What is a Cleft Lip?
The cleft lip and cleft palate are openings or splits that occur in the upper lip, the roof of the mouth, or both.
This condition occurs when the facial structures that develop in a baby in the womb do not close completely.
In addition, this condition is one of the most common birth defects. This disorder most often occurs as an isolated birth defect but is also associated with many inherited genetic conditions or syndromes.
Symptoms of Cleft Lip
Usually, a cleft lip or palate can be noticed as soon as the baby is born. This condition can appear in the form of:
- A split in the lip and roof of the mouth that affects one or both sides of the face.
- A split in the lip that is only visible as a small indentation in the lip, or extends from the lip through the upper gum and palate to the bottom of the nose.
- The presence of a cleft in the roof of the mouth that does not affect the appearance of the face
Less commonly, a cleft occurs only in the muscles of the soft palate (submucous cleft palate), which is at the back of the mouth and is covered by the lining of the mouth.
This type of cleft is often not noticed at birth and may not be diagnosed until later when symptoms appear.
The symptoms of submucous cleft palate include:
- Difficulty feeding.
- Difficulty swallowing with the potential for liquid or food to come out of the nose.
- Chronic ear infection
Causes of Cleft Lip
This condition occurs when the tissues in a baby’s face and mouth do not fuse together properly. Normally, the tissues that form the lips and palate fuse together in the second and third months of pregnancy.
However, in babies with this condition, fusion does not occur or occurs only partially, forming a gap.
Experts believe that most cases of cleft lip and palate occur due to interactions between genetic and environmental factors.
Meanwhile, no one knows for sure the exact cause of this abnormality in babies.
The mother or father can inherit the gene that causes this condition, either alone or as part of a genetic syndrome that includes cleft lip or cleft palate as one of its symptoms.
In some cases, babies inherit genes that make them more likely to develop a cleft along with other environmental factors.
Cleft Lip Risk Factors
Several factors can increase the chances of a baby having this birth defect, including:
- Family health history. People who have this condition are at risk of passing it on to their offspring.
- Exposure to certain substances during pregnancy. This condition is more likely to occur in pregnant women who smoke, drink alcohol, or take certain medications.
- Having diabetes. Women who are diagnosed with diabetes before pregnancy are at higher risk of having a baby with the condition.
- Obesity during pregnancy. Babies born to obese mothers may have an increased risk of cleft lip and palate.
Male babies are more likely to have this condition with or without a cleft palate.
Meanwhile, cleft palate without cleft lip is more common in women.
Cleft Lip Diagnosis
Most cases of cleft lip and palate are immediately recognized by doctors at birth and do not require special tests for diagnosis.
However, over time these abnormalities can be seen on ultrasound before the baby is born.
This is why routinely checking your pregnancy with an ultrasound is an important thing to do.
You can detect this condition with an ultrasound, which you can start around the 13th week of pregnancy.
As the fetus continues to develop, it may become easier to accurately diagnose these birth defects.
If a prenatal ultrasound shows a rupture, the doctor may offer a procedure to take a sample of amniotic fluid from the uterus or amniocentesis.
This test may show that the fetus has inherited a genetic syndrome that results in other birth defects.
Cleft Lip Treatment
The goal of treatment is to improve the child’s ability to eat, speak, and hear normally and to have a normal facial appearance.
Treatment for children with this condition often involves many doctors. Starting from plastic surgeons, oral surgeons, ENT doctors, pediatricians, pediatric dentists, to speech therapists, and genetic counselors.
Treatment involves surgical procedures to correct abnormalities and therapy to help manage other conditions.
For more optimal and appropriate treatment according to the conditions experienced, you can contact a doctor.
Operation
Surgery to repair a cleft lip and palate will be based on the child’s overall condition.
After initial improvement, the doctor may recommend further surgery.
The goal is to improve speaking ability or improve the appearance of the lips and nose,
The operations will usually be carried out in the following order:
- Lip repair — in the first 3 to 6 months of age.
- Cleft palate repair — at 12 months of age or earlier if possible.
- Follow-up operations — between age 2 and the late teenage years.
In the first stage of surgery, the doctor will make incisions on both sides of the gap and fold the tissue which is then stitched to join it together.
