Cleft Lip and Cleft Palate

Cleft lip and cleft palate are congenital abnormalities that are closely related genetically, embryologically, and functionally. A cleft lip is an abnormality of the upper lip from skin to bone, unilateral or bilateral. Folic acid and Vitamin B6 supplementation have lowered the incidence of cleft lip, cleft palate, and neural tube defects.

CAUSES

  • Maternal drug exposure (methotrexate, isotretinoin, alcohol, smoking during pregnancy, and some of the anticonvulsants mainly phenytoin) and genetic factors.
  • Cleft lip, palate, or both are inherited in some families as autosomal dominant.

SIGNS & SYMPTOMS

  • Cleft lip is obvious at birth but cleft palate can be missed if the newborn is not thoroughly examined.
  • Cleft lip is about 30 times more common than cleft palate.
  • Cleft lip is more common in boys, and is found more in Asians, and least in Blacks.

TREATMENT

  • Requires a multidisciplinary approach by a team of plastic surgeon, pediatric dentist, prosthodontist, orthodontist, geneticist, otolaryngologist, speech therapist, social worker, and pediatrician.
  • The immediate problem is feeding and plastic obturators are a great help.
  • Recurrent otitis media is common and may lead to hearing loss.
  • Surgical repair of cleft lip and palate should be individualized.
  • Cleft lips are mostly corrected by 3 months of age. Cleft palates are often corrected surgically by 1 year of age.