Cleft Lip and Palate
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The Anatomy of an Unfinished Masterpiece
It's typical to view a cleft condition as something that "went wrong."
However, it's more accurate to view it as something "unfinished."
A cleft results from incomplete joining (fusion) of some embryo body
areas very early in a baby's development. This failure to fuse
typically occurs during the sixth to 11th week of pregnancy.
After a couple of windows of opportunity, those particular
sections of the body have no further chance to fuse. The body
moves on to other development and the area of unfinished fusion
becomes the basis for a cleft.
Statistics reassure us that having a child with a cleft does not mean
you'll have other children with the same condition. In fact, your
chances only increase by 2 to 5 percent compared to couples
with no cleft-affected kids. Variations in the programmed information
packets (genes) that determine a baby's development enable
clefts to occur in either gender and any race. It tends to affect boys more often than girls, and is slightly more common in some races as compared to others. While cleft lip/palate conditions occur alone, we also see them as a subset of other craniofacial (cranio=head/skull; facial=face) syndromes and conditions.
Studies point to external and/or controllable factors that might contribute to the risk of having a child with this condition. Mothers between the ages of 19 and 35 statistically have a lower incidence of conceiving a baby with a cleft, as do moms who practice preventive measures such as taking supplemental folic acid, and eating a healthy diet with adequate vitamins and minerals. Women can take steps to reduce risk by avoiding environmental factors that may contribute to the likelihood of conceiving a baby with a cleft, including: pesticides, cigarettes, lead, and all varieties of drugs (prescription drugs, over-the-counter medications, illegal drugs, anti-convulsant medications, alcohol and any form of nicotine).
You can determine your approximate risk of conceiving a child with a cleft condition by obtaining genetic counseling prior to conception. Genetic counselors are highly educated in understanding how your health and family medical history relate to having a baby with a cleft. It is becoming the norm, rather than the exception, for cleft palate treatment team referral to occur during pregnancy following ultrasound diagnosis, rather than after the child's birth.
Minimizes facial distortion
Controls palate segments while awaiting palate closure
Prevents abnormal tongue placement habit
Naso-Alveolar Molding Device
Encourages more normal feeding patterns
Reduces air swallowing during feeding
Allows nasal breathing
Decreases lip and nose malformation
Involves family: direct contribution to baby's daily care
Ear and Nasal Repair
Best if greater than 10lbs, 10 weeks, and/or 10mg/dl hemoglobin
Natural-looking closure is top priority
Muscle reconstruction is essential
Nose catilage reshaping stabilizes lip/nose during growlh
Thorough pre-consideration of scar tissue's natural pull
Provides ear ventilation, prevents chronic fluid build-up, infection
9 – 12 months
Repair timed to ensure functional palate by time of speech
Early closure critical to promote best speech development
Prepare for healing process contraction to pull upper jaw back
Single stage closure of hard and soft palate
Preschool to 5 – 7 years
Palatal expander gently shapes/widens upper jaw arch
Creates space for 6-year molars
Setup for bone grafting
Articulation, speech, breathing, and tongue habits learned
Must correct any hearing loss to ensure normal speech/learning progress
Bone Graft(s) at Cleft Site(s)
Fills in the cleft area of dental ridge so incoming incisors anchor well; also creates normal maxillary arch shape and width
Serves as "mortar" between palatal segments
Ensures proper alignment of incoming permanent teeth within arch
Closes any remaining holes in the palatal lining or in the nasal floor
Improves oral/nasal hygiene
May Extract Malformed/Extra Teeth May Bracket/Move Rotated Teeth
7 – 12 years
Rapid growth period: intervention can ellectively influence and assist normal development
12 years to Final Growth
Lip, Nose, Scar Surgery (if needed)
Facial shape may have changed significantly throughout childhood; refinement creates pleasing appearance and improves function (breathing, speaking, eating)
Continue/Complete Orthodontics, Jaw Surgery (required 20%-30% of the time)
When body growth stops, jaw reaches full growth; surgery holds