Cleft Lip and palate, a condition of congenital abnormality that is characterized by a gap or cleft

Cleft lip is a condition of congenital abnormality that is characterized by a gap or cleft in the upper lip. The gap can be found in the middle, right, or the left side of the lips. In addition to the upper lip, the cleft can also occur on the palate. This condition is commonly called a cleft palate.

Cleft lip and cleft palate occur because the tissue on the baby's lips or on the roof of the baby's mouth when in the womb is not fused, thus leaving a gap. Normally the unification process occurs in the second and third months of pregnancy.

Causes of Cleft Lip

Until now it is not certain what causes the cleft lip and cleft palate. But experts believe that this condition occurs due to a combination of genetic and environmental factors.

Some of the following factors might increase the risk of a partner having a baby who is born with a cleft palate. Among others are:

Genetic. Babies born to parents with cleft lip and cleft palate conditions or have relatives with this condition are more at risk of experiencing the same condition.

Gender. A baby boy is twice as likely to experience this birth defect as a baby girl. In baby boys, the condition of cleft lip can occur with or without a cleft palate. While the cleft palate without a cleft lip is more common in baby girls.

Diabetes. There is some evidence that women diagnosed with diabetes before pregnancy are at high risk of having a baby with a cleft lip.

Obesity during pregnancy. Babies of obese mothers are at risk of being born with a cleft lip or cleft palate.

Exposure to certain substances during pregnancy. Mothers who smoke and consume alcohol during pregnancy are at risk of giving birth to a baby with a cleft lip and cleft palate condition. In addition, consumption of corticosteroid tablets and anti-seizure drugs in early pregnancy is also associated with several cases of cleft lip.

Folic acid deficiency during pregnancy.

In some cases, cleft lip is part of conditions that can also cause birth defects, such as DiGeorge syndrome, Pierre Robin syndrome, and Van der Woude's syndrome.

Cleft Lip Symptoms

Generally, the cleft lip and cleft palate can be directly visible when the baby is born, characterized by:

There is a gap in the upper lip or palate which can affect one or both sides of the face.

There is a gap in the lips that can look like a small tear or a tear extending from the lips to the upper gum and palate to the bottom of the nose.

A cleft in the palate that does not affect the appearance of the face.

Children with cleft palate tend to have more frequent ear infections and accumulation of fluid in the ear. This is because the muscles in the palate are connected to the middle ear. If the muscles do not function properly, fluid will collect in the ear and can cause hearing loss. It is important to do a doctor's examination to monitor the child's hearing regularly.

There is also a rare type of cleft, the submucosal cleft. This cleft is only found in the soft palate and covered with the lining of the mouth. This type of cleft is not visible at birth and cannot be diagnosed until the signs appear, such as:

1. Difficulty accepting food intake.
2. Difficulty swallowing food (food and drinks consumed can come out of the nose).
3. Chronic ear infection.
4. Nasal voice.

Cleft Lip Diagnosis

Cleft lip can be identified through an ultrasound examination of pregnancy at week 18 to week 21 of pregnancy. If not detected by the examination, the cleft lip will be seen immediately after the baby is born or through physical examination in the first 72 hours since the baby is born.

Cleft Lip Treatment

Cleft lip can be treated surgically. The purpose of cleft lip surgery is to improve the child's ability to eat and drink, can talk and hear normally, and has a normal facial appearance. In general, surgical procedures performed include:

Cleft lip surgery. To close the gap in the lips, the doctor will make incisions on both sides of the gap and make folds of tissue which are then put together by stitching. This operation will make the appearance and function of the lips for the better. The right time for cleft lip surgery varies, depending on the child's body condition, body weight, and age of the child. Cleft lip surgery is usually done when the child is 10 weeks - 1 year. If necessary, surgery on the nose is also done at the same time.

Cleft palate surgery. The operation may be done several times to close the gap and repair the palate, both the soft and hard part. The doctor will make incisions on both sides of the gap and rearrange the position of the tissues and muscles of the palate, then sewn them together. Cleft palate surgery is recommended to be performed at the age of 6-18 months. Then, further operations for cleft palate can be done at the age of 8-12 years. The next operation is to transplant bone to the palate to support the structure of the maxilla and articulation of speech.

Ear tube insertion surgery. For children with cleft palate, ear tubes are installed at the age of 6 months. This action is done to reduce the risk of hearing loss and can be done in conjunction with cleft lip surgery or cleft palate surgery.

Surgery to improve appearance. Additional surgery may be needed to improve the appearance of the mouth, lips and nose. This operation can be done until the age of adolescents before adulthood.

Monitoring and treatment of cleft lip is recommended to continue until the child is 21 years old, when growth has stopped.

Complications of Cleft Lip

Some complications that may be experienced by babies suffering from cleft lip are:

• Hearing disorders. Fluid buildup in the ear and recurrent ear infections are at risk of causing hearing loss.
• Tooth growth problems. If the cleavage extends to the upper gum, baby's tooth growth will be disrupted.
• Difficulty in sucking milk.
• Difficulty in communication. Cleft lip can make the child's voice development disturbed and will sound nasally.

To overcome the complications that occur, additional treatments can be given, including:

• Treatment of ear infections.
• Orthodontic treatment, such as dental braces.
• Speech therapy to improve speech difficulties.
• Hearing aids for children who are hearing loss.
• Use special techniques, special bottles, or other tools to breastfeed children.

A child with a cleft lip may experience problems in his emotions, behavior, and social life because of his different appearance and the stress of undergoing various kinds of medical procedures. Consultation with a psychologist can help children to deal with this situation.

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