Cleft Lip and Palate is a birth anomaly where 1 in approximately 700 children may have a gap in their upper lip and/or roof of the mouth. The cause for cleft is multifactorial, and although linked to multiple risk factors, the exact cause is difficult to identify. Cleft lip and palate can present a variety of challenges for affected individuals, including:
1. Feeding difficulties: Babies born with cleft lip and palate may struggle to breastfeed or bottle-feed effectively due to the gap in the lip or palate, which can affect suction and swallowing.
2. Speech difficulties: Cleft lip and palate can impact speech development, leading to issues with articulation, resonance, and intelligibility. The openings in the lip and/or palate can interfere with the proper formation of sounds, resulting in speech delays or abnormalities.
3. Dental problems: Cleft lip and palate can affect the development and alignment of teeth, leading to issues such as crowding, missing teeth, and malocclusion (misalignment of the upper and lower teeth). Dental care and orthodontic treatment may be necessary to address these issues.
4. Ear infections and hearing loss: Children with cleft palate are at an increased risk of middle ear infections (otitis media) and hearing loss due to dysfunction of the Eustachian tube, which helps equalize pressure in the middle ear. Persistent ear infections can impact hearing and may require medical or surgical intervention.
5. Facial appearance and psychosocial impact: The visible differences associated with cleft lip and palate can have a significant impact on a person's self-esteem and social interactions. Individuals with cleft lip and palate may face stigma, bullying, and psychological challenges related to their appearance.
6. Nasal issues: Cleft lip can affect the shape and function of the nose, leading to nasal deformities and difficulties with breathing. Surgical repair of the cleft lip may also involve reconstructive procedures to improve nasal symmetry and airflow.
Unilateral cleft lip is a condition where one side of the lip has a gap, which can be either complete or incomplete. In a complete unilateral cleft lip, the gap involves the entire lip and the base of the nose, while in the incomplete form, it only affects the lip. This condition also causes the nose to deviate and the nostril on the affected side to slump down. It can impact feeding, speech development, dental alignment, and facial appearance. While the first surgery aims to correct the lip and nose, additional revisions may be necessary to achieve a near-normal appearance.
Bilateral Cleft Lip is a condition with a gap on both sides of the upper lip. The central lip consists of parts of the upper lip and the front bone from the upper jaw. This portion of the lip may protrude or deviate. Individuals with bilateral cleft lip may experience challenges with feeding, speech development, dental alignment, and facial appearance. Early intervention using an orthodontic device can help align the central portion better, which in turn helps future surgery. It is recommended to have a consultation as soon as possible to understand the condition and be introduced to other team members who will help in improving the child’s outcome.
Cleft Palate is a condition with a gap in the roof of the mouth, which creates a connection between the mouth and the nose. Children born with a cleft palate face difficulty feeding due to the constant leakage of fluids from the mouth into the nose. However, feeding strategies and appropriate techniques can help parents feed their children effectively. It can lead to other varieties of challenges, including speech development, dental alignment, and ear infections. Early consultation is recommended to ensure the child's growth in the initial few weeks to months is not delayed. Faulty feeding can put the child at risk for delayed growth and development.
Cleft palate surgery is critical not only to close the communication between the mouth and the nose but also for speech. The soft palate is essential for a child's speech as its movement prevents air from the voice box from entering the nasal passages while speaking (Velopharyngeal Dysfunction VPD). A larger passage behind the soft palate can lead to a nasal twang, making speech difficult to understand.
In a small percentage of cases, additional surgery may be required after a thorough assessment by a speech therapist to understand the nature of VPD. These surgeries are performed following evidence-based algorithms to provide optimal outcomes for the child or individual.
Cleft Alveolus is a condition where there is a gap in the teeth-bearing part of the jaw. Usually, a tooth (lateral incisor) is missing on the side of the cleft. Having bone in the tooth-bearing area is essential for good arch continuity, the health of the neighbouring teeth, and especially for the eruption of the canine tooth. The presence of a cleft alveolus can have several implications. It can cause a visible gap or notch in the gum line, which may be accompanied by missing or displaced teeth. Additionally, the cleft alveolus can affect the alignment and stability of the teeth adjacent to the gap, as well as the overall structure and function of the upper jaw. The timing of the canine tooth eruption into the oral cavity is determined by the root of the tooth. The ideal time to fill the gap and provide the right environment for the canine tooth to erupt is when the root is two-thirds of its length, which usually occurs between the ages of 9 and 11 years. To fill the gap, bone is taken from a small incision on the hip bone (usually the right) and the soft bone is scooped out. The bone from this region usually grows back, leaving no concerns about the donor site.
Maxillary Hypoplasia (Upper Jaw Backwardly placed): Individuals with clefts may have their upper jaw behind compared to the lower jaw. The position of the upper teeth inside the lower teeth identifies this. The face also appears dished in or hollow under the eyes and around the nose. The consequences of maxillary hypoplasia can vary depending on the severity of the condition. Severe Maxillary Hypoplasia cases can cause significant facial asymmetry, dental crowding, malocclusion (misalignment of the teeth), and breathing difficulties. Jaw surgery allows for repositioning the upper and, in some instances, the lower jaw to improve facial balance. The use of Virtual Surgical Planning software improves accuracy and, thus, the outcomes. In individuals with cleft palate, an assessment of speech is also imperative to establish the speech baseline. In a very small number of cases, there is a risk of resonance change after jaw surgery despite the improved articulation that may occur. This is why a combined evaluation with a speech pathologist is imperative in cleft individuals undergoing Jaw surgery.
When the speech after the cleft palate repair is suboptimal, the speech pathologist will identify the cause of compromised speech. Once a detailed assessment is conducted, an appropriate treatment option will be suggested.
The palate surgery usually combines palate lengthening and muscle repositioning. Following the surgery, the speech pathologist will provide the necessary therapy and it takes approximately six to 12 months for the benefit of the surgery to be appreciated.
The Bhagwan Mahaveer Jain Hospital in Bangalore is a Cleft Leadership Center and boasts the largest multidisciplinary team in the country. With nearly two decades of experience, this unit serves as a centre of excellence and has trained over 25 cleft surgeons from all around the world.
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