Dealing with cleft lip and palate

Cleft lip and cleft palate are kinds of birth defects. A cleft lip is an opening or split in the upper lip. A cleft palate is an opening or split the roof of the mouth (called the palate). A baby can be born with 1 or both of these conditions. Some babies with a cleft lip have a small notch in their upper lip. Others have a larger opening or hole that goes all the way to the bottom of their nose
A team of visiting facial plastic surgeons and local surgeons attend to patients with such facial and oral cleft defects at Rwanda Military Hospital last week. / Courtsey photos.
A team of visiting facial plastic surgeons and local surgeons attend to patients with such facial and oral cleft defects at Rwanda Military Hospital last week. / Courtsey photos.

Cleft lip and cleft palate are kinds of birth defects. A cleft lip is an opening or split in the upper lip. A cleft palate is an opening or split the roof of the mouth (called the palate). A baby can be born with 1 or both of these conditions. Some babies with a cleft lip have a small notch in their upper lip. Others have a larger opening or hole that goes all the way to the bottom of their nose

The lip of a baby forms in the first weeks of pregnancy (fourth and seventh weeks of pregnancy). As a baby develops during pregnancy, body tissue and special cells from each side of the head grow toward the center of the face and join together to make the face. This joining of tissue forms the facial features, like the lips and mouth. 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. The opening in the lip can be a small slit or it can be a large opening that goes through the lip into the nose. A cleft lip can be on one or both sides of the lip or in the middle of the lip, which occurs very rarely. Children with a cleft lip also can have a cleft palate.

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 have problems with feeding and speaking clearly and can have ear infections. They also might have hearing problems and problems with their teeth.

The causes of these cleft birth defects among most infants are unknown. Some children have a cleft lip or cleft palate because of changes in their genes. 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.

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.

Women who used certain medicines to treat epilepsy, certain cancer medicines during the first 3 months of pregnancy have an increased risk of having a baby with cleft lip with or without cleft palate, compared to women who didn’t take these medicines.

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.

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.

Services and treatment for children with these facial clefts can vary depending on the severity of the cleft, the child’s age and needs, and the presence of associated conditions or other birth defects, or both.

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. Surgical repair can improve the look and appearance of a child’s face and might also improve breathing, hearing, and speech and language development. Children born with these clefts might need other types of treatments and services, such as special dental care or speech therapy.

Children and adults with such facial and oral cleft defects among other surgical mouth and facial conditions being operated on at Rwanda Military Hospital, this week. A team of about 15 visiting facial plastic surgeons and our own surgeons were helping patients with such bothersome yet common conditions to face the future with a smile and confidence by carrying out surgery to correct such conditions.

Many other forms of facial and mouth surgeries done, including; surgery for tumors of the face and mouth, both cancerous and non-cancerous, bad scars of the face and other defects of the face whether acquired during ones development or born with.

About 60 Rwandan patients successfully benefited from these surgeries during this plastic surgical camp.

Dr. Ian Shyaka

Resident in Surgery, Rwanda Military Hospital.