Cleft lip and palate is one of the most common deformities in Indian children. It is the oral and facial deformity which affects about 7 in 1000 babies each year. It happens in early pregnancy when the fetus is 7 weeks old inside the womb. The affected child has difficulty in eating, breathing, and speaking.
1. What actually is Clefting?
Clefting results when there is not enough tissue in the mouth or lip area, and the tissue available does not join together properly.
A cleft lip is a physical split or separation of the two sides of the upper lip and appears as a narrow opening or gap in the skin of the upper lip. This separation often extends beyond the base of nose and includes the bones of the upper jaw and/or upper gum.
A cleft palate is a split or opening in the roof of the mouth. A cleft palate can involve the hard palate (the front bony portion of the roof of the mouth), and/or the soft palate (the soft back portion of the roof of the mouth).
Cleft lip and cleft palate can occur on one or both sides of the mouth. Because the lip and the palate develop separately, it is possible to have a cleft lip without a cleft palate, a cleft palate without a cleft lip, or both together.
Compared with girls, twice as many boys have a cleft lip, both with and without a cleft palate. However, compared with boys, twice as many girls have cleft palate without a cleft lip.
Factors responsible in development of cleft in pregnant mother in first trimester (first 3 months of pregnancy)-
* Alcohol, cigarette smoking,
* Deficiency of vitamin A and folic acid
* Women above the age of 35 had a doubled risk of having a child with CLCP. Above 39- tripledrisk.
Difficulties associated
1. Feeding, breathing,speech difficulties
2. Nasal Deformity and Esthetic Problems
3. Dental problems :
-Missing teeth or lesser number of teeth
-Early loss of teeth
-Poor support of periodontal tissue around teeth
-Anterior and posterior crossbite
-Constricted upper arch
Possible management:
In 2 -4 weeks baby, lip is surgically closed followed by palate closure at the age of 12-18 months of age. ”Smile train” is the biggest organization which provides free comprehensive cleft care to children in need in 85+ countries around the world and has several centres in India as well.
The organization also trains local doctors to perform surgeries in their own community. In addition to cleft repair surgery,their local medical professionals evaluate whether or not additional nutritional, speech, orthodontic (for treating misaligned dentition), and therapeutic care is needed in the later age of about 7 to 9 years. New smile is created which ensures the confidence in a child and his parents.