Every parent expecting a new baby hopes that their child will be born healthy and perfect, but unfortunately that is not always the case. According to estimates conducted by the Centers for Disease Control and Prevention (CDC), every year in the United States about 1 in 1000 babies are born with either a cleft palate, a cleft lip, or both, making isolated orofacial clefts, or clefts that occur with no other major facial abnormalities, one of the most common types of birth defects in the United States. Advances continue to be made in the treatment of people with clefts, and today most children with clefts are able to reach adulthood with a good sense of self, an acceptable appearance, and healthy social skills. Still, almost all parents have many questions when first encountering this condition. Answers to some of the most frequently asked questions about orofacial clefts can often help alleviate a great deal of anxiety.
What is cleft lip and cleft palate?
Between the 8th and 12th weeks of fetal development, special cells from each side of the forming head grow toward the center. As the face nears its final form, this space closes and the left and right halves of the upper lip and palate (the roof of the mouth) join. However, in children born with a cleft lip or cleft palate, the space does not fully close and a small gap, or “cleft”, remains. This cleft can form in the lip, causing a split in the upper lip and base of the nose, in the palate, causing a split in the roof of the mouth and back of the nose, or in both. A cleft is not usually dangerous or a medical emergency and causes no pain for the baby. Clefts may occur on one side of the face (unilateral) or both sides (bilateral), but both types can be eventually repaired thorough a gradual treatment process.
What causes cleft lip or cleft palate?
The exact causes of cleft lip and cleft palate among infants are often unknown, but the condition may be inherited from one or both parents. Furthermore, groups or clusters of problems, called syndromes, can sometimes appear together in newborn infants. A cleft lip or palate may be only one part of one of these larger syndromes. A number of clinical studies reported by the CDC over the past several years also suggest that certain environmental factors may increase the chance of having a baby with an orofacial cleft. Specifically, infants born to women who smoked during pregnancy, who were diagnosed with diabetes prior to pregnancy, or who used certain medications to treat epilepsy, such as topiramate or valproic acid, during the first trimester were shown to have an increased risk. Scientific research into the specific underlying causes of cleft lips and palates is still ongoing and a geneticist can tell you more about the risk of clefts in an individual case.
How can cleft lip and cleft palate be treated?
Treatment of a cleft palate requires a team of medical professionals who play different roles in the child’s care. This “craniofacial team” generally includes a craniofacial surgeon, an orthodontist, and an otolaryngologist, but may also include geneticists, speech/language pathologists, nutritionists, and occupational therapists as necessary to meet the child’s specific needs. Craniofacial surgery needs to be specifically tailored to the overall health of the child and the severity and location of the cleft, but initiating treatment as early as possible is highly recommended. The first surgery to repair a cleft lip usually takes place between the third and sixth month and cleft palate surgery, or palatoplasy, can be completed between the ninth and twelfth months. Both involve reconstructing the features to help with appearance and function while helping to insure that the patient will maintain both form and appropriate use as he or she grows. Multiple surgeries and long-term follow-up care are necessary in order to achieve optimal facial reconstructive results.
Every child’s case is unique, and requires individual assessment and diagnosis in order to formulate a treatment plan that best meets their specific needs. If you have additional questions about orofacial clefts, or about any of the facial plastic surgery procedures that I perform, I would welcome you to contact me, Dr. Fernando Burstein, to schedule a consultation. Don’t forget to connect with me on Facebook, Twitter, and Google+ for the latest facial plastic surgery news.