Cleft Lip & Cleft Palate: Causes, Risk Factors, Management and Prevention.

Cleft lip and cleft palate are splits in the upper lip, the roof of the mouth (palate), or combined. Usually results from facial structures that are developing in an unborn baby that fail to fuse completely.

They are among the most common birth defects. Commonly occur as isolated birth defects but are seldom associated with other inherited genetic or syndromic conditions.

Raising a baby born with either forms of clefts is quite challenging, luckily both are surgically amenable. A series of surgeries to restore normal function and appearance are performed with little scarring.

EPIDEMIOLOGICAL BURDEN OF CLEFT LIP AND PALATE.

The prevalence of Cleft lip and cleft palate is locality dependent and specific, with impaired actual data accuracy since most third world countries lack active population-based surveillance systems and depend on hospital-based data.

In the USA about; 

  • 1 in every 1,600 babies is born with combined cleft lip and palate.
  • 1 in every 2,800 babies is born with cleft lip.
  • 1 in every 1,700 babies is born with cleft palate.

In sub-Saharan African countries, active population-based surveillance systems are obsolete. Prevalence is a derivative of hospital-based data. A research conducted by the University Of Witwatersrand, South Africa ranged the prevalence among the different African countries as from 0.2/1000 live births in Ethiopia, 0.5/1000 in Nigeria, 0.8/1000 in Uganda, and 1.7/1000 reported in Kenya. A community household survey in South East Ghana recorded a prevalence of 6.3/1000 people and a recent study conducted in the Democratic Republic of Congo depicted an estimated incidence of 0.8/1000 live births similar to the findings in Uganda, however, the research was devoid of clinical examination. 

CAUSES AND RISK FACTORS

Cleft lip and cleft palate manifest when facial tissues and mouth don’t fuse properly. Usually, tissues forming the lip and palate appose in the second and third months of pregnancy. Cleft (opening) occurs when the fusion fails or occurs only partway.

Researchers dictate that cleft lip and cleft palate result from an interaction of genetic and environmental factors with no definite cause.

Any or both parents can pass on genes that cause clefting, either alone or as part of a genetic syndrome that encompasses a cleft lip or cleft palate as one of its manifestations. Occasionally, Fetuses inherit a gene that makes them more likely to develop a cleft, and then an environmental trigger amplifies the cleft to occur.

Risk factors

Recently, the Centre for Disease Control (CDC) reported on important findings from research studies on several factors that may increase the likelihood of a baby developing a cleft lip and cleft palate, some of the factors include:

  • Family history. Parents with positive family history of cleft lip or cleft palate face an increased risk of having a baby with a cleft.
  • Having diabetes.  Evidence points to women diagnosed with diabetes before pregnancy may have a higher risk of having a baby with a cleft lip with or without a cleft palate compared to women who were not diagnosed with diabetes.
  • Substances exposure during pregnancy. Cleft lip and cleft palate are more likely to occur in pregnant women who drink alcohol, smoke cigarettes or take certain medications such as Topiramate or valproic acid especially in the first trimester of pregnancy.
  • Being obese during pregnancy.  Some evidence suggests that babies born to obese women may have a higher risk of cleft lip and palate.

Complications

Children born with cleft lip or and cleft palate face a variety of challenges, depending on the severity and the type of cleft.

  • Feeding difficulties. One of the urgent and immediate concerns after birth is feeding. Almost all babies with cleft lip can optimally breast-feed, a cleft palate may make sucking difficult impairing the nutritional status of the child.
  • Recurrent Ear infections and hearing loss.  Cleft palate increases the risk of developing middle ear fluid and hearing loss.
  • Dental problems.  Clefts extending through the upper gum, hinder tooth development.
  • Speech difficulties. The palate is used in forming sounds, cleft palate hinders speech development, rendering sound too nasal.
  • Challenges of coping with a medical condition. Children with clefts endure social, emotional and behavioral challenges due to differences in appearance and the burden of intensive medical care.

Management and Prevention

Management and treatment for children with clefts vary depending on the severity of the cleft; the child’s age and needs; the presence of other birth defects as well as associated syndromes.

The surgery to repair a cleft lip usually occurs in the first few months of life within the first 12 months of life, while repairing a cleft palate is recommended within the first 18 months of life or earlier if possible. An early intervention reduces the risks and the severity of clefts related complications.

Quite a number of children will need additional surgical procedures that can improve the appearance of a child’s face as well as breathing, hearing, speech, and language development. Some might need other types of treatments and essential services, such as special dental care and speech therapy.

Prevention

Parents of babies born with a cleft are usually scared about the possibility of having another child with a similar condition. Cases of cleft lip and cleft palate can’t be prevented, but risks can be lowered through:

  • Avoidance of tobacco or alcohol use. Avoidance of alcohol or tobacco use during pregnancy decreases the risk of having a baby with a birth defect.
  • Avoidance of drugs that predispose to birth defects and use of prenatal vitamins. Avoidance of medications such as valproic acids and use of vitamins and iron supplements decrease the risks of birth defects.
  • Control of diabetes. Diabetes mothers must ensure glycemic control prior and during pregnancy to reduce the risks of birth defects like cleft and lip palate.
  • Consider genetic counseling. In advanced societies, parents with a family history of cleft lip and cleft palate, may consult a genetic counselor who can help determine their risk of having children with cleft lip and cleft palate.

Writen by Dr Abdihamid .M. Noor.