Cleft Lip & Cleft Palate (Harelip)

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Cleft Lip & Cleft Palate
Body Parts: Head
Medical Subjects: Children's Health Oral Cavity Genetic disease
Overview

What Is Cleft Lip & Cleft Palate?

What disease is cleft lip?

Cleft lip is a congenital developmental deformity of the oral and maxillofacial region, also known as cleft lip. In the first trimester of pregnancy, under the influence of certain factors during the development of the fetus in the mother, a gap is formed between the lip and palate due to developmental disorders of the soft tissues of the head and face. It is characterized by a cracked upper lip and a collapsed nose. Patients with cleft palate can also see cleft palate in the mouth, cleft palate voice (vowels are not loud and with a strong nasal, consonants are not clear and weak), etc.

What is the relation between cleft lip and cleft palate?

Cleft lip and cleft palate belong to congenital developmental deformity of oral and maxillofacial region, and these two diseases are collectively referred to as oral fissure deformity. Cleft lip patients are often accompanied by cleft palate, but unlike cleft palate patients, cleft lip only shows abnormal soft tissues. Therefore, some physiological abnormalities in cleft lip patients, including sucking dysfunction, poor self-cleaning effect of mouth and nasal cavity, and disordered dentition, are less severe than those in cleft palate patients.

What are the types of cleft lip?

At present, the following clinical classifications are mostly adopted for the classification of cleft lip in some countries or regions:

  • Unilateral cleft lip (I, II, III): I: dehiscence limited to the vermilion area. II: Partial dehiscence of upper lip and complete nasal floor. III: Complete dehiscence of the entire upper lip to the nasal floor.
  • Bilateral cleft lip: Bilateral cleft lip is classified according to the classification of unilateral cleft lip.
  • Implicit cleft lip: The skin and mucosa were not cracked, but the underlying muscle tissues were not united, and there appeared such malformations as shallow groove-shaped depression and lip peak separation.

Is cleft lip common?

In recent years, the prevalence of cleft lip and palate has been increasing, the ratio of male to female is 1.5: 1, and there are more males than females. Race/ethnicity may also contribute to the prevalence of facial cleft. The lowest prevalence was among black Americans (10.2/10,000) and the highest was among American Indians or Alaska Natives (20.5/10,000), with moderate prevalence among other groups (Caucasian, Hispanic, Asian, Pacific Islander).

Cause

What Is The Cause Of Cleft Lip?

What bad habits and diseases of the mother during pregnancy cause the occurrence of cleft lip?

During the first three months of pregnancy, if the mother has vitamin deficiency, smoking, drinking and other bad habits can increase the risk of cleft lip/palate, has been confirmed to include vitamin A and vitamin B2, B6, B12 and other deficiencies, as well as pantothenic acid and folic acid deficiency as a possible cause. Medications such as phenytoin, the folic acid antagonist methotrexate may also increase the risk of cleft lip/palate in the fetus if the mother has diabetes or is ill during pregnancy. Pregnant mothers with epilepsy are 4-11 times more likely to have cleft lip/palate deformities in their fetuses than normal pregnant mothers.

What is the probability of the cleft lip fetus appearing repeatedly in the same pregnant woman?

Cleft lip is a disease caused by a combination of multiple factors. The proportion of children with cleft lip who are pregnant again after the mother gave birth to the first child due to reasons other than genetic factors is not significantly different.

According to the current research, the probability that the fetus born to the mother who is pregnant again after giving birth to the first child with cleft lip due to genetic factors is 31.4%.

Can cleft lip be inherited?

Similar deformities can often be found in the immediate or collateral relatives of cleft lip/palate patients and a genetic link is therefore considered. Genetic studies also suggest that orofacial cleft is a polygenic inheritance disease. At present, the proportion of patients with cleft lip and palate with family history is 7.93% and 8.64% respectively.

Are there differences in sex, region and parents' age in the occurrence of cleft lip?

In general, more males than females have cleft lip with cleft palate, and the male deformities are more severe. However, there are more females than males with simple bilateral cleft lip. Incidence is lower in developed regions than in less developed regions. Older pregnant women over 35 years of age have a higher probability of giving birth to children with cleft lip/palate, and the deformity of male babies is more serious.

Symptom

What Are The Symptoms Of Cleft Lip?

What symptom and expression can cleft lip cause?

Patients with cleft lip mainly present with nasal collapse and lip dehiscence deformity. The simple cleft lip is mostly seen on the left side, which has little influence on sucking and pronunciation function except for causing facial deformity.

What harm does cleft lip have to the body?

