Cleft lip and cleft palate

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Cleft lip and cleft palate
Synonyms	Cheiloschisis (cleft lip), Palatoschisis (cleft palate)
Pronounce	N/A
Specialty	N/A
Symptoms	Facial deformity, Feeding difficulties, Speech problems, Ear infections
Complications	Hearing loss, Dental problems, Psychosocial issues
Onset	Congenital
Duration	Lifelong
Types	N/A
Causes	Genetic factors, Environmental factors
Risks	Family history, Maternal smoking, Diabetes, Obesity
Diagnosis	Physical examination, Prenatal ultrasound
Differential diagnosis	Pierre Robin sequence, Van der Woude syndrome
Prevention	Prenatal care, Folic acid supplementation
Treatment	Surgery, Speech therapy, Orthodontics
Medication	Pain management, Antibiotics
Prognosis	Good with treatment
Frequency	1 in 700 births
Deaths	Rare

Cleft lip and cleft palate, collectively termed as orofacial clefts, are congenital deformities that occur when the tissues of the lip and/or the palate of the fetus do not fuse properly during the first trimester of pregnancy. A cleft lip involves a split in the upper lip, which can extend into the nose and can occur on one or both sides or in the middle. A cleft palate is characterized by an opening in the roof of the mouth that can extend into the nasal cavity.<ref>ML,

 The Evolution of Human Genetic Studies of Cleft Lip and Cleft Palate, 
  
  
 2012, 
  
 Volume: 13, 
  
 DOI: 10.1146/annurev-genom-090711-163729, 
  
  
 Pages: 263–283,</ref>

Cleftlipandpalate

Etiology

The exact cause of cleft lip and cleft palate is not known, but both genetic and environmental factors appear to play a role. Family history, maternal smoking, use of certain medications during pregnancy, and nutritional deficiencies have all been associated with an increased risk of these conditions.<ref>Mossey, P,

 Global strategies to reduce the healthcare burden of craniofacial anomalies, 
 British Dental Journal, 
 2003,
 Vol. 195(Issue: 8),
 pp. 613–620,
 DOI: 10.1038/sj.bdj.4810677,</ref>

Clinical Presentation

The physical characteristics of cleft lip and cleft palate are often recognizable at birth. These include a split in the lip and/or an opening in the roof of the mouth. These defects can result in difficulties with feeding, speech problems, hearing impairment, and recurrent ear infections. Psychological and social issues may also arise due to differences in facial appearance.<ref>Section on Pediatric Dentistry,

 Oral Health Risk Assessment Timing and Establishment of the Dental Home, 
  
  
 2003, 
  
 Volume: 111, 
  
 DOI: 10.1542/peds.111.5.1113, 
  
  
 Pages: 1113–1116,</ref>

Diagnosis

The diagnosis of cleft lip and/or cleft palate is usually made at birth through physical examination. In some cases, prenatal ultrasound can detect these conditions in the fetus. After birth, further tests may be conducted to assess the extent of the condition and its impact on the child's health.<ref>RCA,

 Detection of fetal cleft lip and jaw on routine ultrasound examination, 
  
  
 1986, 
  
 Volume: 155, 
  
 DOI: 10.1016/0002-9378(86)90343-2, 
  
  
 Pages: 526–529,</ref>

Treatment

Treatment for cleft lip and cleft palate often involves a multidisciplinary team of professionals, including plastic surgeons, dental specialists, speech therapists, audiologists, and psychologists. The primary treatment is surgical repair, which is typically carried out within the first few months of life for a cleft lip and before the child's second birthday for a cleft palate.<ref>,

 Parameters for Evaluation and Treatment of Patients with Cleft Lip/Palate or Other Craniofacial Anomalies, 
  
 American Cleft Palate-Craniofacial Association, 
 1993,</ref> Additional surgeries may be required later in life to improve speech or appearance.

Feeding Management

Babies with cleft lip and/or cleft palate often have difficulty feeding due to the opening between the mouth and the nasal cavity. Special feeding techniques and devices, such as squeezable bottles and specially designed nipples, can help ensure that the child receives adequate nutrition.<ref>J,

 A Review of Feeding Interventions for Infants With Cleft Palate, 
  
  
 2011, 
  
 Volume: 48, 
  
 DOI: 10.1597/09-113, 
  
  
 Pages: 567–576,</ref>

Speech Therapy

Because of the structural abnormalities in the mouth and palate, children with cleft lip and/or cleft palate often have speech difficulties. Speech therapy is usually necessary to assist with language development and articulation.<ref>KL,

 Speech and language development in infants with cleft palate, 
  
  
 2011, 
  
 Volume: 48, 
  
 DOI: 10.1597/09-115, 
  
  
 Pages: 173–183,</ref>

Hearing Management

Children with cleft palate are at increased risk of otitis media, a middle ear infection, which can lead to hearing loss. Regular hearing evaluations and appropriate interventions, such as the placement of ear tubes, may be necessary.<ref>Paradise, JL,

 Otitis Media and Tympanostomy Tube Insertions Among Children With Cleft Palate, 
 Archives of Otolaryngology–Head & Neck Surgery, 
 2000,
 Vol. 126(Issue: 5),
 pp. 630–634,
 DOI: 10.1001/archotol.126.5.630,</ref>

Prognosis

With appropriate management and care, most individuals with cleft lip and cleft palate lead a normal life. Early surgical intervention and supportive therapies can effectively manage the physical manifestations of the condition. Ongoing support and counseling may be needed to address potential self-esteem and psychological issues related to appearance and social acceptance.<ref>Broder, HL,

 Psychological adjustment in 12-year-old children with orofacial clefts: A case–control study, 
 The Cleft Palate-Craniofacial Journal, 
 1998,
 Vol. 35(Issue: 6),
 pp. 480–485,
 DOI: <0480:PAIYCO>2.3.CO;2 10.1597/1545-1569(1998)035<0480:PAIYCO>2.3.CO;2,</ref>

References

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