Cleft lip and cleft palate are among the most common birth defects, affecting about 0.5% of the total birth in Indonesia or predicted at 7000 new cases found each year. A cleft is an opening or a split in the upper lip, the roof of the mouth (palate) or both
Cleft lip can affect one or both sides of the upper lip. Cleft lip and cleft palate commonly occur as isolated birth defects, but cleft lip and cleft palate also are associated with many genetic conditions.
Symptoms
A cleft in the lip or palate is usually identifiable at birth. Clefts can appear as a small notch in the lip or can extend from the lip through the upper gum and palate.
Less commonly is a condition of what we called a sub mucous cleft. This type of cleft occurs only in the muscles of the soft palate, which is at the back of the mouth and covered by the mouth’s lining. Because it’s hidden, this type of cleft may not be diagnosed until later.
Causes
The exact cause is unknown. Cleft lips and cleft palates are congenital defects that occur early in embryonic development. Scientists believe a combination of genetic and environmental factors, such as maternal illness, the use of certain drugs or nutritional deficiencies in the mother (particularly a lack of folic acid), may lead to a cleft lip or cleft palate.
Complications
Children with cleft lip with or without cleft palate face a variety of challenges related to their defect, depending on the type and severity of the cleft:
- Feeding. One of the most immediate concerns after the birth of an infant with cleft lip and cleft palate is feeding, which can be difficult due to inadequate suction, lack of an air-tight latch or nasal regurgitation.
- Ear infections and hearing loss. Babies with cleft palate are especially susceptible to repeated middle ear infections, which over time can permanently damage hearing.
- Dental care and tooth development. If the cleft extends through the upper gum, tooth development will likely be affected.
- Speech and language. Because both the lip and palate are used in forming sounds, the development of normal speech can be affected.
- Psychological challenges. Children with clefts are more likely to have social, emotional and behavioral problems due to differences in appearance and family stress.
Treatments
Ideal treatment involves surgery to repair the defect and therapies to improve any related conditions.
The perfect timing for cleft lip repair is around 3 months old of age :
- the child is about 5 kilograms (10 pounds) or more in body weight,
- fully 10 weeks in age or more,
- physically healthy and normal blood test result.
For surgical intervention in cleft palate, the best age period is between 1-2 year old that is when the child is just learning to speak. It is hoped that if intervention is taken place at this stage, it will allow the child to resemble the voice of those without the clefts (normal child).