Cleft Palate: Information on Causes, Diagnosis & Treatments

Cleft Palate Overview

Split Open Palate A cleft palate is a split or opening that occurs in the roof of the mouth and/or upper lip that causes an abnormal facial structure. The defect forms during the development stage when the fetuses told the wound. A cleft palate is one of the most common birth defects that is often an isolated defect. However, it is associated with numerous inherited genetic syndromes and conditions.

Many parents are upset when their child is born with the cleft palate. Fortunately, doctors have developed effective corrective surgical procedures that restore normal function and appearance with only minimal scarring.

What Causes a Cleft Palate?

Doctors. have not yet determined the exact cause of all cleft palate defects. Because of that, there is no known way to prevent the defect from occurring. Many scientists and research documents list of possible cause of cleft palate defects as a combination of environmental factors and genetic predisposition. This is because statistics show that newborns with the parent, relative or sibling born with a cleft palate have a greater chance of developing one.

Medications taken by the mother while she was pregnant might also cause a cleft palate. Some drugs including anticonvulsant and anti-seizure medications, used for treating psoriasis, arthritis and cancer and medications containing Accutane to treat acne are thought to increase the potential risk of the baby developing a cleft palate.

Some scientists believe that a fetus exposed to chemicals or viruses while maturing can be at risk of developing a cleft palate compared to babies who were not exposed to these hazards. Other cases of cleft palate may be associated with another medical condition.

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Who Is at Risk for a Cleft Palate?

The CDC (Centers for Disease Control and Prevention) estimates that more than 2600 newborns in the United States are born with a cleft palate every year. Isolated orofacial cleft defects where children are born without any other major birth defect continues to be the most common form of birth defect in America.

Children born to diabetic mothers or mothers who smoke are at a greater risk of being born with an orofacial cleft defect compared to a child born to a mother without these risk factors. Additionally, children born to mothers who are taking certain medications to treat epilepsy during their first trimester of pregnancy have an increased potential of developing a cleft palate.

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Common Symptoms

Typically, the obstetrician or doctor delivering the baby can immediately identify the cleft palate at birth. This is because the defect usually appears as a split in the roof of the mouth or across the lip that will affect one or both sides of the child's face. However, the defect can also appear as a split in the lip that might or might not extend to the upper gum and out to the palate at the base of the nose or as a defect where there is a split in the roof of the mouth that does not appear on the face.

Less common defects will create a cleft in the soft palate muscles at the back of the mouth. This defect is often undetectable at birth and is usually diagnosed later in life as the child grows older. Common symptoms associated with a sub mucous cleft palate involve:

  • Difficulty with feeding

  • Difficulty in swallowing where food or liquids run or drip from the nose

  • Chronic ear infections and/or hearing loss

  • Speaking in a nasal voice

  • Dental problems as the teeth begin to grow

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Diagnosing a Cleft Palate

Nearly all cleft palate defects are noticed immediately at birth by the delivery team at the hospital. Most defects are obvious and do not require any special testing or procedures to diagnose the condition. Some cleft palate defects are first identified during ultrasound procedures while the baby is still within the wound.

A prenatal ultrasound using sound waves can generate moving images of a developing fetus that can help the doctor identify any abnormality in the child’s facial structures. Usually, a cleft palate defect with a cleft lip defect is easier to identify than a cleft palate that develops inside the mouth without any abnormality seen on the child’s face.

If a prenatal ultrasound identifies a cleft palate, the doctor often recommends an amniocentesis procedure where a sample of amniotic fluid is obtained from the uterus. The fluid test can help identify if an inherited genetic syndrome is the cause of the baby’s birth defects. That said, most causes of a cleft palate are yet unknown. However, there are other birth defects that are known to be associated with the cleft palate. Some of these include:

  • Scoliosis

  • Clubfoot

  • Pyloric stenosis where the stomach narrows where it connects to the body’s small intestine

  • Cardiac Defects

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Cleft Palate Treatment

Successfully treating a cleft, requires patience. This is because it often takes multiples to produce a desirable outcome. Parents often become impatient because of the difficulty with feeding their child or dealing with constant ear infections associated with the condition.

A complete repair of a cleft palate is a multistep nonsense that usually begins within the first twelve months of the child’s life and ends later into their teen years. Usually, the doctor will begin to repair the part of the defect in the palate that allows better feeding to establish normal weight gain, reduced recurrent your infections and minimize hearing loss associated with the defective condition.

Preparing certain portions of the defect at certain stages of development help to ensure that the maxilla (upper jaw) develops normally with the other facial bones. When the child is reaching their eighth year of age, the surgeon can perform a bone graft to provide additional support to the maxilla (upper jaw) structure. This procedure helps aid the child in articulating speech. At some point, the doctor will likely recommend braces to straighten the child’s permanent teeth and encourage the parents to agree to plastic surgical scar revision to remove scar tissue that has developed as the child has grown into adolescence.

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Cleft Palate Repair Prognosis

The prognosis of repairing a cleft palate is usually a good one. With patience and multiple surgical procedures followed by ongoing consultations with multiple medical specialists and effective speech therapy, the family can anticipate a successful outcome on the function of the child’s mouth and their physical appearance. Usually, a cleft palate repair team will approach treatment and follow-up support with an appropriate level of care. The medical team that assists with the repair involves:

  • Plastic surgeon

  • Oral surgeon

  • Otolaryngologist (ear, nose and throat doctor)

  • Dentist

  • Orthodontist

  • Prosthodontist who makes and fits dental appliances

  • Geneticist

  • Hearing specialist (audiologist)

  • Speech pathologist

  • Speech therapist

  • Social worker

  • Psychologist

  • Nurse Coordinator

It is a natural feeling the parents will be upset when they find their baby is born with the cleft palate and/or cleft lip. However, the anxiety, concern, and grief will eventually diminished when the specialists and support care team provides answers and assistance in helping the child developed normally tillable long and healthy life.

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Sources:

https://my.clevelandclinic.org/health/articles/cleft-lip-and-palate

http://www.mayoclinic.org/diseases-conditions/cleft-palate/basics/definition/con-20024619

https://www.cdc.gov/ncbddd/birthdefects/features/craniofacialdefects.html

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