by Daniel Yu, PGY-2
July is Craniofacial Awareness Month: Oral-facial clefts are birth defects involving the lip or the roof the mouth (known as the palate) or both. Oral-facial clefts occur in approximately 1 in 600 live births in the United States A cleft lip is a gap in the upper lip, usually below the nose. A cleft palate is a gap in the in the roof of the mouth or in the soft tissue at the back of the mouth. A cleft lip and cleft palate occur together approximately two-thirds of the time.
The incidences of these birth defects vary among different ethnic backgrounds and vary between the sexes. Oral-facial clefts are more common in Native American and Asian populations, and less common in people of African descent. Males are more likely to have a cleft lip with or without a cleft palate. Females are more likely to have a cleft palate alone.
Around the 5th week of a baby’s development, the middle lip fails to connect with the side portion of the lip resulting in a cleft lip. Between the 5th and 12th week of a baby’s development, an error in the development of the palate results in a cleft palate. The exact cause of cleft lips and palates is unknown, and they can be a result of a combination of genetic and environmental factors.
The presence of other birth defects or a family history of oral-facial clefts can increase the chance a child is born with a cleft lip and/or palate. Certain medications taken during pregnancy (antiseizure drugs, thalidomide, or retinoic acid), smoking and consuming alcohol during a pregnancy, low folic acid during a baby’s development, and maternal diabetes increases the risk for oral-facial clefts.
Between the 18th and 24th week of a baby’s development, a screening ultrasound can detect cleft lips without or without cleft palate approximately 30% of the time. On study in the Netherlands published in 2011, cleft lip with or without palate was detected in a prenatal ultrasound 88% of the time (2).
While not life threatening, people with cleft lips and/or cleft palates may experience problems with feeding, speaking, hearing, and social integration. Thus, a craniofacial team that can include a pediatrician, plastic surgeon, otolaryngologist (ENT), geneticist, dentist or orthodontist, speech-language pathologist, child psychologist, audiologist, and nutritionist, can provide care for these individuals until their young adulthood.
Cleft lips and cleft palates can be surgically corrected. Cleft lips are usually repaired around 3 to 6 months of age. Cleft palates are generally repaired around 9 and 12 months of age. Individuals with oral-facial clefts may require additional surgeries to prevent recurrent ear infections, improve speech, correct teeth abnormalities, and improve their facial appearance.
Pregnant women can reduce the risk of having children with oral-facial clefts by consuming 400 micrograms of folic acid everyday before becoming pregnant.
While cleft lips and cleft palates may be evident at birth, they are not uncommon and are not anyone’s fault. These children with clefts can grow up to have happy, productive, and normal lives. Craniofacial teams, such as the one at Harbor-UCLA led by pediatrician Dr. Carol Berkowitz, are always available to help meet these patients’ and their families’ needs.
For more information:
FACES: The National Craniofacial Association (http://www.faces-cranio.org)
The Cleft Palate Foundation (http://www.cleftline.org/)
Children’s Craniofacial Association (http://www.ccakids.com)
Cleft Lip and Palate Association (http://www.clapa.com)