Cleft Lip and Palate (Cheilognathopalatoschisis): Causes, Symptoms & Treatment

Cleft lip and palate is a relatively common malformation of the mouth. The medical term for it is cheilognathopalatoschisis. Colloquially, cleft lip and palate used to be called harelip. Approximately 1500 children are born in Germany each year with this malformation.

What is cleft lip and palate?

If the facial parts of the embryo do not close completely during growth in the womb, visible malformations occur in the mouth area. Most commonly, a cleft lip, jaw, and palate develops on the left side. Lips, jaw and palate are not completely closed at the same time. However, there are also cleft lip, cleft lip and cleft palate. All cleft types can also occur on both sides. The colloquial term harelip or wolf cleft is rarely heard today because it can be discriminatory. Boys are more frequently affected than girls. Cleft lip occurs in 1 in 500 births. This makes cleft lip and palate one of the most common malformations.

Causes

The cause of cleft lip and palate is not known. Medical experts suspect that genetic factors are responsible, as 15 percent have other cases of cleft formation within the family. A specific hereditary trait variant is also seen clustered in people with cleft formation. In addition to heredity, other factors may also be involved. It is possible that vitamin deficiency, overdose of vitamin A and vitamin E, oxygen deficiency, smoking and alcohol can promote the formation of cleft lip and palate. The embryo develops the face during the first embryonic weeks. If negative influences occur during this time, the face may not fully form. A cleft lip and palate may result. Cleft lip or cleft palate occurs due to disorders during the 5th to 6th week of pregnancy. Cleft palate occurs due to disorders in the 10th to 12th week of pregnancy.

Symptoms, complaints, and signs

Cleft lip and palate can be recognized by the characteristic malformation of the mouth area. In this case, the lips, upper jaw, palate, mouth and nose show severe deformities, although the actual cleft usually occurs on only one side. The deformity causes various symptoms such as malocclusion of the teeth, nasal dribbling and speech problems. Affected children usually develop unclear pronunciation as a result of the deformity and then mumble heavily, for example. In addition, the cleft causes problems with food intake, which can lead to deficiency symptoms. Rarely, the cleft develops within the oral cavity, which can result in problems with swallowing and ear infections, among other things. The cleft can vary in size, expression and localization. It occurs predominantly on the left side and can range from simple skin defects of the upper lip to severe deformities. Cleft lip and palate often occurs in conjunction with other malformations. This can contribute to the development of emotional problems in those affected. Many people who suffer from cleft lip and palate develop depression or social anxiety over the course of their lives. The deformity itself is not life-threatening, but the psychological consequences can greatly reduce the quality of life. With early therapy, much of the deformity can be surgically removed.

Diagnosis and course

The diagnosis can be made easily based on the typical appearance characteristics. Cleft lip and palate can be recognized at first glance in newborns. If the lips are not affected, the doctor must examine the baby’s mouth to make the diagnosis. From the 18th week of pregnancy, a cleft lip and palate can already be detected by an ultrasound examination. Thanks to the very good surgical possibilities, both aesthetic and functional results can be achieved. Today, the course of cleft lip and palate is very positive, because the cleft can be completely closed. Through speech therapy support, it is possible to bring about normalization in 90 percent of all cases.

Complications

As a result of cleft lip and palate, most affected individuals suffer from various deformities that can significantly limit the daily life of the affected individual and significantly reduce the quality of life.As a rule, the malformations mainly affect the palate and the upper jaw. The lips can also be affected by this complaint, so that the absorption of liquids and food is restricted by this complaint. Similarly, malocclusions occur on the teeth and jaw of the patient, which can not infrequently lead to pain and to further restrictions in everyday life. The mouth and nose are also deformed. Furthermore, cleft lip and palate not infrequently leads to bullying or teasing in children and can thus also trigger psychological complaints or depression. In addition, most patients also suffer from speech disorders due to cleft lip and palate and cannot easily communicate with other people. Unfortunately, a causal treatment of this disease is not possible. Those affected are thus dependent on various surgical interventions that can alleviate and limit the symptoms. Complications usually do not occur. Also the life expectancy of the patient is usually not reduced by this disease. It is not uncommon for the parents and relatives of those affected to also suffer from the discomfort of cleft lip and palate.

When should one go to the doctor?

