Oral Clefting

  • Oral-facial clefts are birth defects in which the tissues of the mouth or lip don't form properly during fetal development. In the United States, clefts occur in 1 in 700 to 1,000 births, making it the fourth most common major birth defect. Clefts occur more often in children of Asian, Latino, or Native American descent.

  • The good news is that both cleft lip and cleft palate are treatable birth defects. Most children born with either or both of these conditions can have reconstructive surgery while they're still infants to correct the defect and significantly improve facial appearance.

  • An immediate problem after birth, however, is feeding, but special nipples and even prostheses are available to ensure that children with oral clefting receive adequate nutrition until surgical treatment is provided.

  • For many parents, what's most difficult is handling the fact that their child is different. Many parents feel unreasonable guilt that somehow they caused the problem, as well as worry that their child will be teased because of his appearance or because he has trouble speaking. If your child has oral clefting, it's important that you inform yourself about the defect and seek support from both the medical community and other parents who have been through this experience. Support can help you focus on your child's potential, rather than on the cleft.
  • The fact is, cleft treatments available today are excellent. And for those with more pronounced physical differences, plastic surgery can significantly improve specific problems that may be a concern for you and your child.

What Is Oral Clefting?
Oral clefting occurs when the tissues of the lip and/or palate of a fetus don't grow together early in pregnancy. Children with clefts often don't have enough tissue in their mouths, and the tissue they do have isn't fused together properly to form the roof of their mouths.

A cleft lip appears as a narrow opening or gap in the skin of the upper lip, all the way to the base of the nose. A cleft palate is an opening between the roof of the mouth and the nasal cavity. The front part of the palate is bony and is called the anterior or hard palate, and the rear or posterior palate is called the soft palate. Some children have clefts that extend through both the hard and soft palates, whereas others have only partial clefting.

No one knows exactly what causes clefting, although it's believed to be a combination of genetic and environmental factors. "Everybody has some genetic possibility of having a cleft," says Louis Bartoshesky, MD, a clinical geneticist for Christiana Care Health System in Newark, Delaware. Dr. Bartoshesky is part of a cleft palate team that specializes in treating children born with the condition.

The risk may be higher for children whose sibling or parents have a cleft or who have a history of clefting in their families.

Clefts can be broken down into different categories:

* cleft lip without a cleft palate
* cleft palate without a cleft lip
* cleft lip and cleft palate together

In addition, clefts can be unilateral (occurring on one side of the mouth) or bilateral (occurring on both sides of the mouth).

Twice as many boys as girls have a cleft lip, both with and without a cleft palate. However, twice as many girls as boys have cleft palate without a cleft lip.

Diagnosing Clefts
Because clefting causes specific physical manifestations, it's easy to diagnose. The increasing use of prenatal ultrasound means that some parents know before a child is born that a cleft exists. If the clefting has not been detected in an ultrasound prior to the baby's birth, it's identified immediately afterward.

Complications Related to Clefts
Complications related to cleft lip and palate include increased susceptibility to colds, hearing loss, speech defects, a larger than average number of dental cavities, and missing, extra, malformed, or displaced teeth.

Many children with clefts are especially vulnerable to otitis media because their Eustachian tubes don't drain fluid properly from the middle ear into the throat. Fluid accumulates, pressure builds in the ears, and infection may set in. For this reason, many children with clefts have myringotomy tubes surgically inserted into their ears at the time of their first reconstructive surgery.

Another complication for infants with clefts is feeding. A cleft lip can make it more difficult for your child to suck on a nipple. In addition, a cleft palate may cause formula or breastmilk to be accidentally taken up into the nasal cavity. Special nipples and other devices can help make feeding easier; you will probably receive some instructions in how to use them and where to buy them before you take your baby home from the hospital. And in some cases, until they have reconstructive surgery, children with cleft palates may need to wear a prosthetic palate called an obturator to help them eat properly.

Many parents find that it takes much longer to feed their baby, and the anxiety this creates can make feeding difficult for both parents and baby. If you're experiencing problems, call the coordinator of your cleft palate team - he or she can offer specific suggestions to help you and your baby.

Treating Clefts
The good news is, there have been many medical advancements in the treatment of children with oral clefting. Reconstructive surgery can repair cleft lips and palates, and in severe cases, plastic surgery can address specific appearance- related concerns for you and your child.

Source: KidsHealth.org


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