For patients with third-degree cleft lip, the affected side nose ala is abduction, flat and the nostril is enlarged. Cleft lip and cleft palate will lead to children eating, hearing, disease and speech disorders and may hinder the child's tooth development, such as not combined with cleft palate, simple cleft lip generally does not affect lactation.

Detect

How To Check For Cleft Lip?

Can cleft lip be diagnosed by prenatal screening?

The optimal time for prenatal ultrasound examination of fetal cleft lip and palate is 18–28 weeks gestation. At this time, the fetal lip and mouth is relatively well developed, the amniotic fluid is relatively abundant, and the image is the clearest. More than 85% of fetal cleft lip and palate deformities can be detected. However, the disease is not part of the prenatal screening program in our country.

Through ultrasonic screening, it needs the cooperation of many factors, for example, the face of the child is facing the detection instrument, there is no umbilical cord or 1/3 under the blocking surface of four limbs, and the fetal facial movements separate the fissures, which can be found.

What related inspections are needed to diagnose cleft lip?

Cleft lip can be diagnosed according to the characteristic clinical manifestation of upper lip cracking. After the definite diagnosis, assessment of speech function, examination of velopharyngeal function, microscopic examination of nasopharyngeal fibers, lateral radiography of nasopharyngeal cavity with X-ray and whole craniofacial computed tomography should be performed if conditions permit. Relevant examinations are conducted to exclude other complications.

Prevention

How To Prevent Cleft Lip?

Are there any preventive measures for cleft lip?

During the first trimester of pregnancy (before 12 weeks of pregnancy), especially during the third to eighth weeks of embryonic development, it is important to take active precautions:

  • Women of childbearing age to carry out related knowledge education, pay attention to the rational distribution of nutrients during pregnancy, pregnancy before 3 months and early pregnancy to pay attention to supplement folic acid.
  • In case of vomiting and partial eclipse, vitamins A, B2, B6, C and E as well as minerals such as calcium, phosphorus and iron should be added in time.
  • Pregnant women should avoid mental stress and mood swings, maintain a happy mood, avoid fatigue and trauma.
  • Avoid contact with excessive X-rays and direct exposure to a large number of microwaves, and avoid contact with toxic substances as much as possible.
  • Quit smoking and drinking.
  • Try to avoid infection including cold, hepatitis and other viral diseases, as well as gastrointestinal tract, skin and mucosa and other viral infections.
  • Discontinue medications that may cause fetal abnormalities, such as medications for seizures, and methotrexate.
Treatment

How To Treat Cleft Lip?

What are the treatment methods of cleft lip?

Surgery is the only important means to repair cleft lip. This is a very demanding operation, and the effect of the operation will directly affect the patient's mind and body. To achieve this goal, there is general international recognition that comprehensive sequential therapy may involve:

  • Wearing an prosthesis to close the defect (fitting into the mouth to simulate normal oral morphology)
  • Preoperative and postoperative orthodontic treatment
  • Surgery closes the cleft in the upper palate and the defect in the gums
  • Correct bad pronunciation habits
  • Restoration of missing teeth by installing dentures
  • psychological counseling
  • Jaw deformity secondary to cleft palate also require surgical repair of facial bone deformities

Can cleft lip pass medicaments to treat?

Current research results indicate that cleft lip cannot be treated by medicine in fetal stage or postnatal stage. However, mental and psychological abnormalities such as inferiority complex, reluctance to communicate with others, and irritability caused by cleft lip deformity can be treated with specific drugs under the guidance of a specialist.

Can the cleft lip be cured after treatment?

Surgical treatment of cleft lip aims to restore the normal upper lip morphology, restore the continuity of the muscles of mouth and lip, and restore the normal anatomical morphology of nose. The surgical effect is affected by many factors. However, based on the full understanding of the anatomical characteristics of lip and cleft lip, and according to the anatomical characteristics of specific patients, a multidisciplinary comprehensive sequence treatment method is adopted, and satisfactory treatment results can be achieved with the careful treatment plan and proper implementation.

What is the sequence treatment of cleft lip?

Cleft lip repair is a demanding operation, and the postoperative effects will directly affect the physical and mental health and quality of life of patients, so careful preparation is needed. At present, it is generally recognized in the world that comprehensive sequence therapy is adopted, i.e., before cleft lip repair, especially for children with severe complete cleft lip accompanied by cleft palate and nasal deformity, orthodontic treatment should be performed first to restore the arch shape of the children and improve the nasal deformity of the children, so as to create favorable hard tissue conditions for cleft lip repair as much as possible. After the primary cleft lip repair surgery, the remaining secondary deformities of nose and lip should be corrected in two stages at an appropriate time according to the situation. General choice after 16 ~ 18 years old, that is, after the end of the facial development, can avoid facial development caused by deformity again.