The second stage of surgery will be performed on the cleft palate, aiming to close the gap, repair the palate, prevent fluid buildup in the middle ear, and assist the development of teeth and facial bones.
In the second stage of surgery, the doctor will make incisions on both sides of the cleft, reposition the tissues and muscles of the palate, and then stitch them together. Surgery for cleft palate can be performed when the baby is between 6 and 18 months old.
Advanced surgery for cleft palate can be performed when the child is 8 to 12 years old. Well, this surgery involves bone grafting to strengthen the upper jaw structure and support speech articulation.
For children with cleft lips who also have ear problems, the doctor will perform a third operation in the form of installing ear tubes, which can be done when the baby is 6 months old. The purpose of this operation is to prevent fluid buildup in the middle ear.
Additional surgery to improve the appearance of the mouth, lips, and nose will be performed as the child reaches adolescence and adulthood.
After all stages of surgery are complete, the doctor will carry out monitoring and follow-up care until the child is 21 years old or until growth stops.
In general, the following is a more detailed explanation of the stages:
1. Cleft lip repair
To close the separation or gap in the lip, the surgeon will make incisions on either side of the gap and create flaps of tissue. The flaps are then stitched together, including the lip muscles.
This surgery aims to improve the lips and will result in a more normal appearance, structure, and function of the lips.
Additionally, initial rhinoplasty or surgery is usually performed at the same time if necessary.
2. Repair of gaps in the ceiling
Various procedures can be used to close the separation and rebuild the roof of the mouth (hard and soft palates), depending on the child’s condition.
The surgeon will make incisions on either side of the gap and reposition the tissue and muscles.
Next, the repaired part will be sewn closed.
3. Ear tube surgery
Meanwhile, in children with cleft palate, ear tubes can be installed to reduce the risk of chronic ear fluid, which can lead to hearing loss.
Ear tube surgery involves placing a small, cylindrical or cone-shaped tube in the eardrum.
The aim is to make a hole to prevent fluid build-up.
4. Surgery for the reconstruction of the appearance
Additional surgery may be necessary to improve the appearance of the mouth, lips, and nose of a child with a cleft lip and palate.
Surgery can significantly improve a child’s appearance, quality of life, and ability to eat, breathe, and speak.
However, be aware of the possible risks that may occur during surgery including bleeding, infection, poor healing, widening or raising of scars, and temporary or permanent damage to nerves, blood vessels, or other structures.
In addition, you also need to know various information about Cleft Lip Surgery in Children.
Cleft Lip Complications
Children with cleft lip with or without cleft palate are at risk for one or more of the following complications, depending on the severity of the cleft:
- Difficulty feeding. Most babies with cleft lip can breastfeed, while babies with cleft palate may have difficulty breastfeeding.
- Ear infections and hearing loss. Babies with cleft lip and cleft palate are at high risk for middle ear infections and hearing loss.
- Dental problems. If the gap extends through the upper gum, tooth development can be affected.
- Speech difficulties. Because the roof of the mouth is used in forming sounds, normal speech development can be affected by a cleft palate. The child may have a nasal voice.
- Challenges of coping with medical conditions. Children with cleft lip or cleft palate can face social, emotional, and behavioral problems because of their appearance and the stress of undergoing intensive medical care.
Cleft Lip Prevention
After having a baby with a cleft lip or palate, it is natural for parents to feel concerned about the possibility of having another child with the same condition.
Although many cases of cleft lip and palate cannot be prevented.
Consider these steps to better understand the condition and lower your risk:
- Consider genetic counseling. If you have a family history of cleft lip and palate, tell your doctor before you decide to become pregnant. Your doctor may refer you to a genetic counselor who can help determine your risk of having a child with cleft lip and palate.
- Take prenatal vitamins. If you are planning to become pregnant soon, ask your doctor if you should take prenatal vitamins.
- Avoid smoking and drinking alcohol. Drinking alcohol or smoking during pregnancy will increase the risk of having a baby with birth defects.
Cleft Lip Surgery Costs
The cost of surgery will vary, depending on the location and health facility you choose.
As a benchmark, the lowest cost range is around 26,000/- in Indian rupees.
However, the range can change at any time. In addition, many suggest preparing more funds for unexpected additional needs.
At least 20 to 30 percent of the estimated cost.