One in 700 babies around the world are born with a cleft – a gap or a split – in their upper lip and/or palate (roof of the mouth). It is a birth defect that arises from improper formation in the uterus.

Symptoms

There are several ways in which a cleft can manifest itself. The illustration below depicts these.

These symptoms, as seen above, are the most obvious diagnosis of a cleft. However, there are other symptoms that may be caused as a result of complications alongside the incidence of a cleft. These are discussed below.

Complications

A few complications that may arise due to the incidence of a cleft lip or palate include:

• difficulty in infant feeding – as the child’s mouth may not form a good seal to breastfeed or drink from a normal bottle, there is a possibility of milk coming out through the nose in the case of cleft palates; mothers are usually assisted and trained to adopt alternative methods of positioning and feeding so as to ensure that the child still gets enough nutrition
• auditory issues – a cleft palate makes a child more vulnerable to the build-up of ear fluids and to ear infections, both of which could affect their hearing
• dental issues – due to increased exposure, possible difficulty in cleaning and the presence of a gap, cleft patients possess a greater risk of experiencing tooth decay or improper dental development
• speech issues – if not corrected, a cleft (particularly of the palate) could lead to unclear or nasal speech and difficulty in pronouncing certain sounds
• confidence issues – since the presence of a cleft (particularly of the lip) affects one’s appearance directly, it is understandably linked with confidence issues and self-esteem if not or poorly treated; difficulty with speech may also contribute to this sentiment

Causes

A cleft occurs when the constituent structures of the upper lip or palate fail to fuse properly during development of the baby in the uterus. It is unclear as to what exactly causes the defective development. However, it is likely that the incidence of clefts may be related to one of two factors:

• genetic factor, where there might be someone else in the family with a cleft (although the greater majority of cases are one-offs)
• environmental factor, where the baby’s development in the uterus might have been affected by a drug (such as anti-seizure medication and steroids) taken by the mother, smoking or consuming alcohol, or a lack of folic acid during pregnancy

In some cases, a cleft may occur as part of a wider syndrome or range of birth defects that may arise for reasons of their own.

Diagnosis

A cleft lip or palate is usually diagnosed at the post-natal examination carried out by a doctor soon after a baby is born. A cleft lip is usually obvious at first sight, while a cleft palate may be observed upon examination of the baby’s buccal (oral) cavity.

Prevention

Apart from the general care (physical and medical) to be taken during pregnancy, there is no specific means by which a cleft birth may be prevented.

Treatment

The primary form of treatment for a cleft is corrective surgery, with the recommended ages being at 3-6 months for a cleft lip and 6-12 months for a cleft palate. Surgery can take up to two hours and is usually conducted under general anaesthesia. In some cases, further surgery may be required at around 8-12 years of age to repair clefts in the gum by means of a bone graft. Additionally, adults may choose to have further surgery (such as rhinoplasty) to improve their appearance, later on in life.

Usually, any accompanying hearing issues improve following surgery. However, in some cases, there might still be a build-up of secretions in the ear, leading to hearing impairment. This may be helped with the insertion of tiny plastic tubes (called grommets) into the eardrum to drain out the fluid. Hearing aids may be used in more severe cases.

Since there is a greater risk of tooth decay for children with clefts, it is important to have their teeth checked regularly by a dentist. Also, there is a likelihood of teeth not being properly aligned, or having a missing or extra tooth. Such cases will have to be observed as the child grows, and be treated with braces or other dental appliances that could help to straighten teeth.

While corrective surgery for a cleft might significantly reduce any speech impairment, speech therapy is still required in some cases. Again, this is usually assessed and administered as the child grows.

Cover illustration adapted from Medlife.