Cleft lip is a congenital disorder characterized by a cleft lip. The cleft can appear in the middle, right, or left side of the lip. Cleft lip is often accompanied by the appearance of a cleft in the roof of the mouth which is often referred to as a cleft palate.
Cleft lip and cleft palate occur due to imperfect union of the tissues on the lips or palate of the fetus, resulting in a cleft. Normally, the union process occurs in the first trimester of pregnancy.
Pcauses cleft lip
Until now it is not known exactly what causes cleft lip and cleft palate. But experts believe that this condition occurs due to a combination of genetic and environmental factors.
Having a sibling or parent with a cleft lip or palate is also associated with an increased risk of having a baby. In addition, a number of conditions experienced by the mother during pregnancy can also increase the risk of cleft lip, namely:
- Exposure to cigarette smoke, during pregnancy both as passive and active smokers
- Have a habit of consuming alcoholic beverages during pregnancy
- Experiencing obesity during pregnancy
- Having diabetes before pregnancy
- Having a folic acid deficiency during pregnancy
- Taking medications to treat seizures, such as topiramate or valproic acid, corticosteroid medications, retinoids, methotrexate, during the first trimester of pregnancy
In some cases, a cleft lip is a symptom of conditions, such as DiGeorge syndrome, Pierre Robin syndrome, Moebius syndrome, Van der Woude syndrome, or Treacher Collins syndrome.
Gcleft lip symptoms
While in the womb, the fetus will experience tissue growth and development. Lip formation occurs at 4-7 weeks of gestation, while the palate will form between the 6th and 9th weeks.
If there is a disruption in the union of the lip or palate tissue at this stage, a cleft will form on the lips and/or the roof of the mouth. This condition is known as a cleft lip or cleft palate.
Cleft lip and cleft palate can be detected during pregnancy or when the baby is born. Generally, when a baby has a cleft palate or lip, symptoms will appear in the form of:
- A cleft in the upper lip or on the roof of the mouth that can occur on one side or both sides
- There is a gap that looks like a small tear from the lip to the upper gums and the roof of the mouth to the bottom of the nose
- There is a cleft in the roof of the mouth that does not affect the appearance of the face
- There is a change in the shape of the nose due to a gap that forms on the lips or roof of the mouth
- Impaired tooth growth or irregular arrangement of teeth
Cleft lip is not always accompanied by the appearance of a cleft palate, and vice versa.
Apart from those described above, there is also a rare type of cleft or fissure, namely a submucosal cleft. This type of cleft will cause gaps to appear in less visible areas. Usually, on the soft palate and covered by the lining of the mouth. This type of cleft is not visible at birth and is usually diagnosed when symptoms include:
- Difficulty eating and breastfeeding
- Difficult to swallow, even food and drink can come out of the nose again
- Nasal voice or sound not clear
- Chronic ear infection
When to go to the doctor
Pregnant women need to have regular prenatal checkups according to the schedule determined by the doctor. That way, the development of the fetus and the condition of pregnant women can be continuously monitored.
Cleft lip will usually be detected by a doctor when the newborn is born. If your child is diagnosed with a cleft lip, follow the advice and therapy given by the doctor, and have regular check-ups.
Dcleft lip diagnosis
Cleft lip can be detected when the baby is born until 72 hours later. When the baby has a cleft lip, the doctor will ask about the mother's and family's medical history, including whether there is a history of taking drugs or supplements during pregnancy. After that, the doctor will examine the child's face, including the mouth, nose, and roof of the mouth.
In addition to being known when the baby is born, cleft lip can also be detected during pregnancy. Ultrasound examination of pregnancy performed at 18 to 21 weeks will usually show abnormalities in the fetal facial area.
If the fetus is suspected of having abnormalities in the face and lips, the doctor will usually advise the pregnant woman to undergo an amniocentesis procedure, which is a test carried out by taking a sample of amniotic fluid. This procedure aims to determine the cause of the cleft lip.
Pcleft lip treatment
Treatment of cleft lip aims to improve the child's eating and drinking abilities, maximize speech and listening skills, and improve facial appearance.
Cleft lip can be treated by performing several operations. This depends on the extent and width of the cleft experienced by the child. The first surgery will usually be done when the baby is 3 months old.
Stages before surgery
Before cleft lip surgery, the doctor will make preparations by placing a special tool on the child's lips, mouth, or nose. It aims to improve the results of cleft lip repair. Below are some of the tools used by doctors before cleft lip surgery:
- lip-taping regimen,which is a kind of tool used to unite or narrow the two gaps in the lips
- Nasal elevator, which is a tool used so that the gap does not widen to the nose and helps shape the baby's nose
- Nasal-alveolar molding (NAM), which is a tool like a mold that serves to help shape lip tissue before surgery
Operation stage
The first operation is cleft lip surgery. This surgery aims to repair the cleft lip and close the cleft lip. This operation is performed when the baby is between 3-6 months old. The doctor will make incisions on both sides of the gap and make folds of tissue which are then held together by means of stitches.
The second surgery is cleft palate surgery. This second surgery aims to close the gap and repair the roof of the mouth, prevent fluid buildup in the middle ear, and help the development of the teeth and facial bones.
The doctor will make incisions on both sides of the gap and reposition the tissues and muscles of the roof of the mouth, then sutures. Cleft palate surgery is recommended when the baby is 6–18 months old.
After that, follow-up surgery for cleft palate can be done at the age of 8-12 years. Follow-up surgery is performed by grafting bone to the palate to support the maxillary structures and speech articulation.
If the child has an ear problem, a third operation will be performed. The third operation is ear tube insertion surgery. For children with cleft palate, ear tubes are inserted at 6 months of age. This procedure is performed to reduce the risk of hearing loss and can be performed in conjunction with cleft lip or cleft palate surgery.
The fourth operation is surgery to improve appearance. This additional surgery may be needed to improve the appearance of the mouth, lips, and nose. This operation can be done when the child is in his teens to adulthood.
After surgery, the doctor will continue to monitor and treat the cleft lip. Monitoring and treatment is advised to continue until the child is 21 years old or when growth has stopped.
Additional treatment
In addition to surgery, the doctor will provide additional therapy or treatment. The type of treatment and therapy carried out will be adjusted to the condition of the child. Some types of therapy and additional treatment that can be given are:
- Treatment for ear infections
- Orthodontic treatment, such as braces
- Doing speech therapy to improve speech difficulties
- Providing hearing aids for hearing-impaired children
- Teaches how to feed children or use special cutlery
Children with cleft lip may experience problems in emotion, behavior, and social life because of their different appearance or because of various medical procedures that must be performed periodically. To overcome this, you can take your child to consult a psychologist.
Kcleft lip complications
Some of the complications that may be experienced by babies who suffer from cleft lip are:
- Hearing disorders
- Tooth growth disorders
- Difficulty sucking breast milk
- Difficulty speaking or communicating later
Cleft Lip Prevention
Cleft lip is difficult to prevent because the cause is not known for certain. However, pregnant women can take the following steps to reduce the risk of cleft lip in the fetus:
- Do a genetic examination to the doctor if there is a family member who has a cleft lip
- Carry out regular pregnancy checkups according to the schedule given by the doctor
- Living a healthy lifestyle during pregnancy, such as eating a healthy and balanced diet containing folic acid, maintaining weight so you don't become obese during pregnancy, not smoking, and not consuming alcoholic beverages
- Do not use drugs or supplements carelessly, without a doctor's recommendation