose-throat specialists performs reconstructive surgery. After that, another team of specialists will work on speech therapy and dental care.

Speech And Language Therapy

Repairing a cleft palate will significantly reduce the chance of speech problems, but in some cases, children with a repaired cleft palate still need speech therapy.

A speech and language therapist will assess of your child’s speech several times as they get older.

If there are any problems, they may recommend further assessment of how the palate is working and/or work with you to help your child develop clear speech. They may refer you to community SLT services near your home.

The SLT will continue to monitor your child’s speech until they are fully grown and they will work with your child for as long as they need assistance.

Further corrective surgery may sometimes be required for a small number of children who have increased airflow through their nose when they’re speaking, resulting in nasal-sounding speech.

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Treatment For Cleft Lip And Cleft Palate

Sometimes no treatment is required for a small cleft lip or cleft palate if it does not affect a baby from feeding properly or if the cleft is small and on the uvula or submucous clefts.

However, when treatment is needed it is often surgery. A team of specialists is often involved in the treatment of cleft lip and cleft palate and monitoring other areas of the ear, nose and throat that may be affected by a cleft palate or cleft lip.

Specialists that provide treatment for cleft lip and cleft palate include:

• Plastic surgeons or ENTs who specialize in cleft repair
• Auditory or hearing specialists
• Speech therapists

Surgery is often recommended for severe clefts that will, or are currently, causing problems with feeding, breathing or will likely cause speech delays or impediments in the future. Most surgeries to repair clefts will be done when the child is 3-9 months old before learning how to speak.

The different types of surgical procedures used to repair a cleft include:

What Is My Baby’s Long

Long-term prognosis for isolated cleft lip/palate is good. However, your baby may have several issues that require follow-up.

• Dental concerns: One issue could be dental problems, such as missing, extra or malpositioned teeth. Almost all children with a cleft palate will require braces on their permanent teeth. Also, eruption of the permanent teeth is often delayed.
• Speech problems: As many as 25 to 35 percent of children with cleft lip and palate have speech problems that necessitate a secondary palate surgery and speech therapy. Any baby with a cleft palate should be evaluated by a speech therapist.
• Nasal and septum deformities: There may be some deformities of the nose and septum .
• Hearing problems: Many infants with cleft lip and palate also will have problems with hearing. Most will also need to have tubes placed in their ears to help with chronic ear infections and drainage of fluid. This also helps with their hearing and, ultimately, their pronunciation of words.

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How Does The Diagnosis Of Cleft Lip And/or Palate Affect The Pregnancy

In most cases, the only way a clefting diagnosis affects pregnancies is that mothers will have to undergo some additional tests.

• Ultrasound: Approximately 25 percent of infants with clefts have an associated condition. Therefore, we always recommend a thorough ultrasound exam when we suspect a cleft lip or palate.
• Amniocentesis: Associated conditions can include chromosomal disorders. Your maternal-fetal medicine specialist may recommend an amniocentesis to evaluate your babys chromosomes. We perform this test at 16 to 18 weeks gestation. During an amniocentesis, a physician will insert a needle through the abdominal wall into the uterus to remove a small amount of amniotic fluid. We then send the fluid to the lab for testing. Final test results are usually available in 10 to 14 days.
• FISH test: A quick response test, called fluorescence in situ hybridization or FISH, will give preliminary results in 24 to 48 hours. It is quite accurate for the diagnosis of the three most common chromosomal disorders: trisomy 13, trisomy 18 and trisomy 21.

