The three common kinds of clefts are:
- • cleft lip without a cleft palate
- • cleft palate without a cleft lip
- • cleft lip and cleft palate together
In addition, clefts can occur on one side of the mouth (unilateral clefting) or on both sides of the mouth (bilateral clefting).
More boys than girls have a cleft lip, while more girls have cleft palate without a cleft lip.
Because clefting causes specific visible symptoms, it's easy to diagnose. It can be detected through a prenatal ultrasound. If the clefting has not been detected prior to the baby's birth, it's identified immediately afterward.
Thanks to medical advancements, reconstructive surgery can repair cleft lips and palates and, in severe cases, plastic surgery can address specific appearance-related concerns.A child with oral clefting will see a variety of specialists who will work as a team to treat the condition. Treatment usually begins in the first few months of life, depending on the health of the infant and the extent of the cleft.
Members of the cleft lip and palate treatment team usually include:
a plastic surgeon
an ear, nose, and throat physician (otolaryngologist)
an oral surgeon
a speech pathologist (often called a speech therapist)
a nurse coordinator
a social worker and/or psychologist
The specialists will evaluate your child's progress regularly, and monitor hearing, speech, nutrition, teeth, and emotional state. They'll share their recommendations with you, and can forward their evaluation to your child's school and any speech therapists that your child may be working with.
In addition to treating the cleft, the specialists will work with your child on any issues related to feeding, social problems, speech, and your approach to the condition. They'll provide feedback and recommendations to help you through the phases of your child's growth and treatment.
Dental Care and Orthodontia
Children with oral clefting often undergo dental and orthodontic treatment to help align the teeth and take care of any gaps caused by the cleft.
Routine dental care may get lost in the midst of these major procedures, but healthy teeth are critical for kids with clefting because they're needed for proper speech.
Kids with oral clefting generally need the same dental care as other kids — regular brushing supplemented with flossing once the 6-year molars come in. Depending on the shape of the mouth and teeth, your dentist may recommend a toothette (a soft sponge that contains mouthwash) rather than a toothbrush. As your child grows, you may be able to switch to a soft children's toothbrush. The key is to make sure that your child brushes regularly and well.
Children with cleft palate often have an alveolar ridge defect. The alveolar ridge is the bony upper gum that contains teeth, and defects can:
displace, tip, or rotate permanent teeth
prevent permanent teeth from appearing
prevent the alveolar ridge from forming
These problems can be fixed by grafting bone matter onto the alveolus, which allows the placement of the teeth to be corrected orthodontically.
Orthodontic treatment usually involves a number of phases. The first phase, which starts as the permanent teeth come in, is called an orthopalatal expansion. The upper dental arch is rounded out and the width of the upper jaw is increased. A device called an expander is placed inside the mouth. The widening of the jaw may be followed by a bone graft in the alveolus.
Your orthodontist may wait until all the permanent teeth come in before starting the second phase, which may involve removing extra teeth, adding dental implants if teeth are missing, or applying braces to straighten teeth.
In about 25% of kids with a unilateral cleft lip and palate, the upper jaw growth does not keep up with the lower jaw growth. If this occurs, these kids (as teenagers or young adults) may need orthognathic surgery to align the teeth and help the upper jaw develop.
For these kids, phase-two orthodontics may include an operation called an osteotomy on the upper jaw that moves the upper jaw both forward and down. This usually requires another bone graft for stability.