Cleft lip (cleft lip), cleft cheilognato, cleft palate, cleft lip and palate

The cleft lip or cheiloschisis  (commonly referred to as “cleft lip” or also as or “lupine throat”) is a congenital malformation due to the non-union of the two portions of the   upper lip of the newborn.

When both the upper lip and the gum are affected (but not the palate) it is referred to as  cheilognatoschisis .

Cleft palate is instead a congenital malformation of the palate  it is a cleft that exclusively involves the palate and which manifests itself as a fissure in the anterior part of the hard palate.

When a cleft lip/cleft lip accompanies a cleft palate, it results in a  cleft lip and palate (LPS) .

They are facial and oral malformations that appear in the early stages of pregnancy, during the development of the newborn inside the mother’s uterus.

These are conditions that are due to the fact that sometimes in the area of ​​the child’s mouth or lip there is not enough tissue, and the two parts are unable to join as they should, leaving a fissure (a cleft in fact) .

Isolated orofacial clefts, ie unaccompanied by any other problems, are among the most common birth defects . One in every 800 children has a cleft lip. In one third of cases, these malformations are bilateral.

According to statistics, malformations are clearly hereditary in only 25% of cases. While the environmental factors that determine them, especially during the first three months of pregnancy, are exposure to radiation, uncontrolled intake of drugs, advanced maternal age, alcohol, smoking.

How the cleft lip forms

The baby’s lips are formed between  the fourth  and seventh week of pregnancy . As  the infant develops , tissues and specific cells on both sides of its head grow towards each other, eventually rejoining in the center to form the face, and with it, facial elements such as lips and mouth .

Cleft lip, as we said, occurs when the tissue that makes up the lip doesn’t fully unite before birth, resulting in an opening in the upper lip. This opening can be a small slit or a large opening from the upper lip to the nose.

The cleft lip can occur on one or more sides of the lip; or in the center, which happens very rarely.

Children with cleft lip may also have cleft palate (hence a cleft lip and palate (LPS).

How cleft palate is formed

The roof of the mouth (the palate) forms between the sixth and  ninth  week of pregnancy. Cleft palate occurs when the tissue that forms the palate doesn’t fully join together leaving an opening. For some children, it affects both the front and back of the palate, while for others, only part of the palate.

Possible related problems

Children with cleft lip, cleft palate, or both (cleft lip and palate) often have trouble eating and speaking clearly. They can also get ear infections. They may also have hearing problems, and dental problems( 3 ).

Causes and risk factors

The causes of orofacial clefts in newborns are unknown. Some children have these problems due to genetic mutations.

However, cleft lip and palate are thought to be caused by a combination of genetic factors and environmental factors, such as substances the mother comes into contact with, what she eats, or certain medicines she takes during pregnancy.

Recently, the institution “ Centers for Disease Control and Prevention ” has announced the important discoveries deriving from some studies on some risk factors that increase the probability of having a child with orofacial clefts. These are.

  • smoking  — pregnant women who smoke are more likely to have a cleft baby than those who don’t smoke 
  • diabetes  – compared to women who do not have diabetes, women with diabetes diagnosed before pregnancy have a higher risk of having a baby with a cleft lip with or without a cleft palate; 
  • the use of certain medicines  – women who   take certain medicines to treat epilepsy, such as topiramate or valproic acid, during the first trimester of pregnancy are at a higher risk of having an child with cleft lip with or without cleft palate. 

So, if you’re pregnant or planning to become pregnant, talk to your doctor about the best ways to increase your chances of having a healthy baby.

their diagnoses

Orofacial clefts, especially cleft lip (with or without cleft palate), are diagnosed during routine ultrasonography.

They can also be diagnosed after birth, especially cleft palate.

However, sometimes some types of cleft palate (for example, submucosal cleft palate and bifid uvula) may not be diagnosed until later in life

Management and treatments of orofacial clefts

Treatments for children with orofacial clefts may vary depending on the severity of the condition, age and needs, the presence of associated syndromes, other birth defects, or both.

As for the cleft lip, surgery is usually used during the first months of life and it is recommended to perform the surgery within the first 12 months.

As far as cleft palate is concerned, surgery is usually recommended within 18 months or, if possible, even earlier. 

Many children require further interventions later in their lives. Surgical repair can improve the appearance of your child’s face and also improve their breathing, hearing and speech development.

Children born with orofacial clefts may need other types of treatment, such as special dental or dental care and speech therapy. 

Thanks to these treatments, most children with orofacial clefts lead normal lives.

Some children, if they realize the differences between themselves and other children, may have self-esteem problems.

These problems, which must be evaluated during growth and until reaching adulthood, must be faced and resolved by the various specialists in constant collaboration with the other subjects interested in the problem. 

Katherine Johnson, M.D., is a board-certified obstetrician-gynecologist with clinical expertise in general obstetrics and gynecology, family planning, women’s health, and gynecology.

She is affiliated with the Obstetrics and Gynecology division at an undisclosed healthcare institution and the online platform, Maternicity.com.

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