Determining Factors Of Cleft Lip And Palate

Any one of a variety of factors can come into play to determine if a baby is born with a cleft lip or cleft palate. In most instances, there is no single explanation, but a combination of many factors acting together that results in a cleft lip or palate. However, there are cases which are due to a more comprehensive genetic syndrome that often includes other birth defects. The geneticist evaluates every new patient to determine if the cleft is isolated or part of an underlying syndrome. Isolated cleft lip with or without cleft palate and isolated cleft palate or due to multifactorial causation. Multifactorial causation involves a variety of both genetic and non-genetic factors. This is not due to a single gene abnormality but rather many genes working together along with other factors. We do not know all of the other factors but certainly prenatal exposure to alcohol, cigarettes, high temperatures, and other medications and drugs increases the risk. If a genetic syndrome, such as 22q deletion syndrome is identified, the infant may a have several other physical disorders that will occur as well

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What Are The Chances Of Having A Child With A Cleft

Some conditions like Sickle Cell Anaemia are relatively easy to predict we know which gene causes it, and we can work out the chances of a child inheriting the condition or being a carrier based on whether or not their parents are carriers. The causes of cleft lip and palate are much more complicated and vary greatly from case to case, so even if both parents have a cleft it can be very difficult to accurately predict how, if at all, their children will be affected. Each case needs to be looked at separately.

The below statistics are based on multiple studies looking at a range of different populations, but they are only observations, not predictions, and are subject to change depending on the available evidence. If you want to know more about your particular case, you should talk to your Cleft Team about genetic testing or evaluation.

1/700 people around the world will be born with a cleft lip and/or palate, though some statistics put it closer to 1/600.

This is around 0.14% of the population. A cleft is the most common craniofacial congenital abnormalityin the world, and in the UK alone three babies are born with a cleft every day.

In general, the more people who have a cleft in a family, and the closer theyre related to a child, the more likely that child is to have a cleft. However, the causes of clefting vary so much that its extremely hard to predict how future children will be affected without detailed genetic analysis.

Outlook For Cleft Lip And Palate

The majority of children treated for cleft lip or palate grow up to have completely normal lives.

Most affected children will not have any other serious medical problems and treatment can usually improve the appearance of the face and problems with feeding and speech.

Surgery to repair a cleft lip may leave a small pink scar above the lips. This will fade over time and become less noticeable as your child gets older.

Some adults who’ve had a cleft lip or palate repair may be self-conscious or unhappy about their appearance. Your GP may refer you back to an NHS cleft centre for further treatment and support if there are any ongoing issues.

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How Do Oral Clefts Form

When a foetus has been developing for about 4-7 weeks, the skull and face begin to grow. An oral cleft occurs when the front part of the face doesnt join up fully.

Your cupids bow, or the little indent between your septum and top lip is where the face normally finishes joining together and there will normally be a very small indent, or cleft, here. This cleft under the nose is known as your philtrum.

Very occasionally, babies with an oral cleft will also have ankyloglossia, more commonly known as tongue tie’.

What Causes Cleft Palate And Cleft Lip

As with most birth defects, the question, Is cleft palate/cleft lip genetic? is often discussed with physicians and pediatricians. Some common causes of cleft palate and lip include:

• Genetics: Cleft palate and cleft lip are genetic but only if one or both of the parents carry the gene that causes cleft palate or cleft lip.
• Environmental Factors: Other factors that can also lead to this birth defect are:
• Smoking or using drugs while pregnant
• Viruses or toxins
• Other birth defects

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Cleft Lip & Palate Repair Recovery

The length of cleft palate surgery recovery will depend on multiple factors, such as the extensiveness of the surgery, any additional procedures performed in combination with the surgery, and other circumstances unique to each patient. Prior to your procedure, you will be given specific instructions, including information about how to care for your surgical sites during the healing process, medications to apply topically or take orally to aid in healing and reduce the risk of infection, specific eating and drinking instructions, specific concerns to look for, and when to follow up with your plastic surgeon. As previously noted, the type of procedure, the extent of the procedure, and additional factors will dictate your projected healing timetable. For additional information about the recovery process following cleft plastic surgery, please contact our plastic surgery practice.

