What are Cleft Lip and Cleft Palate?
Cleft deformities are openings or splits in the craniofacial area that do not fuse properly during pregnancy. Cleft lip is an opening in the upper lip, whereas the cleft palate is an opening in the palatine bone and/or the palatine process of the maxilla (roof of one's mouth). Many researchers believe that most cases of cleft lip and cleft palate are from a combination of genetic and environmental factors. However, a definite cause has not yet been discovered.
A split in the lip and palate that is either unilateral or bilateral.
A split in the lip that appears as only a small notch in the lip or extends from the lip through the upper gum and palate into the bottom of the nose.
A split in the roof of the mouth that doesn't affect facial appearances.
Difficulties and concerns:
Difficulty with feeding - Immediate concerns are present at birth. While most babies with cleft lip can breast-feed, it can be more challenging and babies born with cleft palate can have extreme difficulties with sucking.
Ear infections and hearing loss - Babies with cleft palate are at a higher risk of developing middle ear fluid buildup and possible hearing loss.
Nasal speaking voice and speech difficulties - Since the palate is used in forming sounds, normal speech is often affected and creating proper word noises can be difficult for those with cleft palate and lip.
There also exists huge challenges of coping with such a serious medical condition. Children with clefts may face social, emotional and behavioral problems due to differences in appearance along with extensive medical treatment that all can have adverse affects on their mental health. This is why is it is important to educate others on the many aspects of this condition to create a better understanding of the condition as well as support those diagnosed with cleft lip and palate.
Cleft Lip Repair
To repair a cleft lip, a cheiloplasty is performed. Most commonly, this is done through rotation advancement repair. The surgery is usually done within the first 3-6 months of life for babies born with cleft lip. In a rotation advancement repair, a plastic surgeon will make an incision on each side of the cleft, and then use surrounding tissue as needed to create two flaps that when sutured, connect the two sides of the lip together.
Cleft Palate Repair
A cleft palate repair is usually done later at around 1 year of age and either done through a Z-plasty or V-Y-pushback. A Z-plasty is a technique in which 2 triangular flaps are created and essentially replace a short scar for a longer but more natural scar. In a V-Y-pushback, a V-shaped incision is made at the bottom of an opening and the new hole is entirely closed in a triangle/Y shape. In both, the palate is closed in three layers. The inner layer that forms the nasal lining, the middle layer that contains the muscles at the back of the palate, and the final layer which is the oral mucosa.
Challenges in Providing Surgeries
Due in part to a lack of knowledge, the task of fixing cleft lip and palate defects is still largely unfulfilled worldwide. Due to resources being scarce and/or language limitations, global surgical education is problematic. Due to a lack of understanding of fundamental anatomical concepts and procedural stages, surgical teachings for difficult, high-risk procedures like cleft lip and palate surgeries are constrained even within the US.
One out of every one thousand babies are born with either a cleft lip or palate. Yet this condition remains under-discussed and there is a general lack of deep understanding. This is why awareness is important.