CLEFT PALATE (cheiloschisis) is a condition in which thetwo palates of the skull that form the hard palate are notcompletely joined. The soft palate in these cases are cleftas well.CLEFT LIP (palatoschisis) is a physical split or separation ofthe two sides of the upper lip and appears as a narrowopening or gap in the skin of the upper lip. Thisseparation often extends beyond the base of the noseand includes the bones of the upper jaw and/or uppergum.
• Between the 6th and 12th weeks of fetal gestation,the left and rightsides of the face and facial skeleton fuse in the midddle. When they dofail to do so, the result is a craniofacial cleft.• Cleft palate without cleft lip occurs more in females (57%) than males(43%). Cleft lip with or without cleft palate occurs twice as many malesthan females.• It is possible that facial clefts are caused by a disorder in themigration of neural crest cells.• Another theory is that facial clefts are caused by failure of the fusionprocess and failure of inwards growth of the mesoderm.
A mild form of a cleft lip is a microform cleft. A microform cleft canappear as small as a little dent in the red part of the lip or look likea scar from the lip up to the nostril.Incomplete cleft lips can take on a variety of appearances. Theremay be just a small gap or cleft in the vermillion or it may slightlyextend into the skin above the lip or extend almost to the nostril.As with a complete cleft lip deformity, the nose has somedistortion. The distortion is usually to a lesser degree. The nostrilmay be widened, but the floor of the nostril is intact.
In a bilateral incomplete cleft lip deformity, thenose is affected, although not to the same degreeas with a bilateral complete cleft lip deformity.A bilateral complete cleft lip affects both the rightand left sides of the lip. There are no philtralcolumns, no philtral dimple, and there is noorbicularis muscle in the central segment. On bothsides, the cleft extends from the vermillion to thenostril.
GENETIC FACTORS – a study has identified that • Orofacial clefts can be detected4 different regions of the human genomecontains genes controlling risk for cleft lip and during pregnancy by ROUTINEpalate: ULTRASOUND.• IRFG Gene on chromosome 1• MAFB gene on chromosome 20• ABCA4 on chromosome 1 • Usually,orofacial clefts are• a region on chromosome 8 diagnosed when the baby is born.ENVIRONMENTAL FACTORS• Maternal smoking• Maternal alcohol abuse • Minor clefts might not be• Maternal diet and vitamin intake diagnosed until later in life.• Medications take during pregnancy• Exposure to viruses in chemicals of fetus • Diagnosis can also be made by• Women with diabetes diagnosed before PHYSICAL EXAMINATION.pregnancy
MAY APPEAR AS: Difficulty in swallowing• A split in the lip and roof of Nasal Speaking voicethe mouth and palate that can Recurring ear infectionsaffect both sided of the face Change in Nose shape• A split in the lip that can Poorly aligned teethappear as only a small notchin the lip or can extend from PROBLEMS ASSOCIATED WITHthe lip through the upper gum OROFACIAL CLEFT:and palate into the bottom of • Failure to gain weightthe nose • Feeding problems• A split in the roof of the that • Flow of milk through nasal passagedoesn’t affect the appearance during feedingof the face. • Poor growth • Speech difficulties
• SURGERY - to close the cleft lip •Children born with orofacial clefts alsois often done when the child is might need different types ofbetween 6 weeks and 9 months treatments and services, such as specialold. Surgery may be needed later DENTAL OR ORTHODONTIC CARE orin life if the problem has a big SPEECH THERAPY.effect on the nose area. • Because children and individuals with• A cleft palate is usually closed orofacial clefts often require a variety ofwithin the first year of life so that services that need to be provided in athe childs speech develops coordinated manner, services andnormally. Sometimes a prosthetic treatment by cleft team isdevice is temporarily used to recommended. These team usuallyclose the palate so the baby can consist of experienced and qualifiedfeed and grow until surgery can physicians and health care providersbe done from different specialties.
A Team Approach is RequiredThe cleft lip and palate team must work together for the benefit of theyoung patient. The team usually consists of the following members:the pediatrician, plastic surgeon, oral & maxillofacial surgeon, dentist,orthodontist, ENT physician, psychiatrist, psychologist, prosthodontist,speech therapist, audiologist, and coordinator.
• Dentists recommend that the first dental visit be scheduled at aboutone year of age or even earlier if there are special dental problems.• A cleft of the lip and/or palate in the front of the mouth can producea variety of dental problems. These may involve the number, size,shape, and position of both the baby teeth and the permanent teeth.• The teeth most commonly affected by the clefting process are thosein the area of the cleft, primarily the lateral incisors. Clefts occurbetween the cuspid (eye tooth) and the lateral incisor. In some casesthe lateral incisor may be entirely absent.
•In other cases there may be a “twinning” (twin = two) of the lateralincisor so that one is present on each side of the cleft.• Finally, the teeth in the area of the cleft may be displaced, resultingin their erupting into abnormal positions.
A Partial List of Oral Problems in Children with Cleft Lip & Palate•Feeding Problems•Missing teeth- 50%•Supernumerary Teeth- 20%•Dystrophic (hypoplastic) teeth- 30%•Disturbances of tooth eruption•Ectopic tooth eruption•Malocclusion- 100%•Dental caries and gingivitis
Genetic disorders may also be complex, multifactorial, or polygenic, meaning theyare likely associated with the effects of multiple genes in combination with lifestylesand environmental factors. Multifactorial disorders include heart disease anddiabetes. Although complex disorders often cluster in families, they do not have aclear-cut pattern of inheritance. This makes it difficult to determine a person’s risk ofinheriting or passing on these disorders. Complex disorders are also difficult to studyand treat because the specific factors that cause most of these disorders have notyet been identified.On a pedigree, polygenic diseases do tend to “run in families”, but the inheritancedoes not fit simple patterns as with Mendelian diseases. But this does not mean thatthe genes cannot eventually be located and studied.
Multifactorial inheritance, also called complex or polygenicinheritance. Multifactorial inheritance disorders are caused by acombination of environmental factors and mutations in multiplegenes.Some common birth defects can occur as a single isolated conditionand are often caused by many factors. With one affected child in thefamily, the chances of having the condition reoccur are one to five percent depending on the type of birth defect.
Common Examples of Multifactorial Birth Defects are:• Cleft lip/and palate• Club foot• Congenital Heart Defects• Neural Tube Defects (Spina Bifida)