If I Had Another Child Could It Have A Cleft

If you have a child with an isolated cleft, then the chance of you having another child with the same condition depends upon how many people in your family also have a cleft. The greater the number, the greater the risk.The information for this table was adapted from Clinical Genetics Handbook 2nd edition Blackwell Scientific publications. Other sources of information may give slightly different numbers. The figures given depend upon which study was used for the data. The more people in a family that have a cleft the greater the chance another child will have a cleft. There are some families where the chance of having a child with a cleft is as high as 50%. In these families there is a single gene that causes the cleft and it is passed down from parent to child in an autosomal dominant manner. Whichever study is used, if a child has an isolated cleft, it is far more likely that another child in the family will not have a cleft.The chance of having a child with a cleft versus a child with no cleft

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Taping And Nasoalveolar Molding Before Cleft Lip Surgery

NAM is done to reshape the gums, lip, and nose before cleft lip surgery. Molding helps in reducing the gaps in the gums and the lips. It also helps in lifting and shaping the nose.

NAM is done using custom-made plastic molding plates on the babys gum line. The plate directs the gum growth. The doctor will fix the plate every one to two weeks to make the cleft smaller.

Causes Of Cleft Lip And Palate

A cleft lip or palate happens when the structures that form the upper lip or palate fail to join together when a baby is developing in the womb.

The exact reason why this happens to some babies is often unclear. It’s very unlikely to have been caused by anything you did or did not do during pregnancy.

In a few cases, cleft lip and palate is associated with:

• the genes a child inherits from their parents
• a lack of folic acid during pregnancy
• taking certain medicines in early pregnancy, such as some anti-seizure medications and steroid tablets

In some cases, a cleft lip or palate can occur as part of a condition that causes a wider range of birth defects, such as 22q11 deletion syndrome and Pierre Robin sequence.

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Symptoms Of Cleft Lip And Cleft Palate

Orofacial clefts, especially lip clefts, can often be detected through a routine ultrasound as early as 13 weeks. If a cleft isnt seen before a baby is born, its usually apparent at birth. Depending on the size and location of the cleft, you may see:

• Cleft lip: A split in the lip that looks like a small notch or extends up towards the bottom of the nose.
• Cleft palate: A split in the roof of the mouth, with the face itself looking unaffected.
• Cleft lip and palate: A split in the lip that extends into the roof of the mouth.

Babies with cleft lips and/or palates can have other symptoms as well, including:

• Trouble with feeding or swallowing
• Liquids or foods coming out of the nose
• Chronic ear infections
• A nasal-sounding voice

Sometimes cleft palates towards the back of the mouth may be harder to spot at birth, especially if the split is covered by the mouths lining. Called submucous cleft palates, these clefts dont typically affect a babys appearance. But they can still cause feeding and ear problems and cause a childs voice to sound nasal.

Cleft Palate Surgery In Gainesville Fl

Among the most common birth abnormalities affecting children worldwide, cleft lip and cleft palate can occur when a babys lip or mouth does not form properly during their mothers pregnancy. These conditions can vary in severity and might involve one or both sides of the mouth. Individuals with a cleft lip, whether with or without a cleft palate, often experience difficulties with eating, speaking, and swallowing. They may even experience problems with their teeth, hearing problems, and ear infections, which can be long-lasting. Gainesville, FL, plastic surgeon with John W. Tyrone, MD, PLLC, Plastic Surgery offers compassionate care tailored to each patient, combining years of experience, acute attention to detail, and unmatched surgical skill for our patients benefit. Through reconstructive cleft lip and palate treatment, patients can restore aesthetics and function and find pride in their appearance.

Results from cleft palate surgery can be life-changing for adult patients. Contact our plastic surgery office to schedule a virtual consultation or in-office consultation for face plastic surgery and to learn more about our available cosmetic and reconstructive procedures.

*Individual Results May Vary

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Can Cleft Lip And Cleft Palate Be Prevented Or Avoided

The exact cause of these birth defects is unknown. So, you cannot prevent or avoid them. But there are steps you can take to lower your risk of having a baby with a birth defect. These include:

• Taking folic acid before and during pregnancy.
• Avoiding tobacco, drugs, and alcohol during pregnancy.
• Getting to a healthy weight before pregnancy and not gaining too much weight during pregnancy.
• Getting vaccinations and protecting yourself from infections.

Talk to your doctor about these and other ways to help reduce the chance of birth defects.