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Cleft Palate

Cleft Lip; Cleft Lip and Palate; Cleft Palate/cleft Lip 



Article: Cleft

A cleft is a separation in a body's natural structure, usually formed before birth. Clefts that occur in the oral-facial region often involve the lip, the roof of the mouth (hard palate) or the soft tissue in the back of the mouth (soft palate). Two major types of oral-facial clefts are cleft lip/palate and isolated cleft palate, which are congenital deformities caused by a failure in facial development during gestation.

A cleft lip or palate can be treated with surgery shortly after birth with highly successful results. Cleft lips or palates occur in somewhere between one in 600 and one in 800 births. The term hare lip or hair lip are sometimes used to describe the condition because of the resemblance of a hare's lip; both terms are however quite derogatory and old fashioned.

A microform cleft is a very minor cleft where no surgery is required to correct it. A microform cleft can appear as small as a little dent in the red part of the lip or look like a scar. Joaquin Phoenix for example has a microform cleft (see famous people with a cleft below).

Cleft lip

If only skin tissue is affected one speaks of cleft lip.

Cleft lip is formed in the upper lip as either a small gap or dent in the lip (partial or incomplete cleft) or continues into the nose (complete cleft). Lip cleft can occur as one sided (unilateral) or two sided (bilateral).

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Unilateral incomplete
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Unilateral complete
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Bilateral complete
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Right sided unilateral cleft lip

Cleft palate

Cleft palate is a condition in which the two plates of the skull that form the hard palate (roof of the mouth) are not completely joined. The soft palate is in these cases cleft as well. In most cases, cleft lip is also present.

Palate cleft can occur as complete (soft and hard palate, possibly including a gap in the jaw) or incomplete (a 'hole' in the roof of the mouth, usually as a cleft soft palate). When cleft palate occurs, the uvula is usually split.

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Unilateral complete lip and palate
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Bilateral complete lip and palate
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Incomplete cleft palate
 

Causes

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It has been suggested that Clefting Prevalence in Different Cultures be merged into this article or section. (Discuss)

During the first six to eight weeks of pregnancy, the shape of the embryo's head is formed. Five tissues grow: one from the back of the neck over the top of the head down towards the upper lip, two from the cheeks and meet the first layer to form the upper lip and two from each side form the chin and lower lip. If these tissues fail to meet, a gap appears where the tissues should have joined.

The cause of cleft lip and cleft palate formation is genetic in nature. A specific gene that increases three-fold the occurrence of these deformities has been identified in 2004 as reported by the BBC [1]. If a person is born with a cleft, the chances of that person having a child with a cleft, given no other obvious factor, rises to 7 in 100 (instead of 1 in 700). Folic acid reduces the odds slightly.

Clefting seems to be at least in part related to ethnicity, occurring most often among Asians, Latinos and Native Americans (1 in 500), next most often among persons of European ethnicity (1 in 700) and least often among persons of African ethnicity (1 in 1,000).

In some cases, cleft palate is caused by syndromes which also cause other problems. Stickler's Syndrome can cause cleft lip and palate, joint pain, and myopia. Many clefts run in families, even though there does not seem to be any identifiable syndrome present.

Therapy

Within the first 6 months after birth, surgery is performed to close the gap in the lip. Most large hospitals have a Cleft or Craniofacial team of specialists to treat children and aid parents. Often an incomplete cleft requires the same surgery as complete cleft. This is done for two reasons. Firstly the group of muscles required to purse your lips run through the upper lip. In order to restore the complete group a full incision must be made. Secondly, to create a less obvious scar the surgeon tries to line up the scar with the natural lines in the upper lip (such as the edges of the philtrum) and tuck away stiches as far up the nose as possible. Incomplete cleft gives the surgeon more tissue to work with, creating a more supple and natural-looking upper lip.

Cleft palate also can be corrected by surgery, usually performed between 9 and 18 months. Combinations of surgery methods and repeated surgeries are often necessary as the child grows. One of the new innovations of cleft lip and cleft palate repair is the Latham appliance. The Latham is surgically inserted by use of pins during the child's 4th or 5th month. After it's in place, the doctor, or parents, turn a screw daily to bring the cleft together to assist with the future lip and/or palate repair.

If the jaw is also cleft, the gap is usually corrected by filling the gap with bone tissue. The bone tissue can be aquired from the patient's own chin, rib or hip. There is no preferred age for jaw correction and is usually decided on a per case basis.

Note that treatment procedures can vary between craniofacial teams. For example some teams wait with jaw correction until the child is aged 10 to 12 (argument: growth is less influential as deciduous teeth are replaced by permanent teeth, thus saving the child from repeated corrective surgeries) while other teams correct the jaw earlier (argument: less speech therapy is needed at a later age when speech therapy becomes harder). Within teams treatment can differ from each individual case dependant of type and severity of the cleft.

Most children with a form of cleft are monitored by the craniofacial team up to the age of 18.

Complications

Cleft may cause problems with feeding (see also Haberman Feeder), ear disease, and speech. Some of the primary and permanent teeth may also be missing. When the lip is cleft, the person may face social stigma within their own environment. This socialized stigma, however, generally depends on the severity of the abnormality, and the outward appearance of the person.

Controversy

In some countries cleft lip or palate deformity are either tolerated or officially sanctioned reasons to perform abortion beyond the legal fetal age limit, even though the fetus is not in jeopardy of life or limb. Some human rights activists contend this practice of "cosmetic murder" amounts to Nazi eugenics. A London clergywoman, who suffered from a congenital jaw deformity herself (not a cleft lip or palate as is sometimes reported), has started legal action to stop the practice in England as reported by CNN[2] and the BBC [3]

Famous people with a cleft

  • Tom Brokaw
  • Carmit Bachar
  • E. Charlton Fortune
  • J├╝rgen Habermas
  • Wendy Harmer
  • Doc Holliday
  • Jesse Jackson
  • Stacy Keach
  • Thomas Malthus
  • Cheech Marin
  • Rita MacNeil
  • Blaise Winter
  • Jason Robards
  • Chris Fry
  • Nikki Payne
  • Eric Edgar Cooke
  • Research reported that pharaoh Tutankhamun had cleft palate [4].
  • President Abraham Lincoln's son Thomas Lincoln had cleft palate [5].

It is a popular belief Joaquin Phoenix has a cleft lip. The mark on his lip is a miniform, an almost cleft that healed itself in utero. If the tissues joined up just enough to create correct bone and muscle tissues, no corrective surgery is required, as is the case with Joaquin Phoenix.

Cleft lip and palate in animals

Cleft lips and palates are occasionally seen in dogs and rarely in cats and ferrets. Most commonly, the defect involves the lip, rhinarium, and premaxilla. Clefts of the hard and soft palate are sometimes seen with a cleft lip. Difficulty with nursing is the most common problem associated with clefts, but aspiration pneumonia may be seen with a cleft palate. Providing nutrition through a feeding tube is often necessary, but corrective surgery can be done by the age of twelve weeks. Brachycephalic dogs such as Boxers and Boston Terriers are most commonly affected.[1]

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Cleft lip in a Boxer
3671-180px-cleft-lip-in-boxer-2-cleft-palate.jpg
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Cleft lip in a Boxer with premaxillary involvement


Resources



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July 23, 2014



Page Updated: July 22, 2006
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