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Cleft lip and palate

 

These are congenital malformations which happen when the structures that form the lip and palate fail to fuse together properly, early in the intrauterine life. They result quite often into a disfiguring appearance, which could change the life of the new born and his family dramatically.

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As possible causes (risk factors) of cleft lip and palate one could enumerate:

  • Inherited genes

  • Race

  • Sex – males are twice as likely to have a cleft lip, with or without a cleft palate, whilst cleft palate without a cleft lip is more common in females

  • Smoking and alcohol consumption during pregnancy

  • Lack of folic acid during pregnancy -> all pregnant women should take a daily supplement of folic acid, during the first 4 months of pregnancy. Although it is known the fact that folic acid deficiency during pregnancy increases the risk of a cleft developing, there is no confirmed evidence yet to suggest an intake of higher doses of folic acid prevents clefts.

  • Consanguineous marriages (quite often encountered in several parts of Asia and Africa)

  • Obesity and nutrition

  • Diabetes

  • Some medication during pregnancy

  • A large number of syndromes which include cleft lip and palate (ex. Pierre Robin sequence, Shpryntzen Syndrome – velocardiofacial,Van der Woude, Treacher Collins Francheschetti)

 

The existence of a facial cleft can be detected by the mean of ultrasounds, beginning around the 13th – 14th weeks of pregnancy. The amniocentesis is the test that may indicate that the fetus has inherited a genetic syndrome.

The deformity can affect, complete, incomplete or combined, the lip only, the palate only, the both of them, uni – or bilateral.

 

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The goal of any method of treatment for CLP is to restore the appearance and function of the involved structures (speech, food intake, hearing and aesthetics).

The treatment of CLP is a multidisciplinary one, involving a large number of professionals, such as:

  • Neonatologists

  • Oral and maxilla facial surgeons

  • ENT surgeons

  • Pediatricians

  • Nurses

  • Anesthetists

  • Orthodontists

  • Dentists

  • Psychologists

  • Genetic counselors

  • Social workers

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It is very important that, right after the moment such a deformity is diagnosed, the parents receive proper psychological counseling, to understand the whole process of repair and recovery of function and aesthetics. Each step of treatment should be explained to them in details and no possible complication one should forget to be mentioned.

In some particular cases, with a severely protruded premaxilla, a prosthetic appliance can be made to be worn shortly after the child is born, the purpose being to bring back the premaxilla to its normal position, thus facilitating the cleft closure.

The timing that we use in cleft lip and palate cases is as follows:

  • Lip and alveolus and primary nasal correction –  at the age of 3 month

  • Palate – at the age of 8 – 9 months

  • Other corrective surgeries – from the age of 2 years onward

  • Orthognathic corrections ( jaws surgery ) – from the age of 18 years onward

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For children with cleft palate, ear tubes can be placed, regularly at 6 month of age, to reduce the risk of chronic ear fluid, which can lead to hearing loss or impairment.

The possible complications of surgery include:

  • Bleeding

  • Infection

  • Poor healing

  • Wound disrupture ( dehiscence )

  • Damages to the tooth buds

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In addition to the surgical repair of cleft lip and palate, one should consider:

  • Feeding strategy ( the use of a special bottle nipple or feeder)

  •  Speech therapy

  • Orthodontic treatment

  • Monitoring by dentist

  • ENT follow up

  • Therapy with a psychologist to help the child cope with the idea of having a disfiguring deformity and the stress of repeated surgeries

 

Doctor Paraschivescu’s great experience in the field of cleft lip and palate management will help the parents with children suffering from cleft lip and palate gain confidence and have hope. He examined and operated almost 1000 cleft cases in India, Niger and Romania, thus gaining the proper expertise that give the people in need the chance to a normal life. We cannot fight against prejudice, as a mass phenomenon, all we can do is to help each individual to get his right to dignity and aim high in life. The most difficult and complex cases will be discussed with some of the best cleft surgeons in the world, like Prof. Dr. Dr. Med. Dr. H.c. mult. Hermann Sailer,Ph.D, Prof. Dr. Dr. Med. Gosla Reddy, Ph.D, or Prof. Dr. Dr. Med. Stefaan Berge, Ph.D.

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The parents and other members of the family are encouraged to support the child in all possible ways, such as:

  • Focus on their child as a person, and not as a malformed child

  • They should help the child gain confidence

  • The lines of communication should always be open, so that the child can talk all his problems out.

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