Cleft lip and palate is usually diagnosed immediately at the birth of the child by attending physicians, pediatric nurses or nurse practitioners. Because various obstetricians are present in the inpatient setting during this process, they provide further medical care for the newborn. It is therefore not necessary for the parents to initiate a visit to the doctor. If a home birth takes place, the initial care of the child is taken over by the midwife who is present. In the event of irregularities, she establishes contact with a doctor and initiates the necessary steps for treatment. If, in exceptional cases, a sudden birth takes place without the presence of nursing staff or under medical care, a doctor should be consulted immediately after the birth. Calling an ambulance is recommended so that mother and child can be transported to a hospital as soon as possible. The visual changes of cleft lip and palate can be seen immediately at the time of delivery by visual contact of the child. To avoid further complications, medical treatment should always be given immediately. In severe cases, the newborn’s airway is impaired. In these situations, first aid measures must be taken. Since cleft lip and palate can be diagnosed before birth, the expectant mother should attend all offered check-ups during pregnancy.

Treatment and therapy

Treatment of cleft lip and palate may continue into adulthood. The first goal is to have the child’s appearance normalized before he or she starts school. In addition, speech, chewing, hearing and breathing should be possible normally. Several doctors work together in the treatment of cleft lip and palate: Pediatricians, dentists, orthodontists, oral and maxillofacial surgeons, otolaryngologists and speech therapists. In some cases, treatment by a psychotherapist is also advisable. Initial treatment measures should be initiated right in the first days after birth. In order to promote the growth direction of the palate, the position of the tongue and tongue function, and to enable relatively normal drinking, the first thing the doctor does is to take an impression of the jaw. This is used to make a palatal plate. This separates the nasal cavity from the mouth. Other malformations must be ruled out. The doctor examines the heart and kidneys. The cleft lip and palate is surgically corrected as the child grows older. In order for the child to learn the formation of sounds and speech correctly, speech therapy treatment is important. In order for the teeth to be properly aligned and form correctly, orthodontic measures are necessary along with proper dental care. Psychological therapy helps the child and his parents to cope with the psychological stress. The first surgical intervention is performed at the age of three bi six months. The soft palate, upper jaw and lips are closed. The hard palate is corrected at the age of 12 to 18 months. Additional surgeries may then be necessary until adulthood. For example: Nose corrections, tooth alignment corrections, lip corrections and soft palate corrections.

Outlook and prognosis

The malformation of the mouth or jaw can be treated well in most patients thanks to medical options. Nevertheless, the prognosis depends on the extent of the cleft palate and the start of treatment. If the birth takes place in an inpatient setting, correction is initiated immediately after the birth process. If the birth takes place in a birthing center or home setting, the procedure can only be performed with a time delay after transport to the hospital. This often results in the suture remaining more visible as the child continues to develop and grow due to the time delay of the procedure. Basically, cleft lip and palate can be treated so well nowadays that there are hardly any physical impairments in speech or chewing. Functional disorders are therefore not to be expected in the long term. Nevertheless, despite all efforts, the malformation still leaves a visual stain due to the corrective surgery. Follow-up treatments can be taken, which lead to an improvement. The severity of the abnormality nevertheless remains individual and can lead to a strong emotional burden. In case of an unfavorable course of the disease, psychological sequelae occur. This circumstance must be taken into account when making the overall prognosis. In addition, there is an increased risk of developing inflammation of the head more frequently over a lifetime.

Prevention

Cleft lip and palate can be prevented only to a limited extent. However, the risk can be reduced by women avoiding alcohol, cigarettes, oxygen deficiency, vitamin deficiency, malnutrition, vitamin E overdose, and stress before and during pregnancy.

Follow-up

As a result of cleft lip and palate, affected individuals suffer from various deformities that significantly limit them in their daily lives and reduce their quality of life. As a result, affected individuals suffer from their external appearance. In most cases, the condition is treated surgically in early childhood. Follow-up care in the actual sense is largely unnecessary, provided that no further physical complaints occur. Rather, the aim is to promote a self-confident approach to the condition in the long term. In more severe cases, the help of a professional psychologist can be supportive. This can sometimes also prevent the development of severe depression and other mental illnesses and rather ensure to live well with the restriction.

What you can do yourself

With cleft lip and palate, a lifelong cosmetic blemish often remains despite good and prompt medical care. The health impairments can be cured and corrected very well due to medical progress. Nevertheless, many of those affected suffer from the permanent optical change. Men can often help themselves in everyday life by using their beard growth to cover up the irregularity. Depending on the individual circumstances, this can almost completely cover the conspicuousness. Bystanders thus do not notice any difference to other people and unpleasant looks or phrases are avoided. For girls and women, it is possible to use cosmetic products to alleviate the stitching on the lip. Since the visual changes of a cleft palate nevertheless do not disappear completely with this method, it is helpful to show a self-confident approach. Relaxation techniques can be used to strengthen mental power. These lead to a reduction of inner stressors and strengthen vitality. Via yoga or meditation, the focus of perception is placed on other areas of life as well as on one’s own strengths. Many sufferers also find it helpful to exchange experiences with other sufferers. Experiences and experiences are discussed with each other. In addition, helpful tips can be given on how to deal with the symptoms in everyday life.