Cleft Lip and Cleft Palate
Cleft lip occurs when the sides of the upper lip fail to grow together properly before an infant is born. Cleft palate is a similar defect affecting the roof of the mouth, such that a split or opening exists between the two sides. Cleft defects occur in one out of seven hundred births in the United States, and in 45 percent of the cases both the lip and palate are involved. Some cases are caused by a defect in the intrauterine environment early in pregnancy, while others are hereditary. The disfigurement is immediately apparent at birth; modern surgical methods, however, have rendered cleft defects far less serious than they were in the past.
The Danger: An immediate and urgent feeding problem exists, because infants with cleft defects often cannot suck or swallow properly. Later on there are likely to be speech problems and hearing defects (caused by infections of the middle ear to which these children are extremely susceptible) in approximately half of all cleft cases. Other complications include pneumonia, bronchitis, other respiratory infections, and dental problems.
Symptoms: Obvious physical malformation, the inability to suck or swallow, ear infections, dental problems, and a nasal voice.
Treatment: The primary treatment is surgery, performed immediately after birth or at a weight of 8 to 10 pounds in the case of cleft lip
(which effectively closes the gap between the two sides of the upper lip), followed by cosmetic surgery during the second year of life. Cleft palate surgery is usually performed after the first year. Other treatment involves revised feeding techniques (including the possible use of prosthetic devices), speech therapy, monthly ear examinations, and treatment of infection. The services of a pediatrician, oral surgeon, plastic surgeon, audiologist, orthodontist, otolaryngologist, and speech therapist may all be required in the effective treatment of these defects.
Outlook: With early treatment and proper surgical procedures, the child with cleft defects will reach school age with only the most minimal disfigurement or impairment of function.
