Cleft lip or cleft palate is a congenital disorder characterized by a cleft lip. The cleft can appear in the middle, right, or left side of the lip. Cleft lip is often accompanied by the appearance of a gap in the roof of the mouth called a cleft palate.

The process of formation of fetal lip tissue normally occurs in the first trimester of pregnancy. However, in babies with cleft lips, this process does not occur completely so that a gap forms on one or both sides of the lip. In addition, babies with cleft lips can also have other genetic disorders .

Causes of Cleft Lip

Cleft lip occurs when the tissues that make up the lips of a fetus don't fuse properly. The cause is not known with certainty, but is thought to be related to a combination of genetic and environmental factors.

Mothers with a family history of cleft lip are more at risk of giving birth to babies with cleft lip . Other conditions that can increase the risk of a mother giving birth to a baby with a cleft lip are:

  • Exposure to cigarette smoke during pregnancy, both as active and passive smokers
  • Consuming alcoholic beverages while pregnant
  • Experiencing obesity during pregnancy
  • Had diabetes before getting pregnant
  • Having folic acid deficiency during pregnancy
  • Taking certain drugs, such as topiramate, valproic acid , corticosteroids, retinoids , and methotrexate , during pregnancy

In some cases, cleft lip is a symptom of other inherited disorders, such as DiGeorge syndrome , Moebius syndrome, Pierre Robin syndrome, Van der Woude syndrome, or Treacher Collins syndrome .

Cleft Lip Symptoms

Lip formation occurs at 4-7 weeks of gestation, while the palate will form between the 6th and 9th weeks. Disruption of this process can lead to the formation of clefts in the lips or roof of the mouth.

Common signs that appear on the cleft lip are:

  • A cleft on the upper lip or on the roof of the mouth that can occur on one side or both sides
  • A gap that looks like a small tear from the lip to the upper gums and roof of the mouth to the bottom of the nose
  • Changes in the shape of the nose due to gaps that form in the lips or roof of the mouth
  • Impaired tooth growth or irregular arrangement of teeth

In addition, there is a rare type of cleft, namely a submucosal cleft. This cleft is characterized by the appearance of a gap in the soft palate and covered by the lining of the mouth.

Common symptoms of submucosal clefts are:

  • Difficulty breastfeeding and eating
  • Difficulty swallowing, even food and drink can come back out of the nose
  • Speak in a nasal or muffled voice
  • Chronic ear infection

When to see a doctor

Pregnant women are encouraged to routinely undergo pregnancy checks according to the schedule determined by the doctor. It is important to monitor the development of the fetus and the condition of the mother as a whole.

Cleft lip will usually be detected when the baby is born. If your baby is suspected of having a cleft lip, follow the advice and therapy given by the doctor , and carry out routine controls.

Cleft Lip Diagnosis

Cleft lip can be detected when the baby is born until 72 hours later. If the baby is suspected of having a cleft lip, the doctor will ask and answer questions with the mother about the health history of the mother and her family, as well as the drugs or supplements taken during pregnancy, followed by a physical examination.

Cleft lip can also be detected during pregnancy tests. Ultrasound examination of pregnancy performed at week 18 to week 21 can usually show abnormalities in the fetal facial area.

If the fetus is suspected of having abnormalities on the face and lips, the doctor will advise pregnant women to undergo an amniocentesis procedure . This test is done by taking a sample of amniotic fluid to determine whether the baby also has a genetic disorder that can cause cleft lip.

Cleft Lip Treatment

The goal of cleft lip treatment is to improve the ability to eat and drink, speak and hear, and improve the child's facial appearance. The handling method can be in the form of surgery which is carried out in stages. Here is the explanation:

Preparation before surgery

Before cleft lip surgery is performed, the doctor will install special tools in the child's lips, mouth or nose, to improve the results of cleft lip repair. Some of these tools include:

  • Lip-taping regimen , which is a tool used to unite or narrow two clefts on the lips
  • Nasal elevator , which is a tool used so that the gap does not widen to the nose and helps shape the baby's nose
  • Nasal-alveolar molding (NAM), which is a tool that functions to help shape lip tissue before surgery

Operation stage

Cleft lip surgery is divided into two stages. The first stage aims to repair the cleft lip and close the cleft lip. Surgery is generally performed when the baby is between 3-6 months old.

In the first stage of surgery, the doctor will make incisions on both sides of the gap and fold the tissue which is then put together by stitches.

After that, the doctor will perform a second stage of surgery on the cleft palate. The purpose of this surgery is to close the gap and repair the roof of the mouth, prevent fluid buildup in the middle ear, and help the development of the teeth and facial bones.

In the second stage of surgery, the doctor will make incisions on both sides of the gap and reposition the tissues and muscles of the roof of the mouth, then sutures. Cleft palate surgery can be performed when the baby is 6–18 months old.

After that, follow-up surgery for cleft palate can be done when the child is 8-12 years old. Follow-up surgery is performed with bone grafting for the palate, to support the maxillary structure and speech articulation.

In children with cleft lip who also have problems in the ear, the doctor will perform a third operation in the form of inserting an ear tube. This operation can be done when the baby is 6 months old. The goal of this surgery is to prevent fluid buildup in the middle ear.

Next, the doctor will perform additional surgeries to improve the appearance of the mouth, lips, and nose. This operation can be done when the child is in his teens to adulthood.

After all stages of the operation are completed, the doctor will carry out monitoring and treatment, until the child is 21 years old or when growth has stopped.

Additional treatment

Apart from surgery, the doctor will provide additional therapy or treatment, the type of which will be adjusted to the patient's condition. Treatment methods that can be given are:

  • Treatment for ear infections, including monitoring of the eardrum and inner ear canal
  • Orthodontic treatment, such as installing braces
  • Speech therapy, to improve speech difficulties
  • Installation of hearing aids , for children with hearing loss
  • Training how to feed or use special cutlery
  • Therapy with a psychologist, to help children who experience stress due to undergoing various medical procedures on a regular basis

Cleft Lip Complications

Children who have cleft lips if not treated immediately can experience a number of complications, such as:

  • Difficulty in breastfeeding, eating and drinking, which results in growth and development disorders
  • Difficulty speaking or communicating
  • Hearing disorders
  • Disorders of teeth growth

Cleft Lip Prevention

Cleft lip is difficult to prevent because the cause is not known for certain. However, to avoid the risk of a child being born with a cleft lip, couples planning a pregnancy can undergo genetic screening first, especially if there is a family history of cleft lip.

In addition, there are several efforts that pregnant women can take to reduce the risk of cleft lip in the fetus, such as:

  • Undergo regular pregnancy checks according to the schedule determined by the doctor
  • Eat a healthy and nutritionally balanced diet
  • Control your weight and keep it ideal
  • Do not smoke and do not consume alcoholic beverages
  • Avoid taking drugs and supplements without a doctor's prescription
  • Be careful in choosing beauty care products
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