Oral-facial cleft is the general term applied to cleft lip and cleft palate birth defects, where the tissues, or lack of, failed to fuse the mouth or lip properly during fetal development. The lip tissue usually joins in the middle and fuses by about 5 to 6 weeks after conception; the palate forms at about 7 weeks.
Oral-facial cleft can appear either as cleft lip without a cleft palate, cleft palate without a cleft lip, or a combination of both the cleft lip and cleft palate. An infant born with a cleft lip has a fissure or elongated opening where the upper lip failed to fuse. This can vary from a small notch at the top of the lip to a complete separation extending to the nose. The lip may be cleft only on one side, or on both sides, and the lower part of the nose is involved. Nasal widening is often associated with cleft lip deformities. In a cleft palate the roof of the baby's mouth has failed to close. The defect may involve the soft palate, the soft tissue in the back of the mouth, or it may extend forward through the front of the mouth, the hard palate, with varying degrees of separation.
All babies with oral-facial clefts should be thoroughly examined by a doctor soon after birth to diagnose, and provide appropriate treatment depending on his or her appraisal of the case. The most immediate problem for a baby born with oral-facial cleft will be feeding. The difficulties in feeding are contributed to milk “backing up” through the nose. Soon after birth, a specially designed prosthesis can be fitted over the palate so that the baby can be fed.
The clef palate and cleft lip will require surgery to be corrected. Normally, a baby with a cleft lip typically has an operation to close the lip at one or two months of age. A cleft palate is closed within the first year of life. The goals of surgery are to make it possible for the child to speak in a normal voice. If the child does not have the operation by three years old, prosthesis may be used to help the child develop intelligible speech. Plastic surgery for cosmetic affect, a nasal operation to narrow the nasal base, and for repair of previous surgery scars can be performed when the child is fully developed.
Complications of oral-facial cleft include recurring ear infections, hearing loss, an excessive number of dental cavities, and displacement of the teeth, which requires orthodontic correction. Some children continue to have speech defects even after surgery because of muscle problems in the palate. Speech therapy may be required for correct pronunciation. The more complicated cases require teamwork between a pediatrician, surgeon, dental specialist, and speech therapist.
The causes of oral-facial cleft are not well understood. Studies suggest that a number of genes, as well as environmental factors, may contribute. Factors that may contribute include drugs, maternal smoking, maternal alcohol, infections, and deficiency vitamins and iron. If parents without oral-facial clefts have a child with a cleft, the chance that another baby will have a cleft is usually about 3 to 5 percent. If one of the parents is affected, the risk for future offspring is greater.
