During early pregnancy, various facial components develop independently and later come together. A cleft occurs when these sections fail to meet correctly and in the proper position. If this happens on the upper lip, it is termed a cleft lip. A fully formed lip is crucial for the ability to suck and produce various speech sounds, in addition to its significance for physical appearance. A cleft lip results in a gap in the upper lip, between the nose and the mouth, creating a split appearance. This condition can make speech challenging and ranges from a slight indentation on the colored part of the lip to a complete separation extending to the base of the nose. A unilateral cleft is asymmetrical or on one side, while a bilateral cleft affects both sides.
The condition is termed a cleft palate if the gap extends along the mouth. The palate, consisting of bone, muscle, and a thin layer of skin, forms the red covering inside the mouth and separates the nose and mouth. The palate is crucial for speech and eating, preventing air from escaping through the nose during speech and containing food or liquids.
Similar to a cleft lip, a cleft palate develops during early pregnancy when different parts of the face form. A cleft palate represents a gap in the top of the mouth, with the soft palate at the back and the hard palate at the front. The severity of a cleft palate can range from a minor opening in the soft palate to a complete division of both the hard and soft portions.
In some cases, babies may be born with a cleft palate and a small chin, which can complicate breathing. Since the lips and palate develop independently, a baby may have apertures in either or both features. On average, clefts occur in one out of every eight hundred babies.
Children born with cleft lip and palate often require the expertise of various professionals to address associated challenges, including feeding, hearing, psychological support, and speech. Surgery is commonly recommended to address the defects, and it can significantly improve many of the issues associated with these congenital conditions.
Cleft palate surgery is typically performed very young, often as early as ten weeks old. The primary goals of this surgery are to close the gap, normalize the shape of the mouth, and restore the function of the muscles. While some cases may allow for the resolution of the deformity in a single surgery, others may necessitate additional procedures for a more comprehensive correction. The timing and approach to surgery can vary based on the individual case and the severity of the cleft palate. Early intervention is often favoured to address the condition and support optimal development.
Cleft palate surgery is typically performed when the child is a bit older, typically between seven to eighteen months, with the timing influenced by the individual child’s needs and the location of the aperture. Prioritization of surgery may also depend on the presence of other concurrent issues. The primary goals of the surgery are to close the gap in the roof of the mouth, reestablish muscle connections, and ensure the palate functions appropriately. Additionally, the palate is lengthened to enable proper functionality. Various surgical approaches may be considered, which will be discussed with the medical team before the procedure.
For cases involving a cleft in the hard palate, surgery may be delayed until the age of eight to twelve months, when the canine teeth begin to develop. This surgery typically involves harvesting bone mass from the hip to close the defect. The procedure can also be performed on teenagers and adults as a stand-alone surgery or concurrently with corrective jaw surgery if needed.
