The clearly visible deformity is not the only problem that affected children have. In many cases, they still have difficulty breathing and eating.
The ECG cleft can be unilateral or bilateral. Unilateral clefts are usually on the left side. Approximately one in seven deformities is bilateral.
Specialists from various disciplines work together to provide medical treatment for cleft lip and palate. These include oral and maxillofacial surgeons, ENT specialists, orthodontists, dentists and speech therapists (speech therapists).
The clefts can be located on one side (right or left) or on both sides of the face @ corbacserdar /AdobeStock
The malformation occurs in the womb when certain parts of the face do not grow together completely or at all during the child's development. It can also happen that the tissue that has already grown together tears open again.
The resulting malformations differ greatly depending on when they occur during embryonic development:
In a simple cleft lip, for example, only the upper lip is affected. The cleft is located between the red lips and the nostril.
Children with a cleft lip and jaw have a cleft along the philtrum (groove between the nose and the middle of the upper lip) and the lateral maxillary incisor.
In the worst cases of cleft palate, the mouth and the nasal cavity are not separated from each other. If the child has both malformations, it has a cleft lip and palate.
What exactly triggers the malformation during pregnancy is unclear according to current medical knowledge. Medicine suspects a genetic cause: if one parent has a cleft, the probability of the child developing a cleft is slightly increased.
If both parents are affected, the child has a risk of 35%, as the inheritance occurs through several genes.
Other factors that contribute to impaired development are
If several of these factors come together, the risk of the child being born later with a cleft lip and palate is significantly increased.
The malformation can be clearly seen on the ultrasound image as early as the 20th week of pregnancy. After birth, you can see that the child has a curved nasal septum. One nostril is also flatter than the other. This hinders breathing.
The cleft palate causes problems when sucking: the food ingested repeatedly enters the nasal cavity. Breastfeeding is also more difficult than in children without a malformation. It is hardly possible without special aids such as a Haberman feeder or the use of a palatal plate.
When the affected child begins to speak, the cleft palate causes a nasal sound and a "guttural" pronunciation of certain sounds. It also leads to ear, nose and throat disorders such as middle ear infections and hearing loss, resulting in impaired speech development.
Other symptoms are
The malformation is usually treated in the first few days of the child's life. By the time the child starts school, it should be so far advanced that it will develop normally in the following years. Further treatment may also be necessary in early adulthood.
Immediately after birth, babies affected by a unilateral cleft palate are given a removable palatal plate. This separates the mouth from the nasal cavity and helps the jaw to grow together. It also ensures that the child's tongue becomes accustomed to the anatomically correct position.
The palatal plate enables nasal breathing and facilitates breastfeeding and bottle feeding. If the ENT specialists are concerned that an inflammation of the middle ear may occur, they insert tympanostomy tubes to ventilate the ear sufficiently.
After 3 days, but no later than 6 months, doctors close the gap in facial surgery. This is done either in several operations or in a single surgical procedure.
Doctors perform these primary operations before the child makes its first sounds. At the latest when they are sure that the operation will not inhibit jaw growth.
In babies with a double-sided cleft palate, doctors must also lengthen the nose surgically (columelloplasty). If the cleft affects the stability of the jawbone, a secondary operation is performed.
For cleft osteoplasty, they insert bone tissue from the pelvic bone into the jawbone. This makes the adult dentition more durable later on.
Successful treatment of cleft lip and palate @ jorgecachoh /AdobeStock
Once the growth process of the nose is complete, surgeons straighten the part of the nose that consists of bone. They shape the lips and correct the nose to improve the patient's appearance.
To enable the child to speak normally, doctors shape the soft palate with a velopharyngoplasty. Treatment by a speech therapist is then necessary. This involves practicing the correct formation of certain previously mispronounced sounds with the patient.
The orthodontist then corrects any misaligned teeth. Regular hearing tests are carried out to prevent hearing loss.
Children with cleft lip and palate are often teased, which can lead to psychological problems. It is therefore advisable to take advantage of psychological services. Alternatively, there is a self-help group. It can provide affected parents with advice and support
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