Cleft lip and cleft palate are birth defects that occur when a baby’s lip or mouth do not form properly during pregnancy. Together, these birth defects commonly are called “orofacial clefts”. Worldwide, orofacial clefts are among the most common facial inborn malformations occurring in about one in every 700 live births (World Health Organisation [WHO]. A cleft lip is an opening or split in the upper lip. A cleft palate is an opening or split at the roof of the mouth, called the palate. A baby can be born with one or both of these conditions. Cleft lip accounts for about 60 per cent while isolated cleft palate accounts for the remaining 40 per cent of orofacial cleft referrals. A cleft lip happens if the tissue that makes up the lip does not join completely before birth. This results in an opening in the upper lip, which can be on one or both sides of the lip or at times in the middle of the lip. A cleft palate happens if the tissue that makes up the roof of the mouth does not join together completely during pregnancy. For some babies, both the front and back parts of the palate are open. For other babies, only part of the palate is open. Children with a cleft lip, with or without a cleft palate or a cleft palate alone, often are faced with disturbances in feeding, speech, hearing or dental irregularities and many potential psychological problems as a direct consequence of these, or among peers. The exact causes of these cleft birth defects among infants are still unknown. Cleft lip and cleft palate are thought to be caused by a combination of genes and other factors, such as things the mother comes in contact with in her environment, or what the mother eats or drinks, or certain medications she uses during pregnancy (such as epilepsy, some cancer drugs). Women who smoke or drink alcohol during pregnancy are more likely to have a baby with these facial cleft defects than women who do not smoke. Women with diabetes diagnosed before pregnancy have an increased risk of having a child with a cleft lip with or without cleft palate, compared to women who did not have diabetes. These facial clefts, especially cleft lip with or without cleft palate, can be diagnosed during pregnancy by a routine ultrasound. They can also be diagnosed after the baby is born, especially cleft palate. However, sometimes certain types of cleft palate might not be diagnosed until later in life. Surgery to repair a cleft lip usually occurs in the first few months of life and is recommended within the first 12 months of life. Surgery to repair a cleft palate is recommended within the first 18 months of life or earlier if possible. Many children will need additional surgical procedures as they get older. Children born with these clefts might need other types of treatments and services, such as special dental care, rhinoplasty or speech therapy. Repair of these orofacial cleft conditions requires highly skilled surgeons, such as plastic surgeons or surgeons with special training in these surgeries. These surgeries are also costly to the patient and their families, especially given most of these surgeries are done on more than one occasion to obtain the best results. Initially, early access to these surgical correction procedures by patients wasn’t easy largely because of limited medical expertise country-wide, coupled with less public knowledge about these conditions, hence were easily ignored by some parents until late in childhood. Currently, Rwanda Military Hospital is doing repair of these orofacial cleft surgeries and through collaboration with Smile Train (a nonprofit organisation and charity providing corrective surgery for children with cleft lips and palates globally), all Rwandan children with these orofacial cleft malformations are able to receive high quality surgical correction services by a skilled plastic surgeon, for free. To reduce the risk of bearing a baby with these facial cleft defects, women who are pregnant or planning to get pregnant should take a “prenatal” multivitamin that has at least 400 micrograms of folic acid. They should also not smoke or drink alcohol, and should also always tell their doctor about any medicines they are taking. Dr Ian Shyaka , Resident in Surgery, Rwanda Military Hospital, iangashugi@gmail.com
