What is cleft lip or cleft palate?

A cleft lip is a split in the upper lip. A cleft palate is a split in the roof of the mouth.

How does this defect arise?

This condition is the result of incomplete fusion of the mouth parts during early development of the baby while in the first three months of pregnancy.

Causes:

• Usually unknown.
• Hereditary (30% have a relative with similar defect).
• Genetic condition (associated with other birth defects).
• Toxic agent (drug, viral infection, toxin in pregnancy).

Are there different types?

Cleft lip and cleft palate may occur separately or together. The cleft may be one-sided (unilateral), both sided (bilateral) or in the midline (median cleft).

How often does it occur?

Cleft lip and cleft lip/palate occurs in approximately 1:1000 births. Isolated cleft palate occurs less often, in approximately 1:2000 births.

What are the complications of cleft palate and cleft lip?

1. Feeding problems
   • Babies may have a problem nursing as their mouths are unable to form a complete seal. The extent of the problem depends on the severity of the cleft. Solution: As far as possible, direct breastfeeding is encouraged. If the baby is unable to do so, they can be fed expressed breast milk or infant formula through a bottle with a specially designed teat or with a spoon.
   • They swallow more air during feeding and milk tends to go through the nose or to the inside of the ears. Solution: They should be held in a head-up position during and after feeds. They should also be burped properly
2. Ear disease
   • They have a greater tendency to develop ear infections and accumulate fluid in their middle ear. This can affect the baby’s hearing. Solution: The fluid may need drainage and infection should be adequately treated.
   • Hearing loss may be an added problem. Solution: There should be regular follow-up and assessment at the ENT (ear-nose-throat) clinic.
3. Speech development
   • In children with cleft palate, the muscles of the palate do not move well. Thus, they have “hypernasal speech” and difficulty articulating certain sounds.
   • Concomitant hearing loss also hampers speech development. Solution: Speech therapy sessions should be instituted early and hearing tests conducted regularly.
4. Dental development
   • Children with clefts affecting upper gums/palate may have abnormally shaped teeth or missing teeth. Solution: The dental team should be involved from an early age, even before tooth eruption. Oral hygiene should be well-maintained. Orthodontic treatment may be required in the school age years.
5. Cosmetic problems
   • The cosmetic outcome of improperly treated cases tends to be very unsatisfactory.
6. Psychological impact
   • The combination of multiple problems involving speech, hearing, dental and cosmetic appearance can lead to poor self-esteem and other psychological effects. Solution: Proper support must be offered to the affected children and their families.

Treatment

Treatment requires multi-disciplinary involvement. This would include a team of plastic surgeon, otolaryngological (ENT) surgeon, dentist, orthodontist (dentist specialising in alignment of teeth), audiologist and speech therapist. Other health care personnel may also be involved.

Surgical treatment cleft lip surgery can be done from age of 3 months.

Cleft palate surgery is usually done between six months to 1 year of age. A bone graft may be required later. Jaw correction surgery may also be needed at a later age.The timing of surgery usually depends on the health condition of the child, the type of cleft and the local health facilities.

Prevention

• Ask your doctor about the risk of recurrence in subsequent pregnancies.
• Avoid potential toxic agents during pregnancy.

Rehabilitation

• Speech therapy.
• Orthodontic treatment.

Support Group

CLAPAM (Cleft Lip and Palate Association of Malaysia)
No. 121 Lot 4 – 46A
4th floor Wisma Central Jalan Ampang
50450 Kuala Lumpur
Tel/fax: 03-21621445
E-mail : clapam@tm.net.my