Overview: What are cleft lips and palates?
The medical term “cheilognathopalatoschisis” is made up of the Greek words “cheĩlos” lip, “gnáthos” jaw, “schisis” cleft and the Latin word “palatum” palate. During the fifth to seventh week of pregnancy, the previously separate parts of the nose, lip and jaw join together. By the twelfth week, a coherent palate normally develops from parts of the upper jaw. These two processes are independent of each other, which is why either a cleft lip and jaw or a cleft palate can also develop independently of each other in the event of disorders of embryonic development. Very often, however, the malformations occur together.
In earlier times, a cleft lip and palate was a massive health problem; breathing, eating, hearing and speaking were seriously impaired. Modern medicine makes very good treatment possible and thus not only contributes to the complete health of those affected. The stigma arising from the deviating aesthetic appearance and the associated social, emotional and psychological hurdles can be prevented. Treatment is complicated and takes a long time. The fact that the clinical picture of cleft lip and palate can now be treated at all and so well ensures a good quality of life for the affected children and their parents.
Cleft lip and palate – frequency and distribution
At 10 to 15 percent, cleft lip and palate is one of the most common congenital malformations in humans worldwide. For every 500 births in Europe, 1 newborn is born with a cleft lip and palate. Clefts of the lips and jaw occur more frequently in boys, those of the palate more frequently in girls. The left side is more likely to be affected than the right, and in around 15 percent of cases the fissures are on both sides. There is a demonstrably increased risk in children in whose immediate family environment the disease has already occurred. Around a quarter of those affected have cases of cleft lip and palate in their family.
Cleft lip and palate: Causes and risk factors
The exact causes for the development of one of the forms of cleft lip and palate have not yet been conclusively clarified. In addition to genetic causes and syndromes based on defective genetic material, doctors are aware of other factors that favor cleft lip and palate. This includes the health and behavior of the expectant mother. These include:
- Smoking
- Alcohol consumption
- Drug use
- Folic acid deficiency
- Overdose of vitamins A and E
- stress
- Pre-existing conditions
- Acute illnesses (for example rubella)
- Insufficient supply of oxygen to the embryo
- Radiation exposure
- Fever
- Exposure to toxins
- Taking various medications
Especially in the first weeks and months of pregnancy, the embryo is at risk if it is inadequately cared for or exposed to harmful influences in the mother’s womb. A large number of disorders are triggered by alcohol and smoking. Experts recommend that women who want to have children should limit all behaviors that could endanger the health of a baby.
Symptoms: Cleft lip and palate
Depending on the week of pregnancy in which the developmental disorder of the embryo occurred, different degrees of severity and forms of cleft lip and palate appear in the infant after birth:
- Lip notch: Part of the upper lip has not grown together completely. However, the gap does not extend as far as the nose.
- Cleft lip: The upper lip is not closed between the mouth and nose. The gap runs from the nostril to the red of the lips. Two columns with a lip segment in the middle are also possible.
- Cleft lip and jaw: Here the cleft extends from the upper lip to the upper jaw along the lateral incisor.
- Cleft palate: This malformation can range from a gap in the uvula to complete separation of the palatal parts. The mouth and nose are then connected. The gap can affect only the hard palate, only the soft palate or both palates. In some cases, the mucosa can span the cleft and thus delay the diagnosis.
- Cleft lip and palate: Here, malformations are present in all three areas.
The intensity of the malformations varies from very mild (mild lip notch), which may require no or only cosmetic treatment, to the most severe degrees, which have significant medical and psychological consequences. Fortunately, medicine today is well equipped to meet the challenges of correcting or repairing cleft lips and palates.
Cleft lip and palate: Diagnosis with us
If the lip area is affected by the disease, the malformation will be detected immediately after birth during the routine examination of a newborn. If there is a cleft jaw and/or palate without the lips being affected, only a detailed examination of the oral cavity can reveal the developmental disorder. We also detect cleft lip and palate before birth using ultrasound, but only if the embryo is positioned favorably in the womb during the examination. A diagnosis as part of the prenatal examination is possible from the 20th week of pregnancy at the latest. It enables parents-to-be to find out about the disease and treatment methods before the birth.
The following methods are also used in the examination of cleft lip and palate:
Cleft lip and palate: Prevention, early detection, prognosis
As the causes of cleft lip and palate have not yet been conclusively clarified, women who wish to have children and pregnant women can only prevent it by following as healthy a lifestyle as possible. Doctors recommend taking folic acid: a daily dose of 400µg (micrograms) before pregnancy and 800µg per day during the first trimester (first three months of pregnancy). After the 13th week of pregnancy, it is no longer necessary to take folic acid, as the development of the embryo is complete. Expectant mothers should avoid the following risk factors:
- Alcohol
- Smoking
- Oxygen deficiency
- Vitamin deficiency
- stress
- Overdose of vitamins A and E
- Poor nutrition
Early detection is possible as part of prenatal diagnostics using ultrasound if the embryo is in a favorable position in the womb.
Progression of cleft lip and palate
In the case of an isolated cleft lip without malformations of the jaw and/or palate, the effects are minor and can usually be completely corrected by surgery. However, the use of speech therapy is usually necessary for correct articulation. An isolated cleft palate or a full cleft lip and palate causes various, sometimes severe, symptoms:
- Difficult food intake: food can enter the nasal cavity. Various aids make breastfeeding easier.
- Diseases of the ear, nose and throat: The ventilation of the middle ear may be disturbed. This results in frequent ear infections, effusions, growths, a tendency to inflammation and delayed speech development due to impaired hearing.
- Dental problems: A cleft in the jaw can cause misaligned teeth or gaps. Even if the jaw is only slightly malformed, surgery can cause later malocclusions due to scarring and muscle imbalance.
- Problems with speaking: The nose and mouth as the resonance chamber of the voice are not optimally developed as a result of a cleft lip and palate. As a result, some consonants are articulated and formed in the wrong place and vowels are usually pronounced with too many nasals.
- Psychological challenge: Scars or speech errors can lead to difficult situations for affected children when dealing with other people (e.g. teasing, exclusion, etc.).
Prognosis of cleft lip and palate
State-of-the-art surgical techniques and combined therapy procedures mean that cleft lip and palate can now be treated very well both functionally and aesthetically. Some patients who have not been able to benefit from modern treatment methods due to their advanced age can claim a severe disability. The ability to work is reduced by up to 50 percent. Younger generations benefit from the highest standards of medicine and highly developed accompanying measures such as speech therapy and psychological support. This usually enables a completely normal life. Nevertheless, in order to detect possible deficits – for example in hearing or speech – at an early stage, regular routine examinations are important until the affected children are adults.
Cleft lip and palate: Treatment
Treatment of a cleft lip and palate is ideally carried out by interdisciplinary specialists and therapists. These include:
- Pediatrician and pediatrician
- Oral and maxillofacial surgeon
- Orthodontist and orthodontist
- Dentist and dentist
- Ear, nose and throat doctor
- Speech therapist (speech therapy) and speech therapist
- Psychologist and psychologist
- Style consultant and breastfeeding consultant
- Nutritionist and dietician
There are now treatment centers that specialize in patients with cleft lip and palate. Interdisciplinary cooperation is optimally coordinated there. The aim is to provide comprehensive treatment for the child in the first few years of life so that it does not show any visual abnormalities and can breathe, chew, hear and speak normally by the time it starts school. In the first few days after birth, a palatal plate is made according to the jaw impression to ensure that the baby can drink normally: the plate separates the nose from the mouth and allows the tongue to function healthily as well as allowing undisturbed feeding.