Cleft lip and palate

    What is Cleft Lip?

    Cleft lip or cleft palate is a condition when the two sides of the lip, developing in an unborn baby, do not completely fuse together.

It affects weight speech and chewing habit of a child and leads to abnormal arrangement of teeth, poor jaw relations and facial aesthetic.

 

What causes the Cleft Lip?

Cleft lip is caused by the genes and the number of factors. It also depends upon the mother's environment, what she eats and consumes also can impact the child. it might also be due to certain medication as well. 

Anti Seizure/ anti convulsant medications, acne - treatment medication which contains methotrexate can be responsible for cleft lip. 

Other possible factors are- 

    Folic Acid Deficiency ( Vitamin Deficiency )

    Smoking during pregnancy 

    Substance Abuse

    Result of exposure to virus or chemicals when a woman is pregnant. 

 

  Also, if someone in the family has a history of Cleft lips, there are more chances the child might get the condition.

Cleft lip is one the fourth most common disease in the U.S. However, the disease is more prevalent among Asians, Latino, or Native American Descent. 

 Problems Associated with Cleft Lips/ Cleft Palate

The medical condition for Cleft lips are not only limited to the appearance but also, it can cause following problems- 

1- Eating Problems- There can be problems related to eating as food and liquid can pass from the mouth back through nose. 

2- Ear infections and hearing loss- Children with cleft palate are having more risk of ear infections since they are more prone to fluid buildup in the middle ear. 

If the ear infection is not treated on time, it might lead to hearing loss. 

3- Speech Problems- Children suffering from this condition might have speaking problems. Voices might differ. Mostly surgery can fix these things entirely. 

4- Dental Problems- Children with cleft get more dental issues, like more cavities, and displaced teeth. 

 

Treatment for cleft lips/ palate

There are different problems associated with cleft lips, therefore a team of specialised doctors usually work together to develop care for the patient. 

The team of doctors usually includes-

-
Plastic Surgeon

- Orthodontist 

- Dentist

-Prosthodontist

Speech pathologist

-Audiologist

- Nurse

-Geneticist

the treatment usually begins in infancy. 

 

Cleft lips in India 

Smoking, alcohol consumption, exposure to chulha smoke are harmful for the baby

Smoking, alcohol consumption, exposure to chulha smoke or passive smoking, over-medication and radiation exposure during the first few weeks of pregnancy along with nutritional deficiencies may lead to congenital deformities of the face such as cleft lip and palate anomaly, according to a study by AIIMS.

Cleft lip and palate anomaly constitute nearly one-third of all congenital malformations of the craniofacial region with an average worldwide incidence of 1 in 700.

The incidence in Asian population is reported to be around 1.7 per 1,000 live births or higher.

In India, even though a national epidemiological data is not available, many studies from different parts of the country have reported a variation in the incidence of cleft anomaly.

Based on rough estimates, it is suggested that approximately 35,000 new-born cleft patients are added every year to the Indian population.

Comprehensive protocol

The study, initiated by Centre for Dental Education and Research (CDER) at All India Institute of Medical Sciences since 2010, was conducted in three phases: pre-pilot, pilot and multi-centric.

The pre-pilot phase was conducted between 2010 and 2012. It aimed at developing comprehensive protocols for recording the history, investigations on dental anomalies, hearing defects and evaluation of speech-related problems in patients with cleft palate.

During the pilot phase (2012-2014), data of 164 cases with cleft lip and palate anomaly were recorded from three high-volume cleft care centres in Delhi and National Capital Region, involving two public funded hospitals — AIIMS and Safdarjung — and one private hospital — Medanta-The Medicity in Gurgaon.

What did the study reveal?

It revealed that patients suffering from this deformity had high treatment need with an immediate need to devise strategies to improve the delivery of quality care.

Currently, the multi-centric phase is under way in New Delhi, Hyderabad, Lucknow and Guwahati.

In the study, it evaluated a few risk factors including maternal smoking and alcohol consumption, intake of drugs during the first trimester of pregnancy and exposure to smoke during the same time by the use of chulha at home or due to passive smoking.

It was also taken into account the history in drug intake and radiation exposure in the first trimester of pregnancy and it was concluded that all these risk factors may be related to increased incidence of cleft in the progeny.

The government’s Rashtriya Bal Swasthya Karyakram has identified cleft lip and palate as one of the visible deformities which are recorded under the programme.

A web-based recording system, “IndiCleft” tool, has been developed with the help of The National Informatics Centre.