When is the optimal operation treatment opportunity of cleft lip?

Conventional cleft lip and palate repair is arranged within 3–6 months after the child is born, and immediate surgical repair is not required in most neonates. Unilateral cleft lip repair should be performed 2–3 months after birth. Bilateral cleft lip repair is a complex and traumatic procedure that can be delayed to six months. If the whole body condition of the child is poor, we will perform the operation after the nutrition is improved. It is best not to exceed 1 year old.

What side effect does cleft lip operation possibly have?

At present, it is considered in the academic circles that the cleft lip surgery may inhibit the growth and development of the middle part of the patient's face to a certain extent, such as the development of jawbone and alveolar bone. However, cleft lip repair is the only means to repair the cleft lip deformity, and it is crucial to minimize the interference of the surgery on the development of jawbone.

What are the precautions before and after cleft lip surgery?

Before cleft lip surgery, patients should be fully evaluated, including body weight, nutritional status, heart and lung conditions, presence of upper respiratory tract infection and dyspepsia, and chest radiography should be performed to exclude congenital heart disease and thymic hypertrophy.

Postoperative prevention of repeated dehiscence is particularly important and should prevent crying in children. Patients were fed with an eyedropper or a small spoon after surgery, and the general recovery period was about 2–3 weeks.

Can you speak normally after cleft lip operation treatment?

After cleft lip surgery, the normal shape and muscle continuity of the upper lip can be restored, and the normal voice function can be restored after certain voice training.

Do you need to have plastic surgery again after cleft lip surgery?

As cleft lip repair is a plastic surgery with high aesthetic requirements and patients are generally younger during the initial operation, some patients still need two-stage reconstructive surgery for the residual or secondary nasal and lip deformities.

How to nurse after cleft lip operation?

Children with cleft lip should lie flat with their heads to one side when they are not awake after anesthesia, so as to avoid aspiration. A small amount of fluid or breast milk (administered with a dropper or scoop) may be administered 4 hours after awakening from general anesthesia. The wound dressing can be removed on the first postoperative day to allow exposure, but the child's hands should be restrained to prevent scratching the wound. Postoperative systemic antibiotics should be given to prevent infection, and the stitches can be removed from the normally healed wound within 5–7 days. Attention should be paid to prevent the wound from being cracked due to the fall of children.

How to carry out speech training after cleft lip surgery.

Correction of pathological speech sounds of cleft lip and palate is a long-term and arduous task. Simple generalization refers to correction of bad pronunciation habits with standard pronunciation method and training with standard speech system so that patients can master correct pronunciation methods and rules. You can consult your doctor, cleft lip and palate hospital or dental hospital for the treatment.

What mental and psychological precautions do cleft lip patients have?

Cleft lip children suffer setbacks in their studies, marriage, job selection, social and family life due to nose and lip deformities and unclear speech, thus affecting their psychological activities. Mainly manifested as inferiority, withdrawn, paranoid or restless, there will be learning skills, motor development disorders. Psychological dredging for children should be carried out by professionals from their parents, correct guidance, and actively cooperate with medical treatment. It also needs the common attention of the whole society.

Life

What Should Patients With Cleft Lip Pay Attention To In Life?

How to feed children with cleft lip?

Simple cleft lip had little effect on sucking function and little effect on feeding. If combined with cleft palate, children may have the loss of sucking function, so feeding is relatively difficult for children:

  • Family members should pay attention to the body position of the child during feeding: the child should take a sitting position, a 45-degree hug position or a prone position, and the head and neck of the child should form a straight line with the shoulder or bend slightly to the chest. No one should lie flat, so as to avoid choking and coughing.
  • Choose a nipple with a cross opening. The nipple should be kept with the top down, and the parents should adopt the feeding method of squeezing the feeding bottle.
  • Usually, you can train the cheek and tongue functions by blowing balloons, sucking empty pacifiers, or massaging muscles.
  • Children with cleft lip and palate tend to swallow a large amount of air during feeding, so they need to be fed in batches, and the time for each feeding is limited to 30–40 minutes. Too long a batch of milk will cause children to inhale a large amount of air. The amount of milk taken is the same as that of a normal child, and the infant can be fed in multiple times.
  • Pat the child's back lightly when the feeding is suspended to help expel air.
  • Clean the mouth and nasal cavity of the child promptly after feeding.

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