Cleft lip and cleft palate are very common birth defects, effecting one in every 700 live births in the United States each year. A cleft lip results when the "lip edges" do not properly come together. A cleft palate is caused by incomplete fusion of the palate. Both are developmental deformities that occur in the first trimester of life; cleft lip in the sixth or seventh week in utero, and cleft palate in the eight or ninth week in utero. Although the cause is unknown, there appears to be a genetic link, as the probability of a child having cleft lip or palate increases if parents or close relatives have the deformity. Cleft lip and cleft palate occur together in about half the cases, and a quarter of the cases they each occur separately. Cleft lip and cleft palate can cause a child to have difficulty speaking, swallowing, and breathing, suffer from frequent ear infections (otitis media), and cause significant facial and dental deformity. Cleft lip and palate are also linked with disorders of the head and neck, extremities, genitalia, or heart in about 20 % of the cases. Cleft palate is associated with Down’s syndrome and other genetic disorders.
Cleft lip is usually surgically repaired in the first few months of a child’s life. Cleft palate usually later, from about six months to a year. Infants with a mild case of cleft lip will usually have no problems with feeding, while those with more severe clefts, especially involving the palate, will often have more difficulty. If there is difficulty swallowing, the infant’s palate can be temporary closed off with a device called an oral obturator. The dentist makes the obturator to block the opening in the palate and allow improved eating and swallowing prior to corrective surgery.
As a resident at Mount Sinai Medical Center in New York, I had the opportunity to work with a cleft palate team. The cleft palate team consisted of dentists, including general, orthodontists and oral surgeons, social workers, speech pathologists, ear, nose and throat (ENT) physicians, and plastic surgeons. Each member of the team concentrated on a different problem. The oral surgeons, ENTs, or plastic surgeons would surgically correct the cleft lip or palate. The plastic surgeon would help remove disfiguring scars and improve the shape and contour of the face damaged by the clefts. Later, the general dentists would help to repair or replace missing or damaged teeth often found in cleft patients, and the orthodontists would assess the need for braces as the child matures. The speech pathologist helps the child develop a normal speaking voice, and tries to eliminate the nasal sound of some cleft patients. Last and certainly not least, the social worker deals with the emotional impact borne by the child and the family.
During my residency, I recall one occasion where I assisted our chief of oral surgery and an older surgeon who was both a general and oral surgeon, in a cleft palate case. My chief asked the older surgeon what method he would use to stitch the palate, as he had always found it difficult. To our amazement, the older surgeon said that it’s much better to stitch the soft palate inside out. Later, my chief and I asked, "What about packing the sides of the surgical area?" "It’s not necessary", said the older surgeon confidently. That evening, and for the following week, we rounded on our patient and were impressed at how well the palate was healing. It was a great learning experience for me, and my chief!
Cleft lip and cleft palate are unfortunately a fairly common congenital disorder. Modern dental and medical team treatment can greatly reduce the physical and emotional scars associated with it.