Cleft lip, also called cleft lip, is a characteristic that some children are born with due to various factors. Both cleft lip and cleft palate, or a combination of both, occur during gestation: they are congenital, but that does not mean that they are always hereditary. It seems that taking folic acid supplements during pregnancy may help prevent these types of malformations.
What are the causes of cleft lip?
The specialty of dentistry and stomatology works with this type of congenital malformation.
The baby is born with cleft or cleft lip, these pathologies do not develop after birth. From week 5 to 17 of gestation is when alterations in the development of the facial shape and palate may occur.
Despite being born with it, cleft lip is a multifactorial trait, which is not always hereditary. Its casuistry is very diverse:
- Hereditary origin, with the alteration of a gene or several genes.
- Chromosomal alteration, in which case it would be part of a syndrome, such as Crouzon syndrome or Pierre Robin syndrome.
- Environmental factors during the mother’s gestation period.
- Certain medications, such as some anti-epileptic drugs, can generate these alterations inside the uterus.
- Maternal tumor that presses on the embryo.
Similarly, a small relationship has been observed between an older age of the mother and a slight increase in the incidence of this pathology. It seems that the intake of folic acid supplements during pregnancy helps to prevent this type of malformation. In any case, more studies are needed.
Characteristics of cleft lip
There are different types of cleft lip or cleft palate depending on the degree of involvement:
- Unilateral: they affect only one side of the face. It is more frequent to affect the left side.
- Bilateral: they affect both sides.
According to the degree of tissue involvement:
- Incomplete: there are babies born with a cleft that only affects the lip and part of the nasal ala, which we call cleft lip.
- Complete: other babies present a more complex pathology that also affects the palate. It can even reach the uvula or uvula, the so-called complete cleft lip and palate. There are clefts only of the palate; and even those that only affect the uvula.
We can also find a type of submucous cleft palate, where apparently the shape of the palate is normal, but it is under the superficial tissues where the cleft is found.
It is important to emphasize, for the parents’ peace of mind, that the child with some variety of cleft lip and palate can suffer from various alterations in different health areas, but not all of them are necessarily manifested in all cases. However, professionals must take them all into account to prevent them and minimize the negative impact on health.
This affectation can present:
- Facial alterations: in the shape and aesthetics of the face.
- Occlusal alterations: in the shape, width of the dental arches and the way they relate to each other, which affects the way the person bites and swallows.
- Dental alterations: in the shape, color or number of teeth. Frequently, there is a higher incidence of caries, which is why dental hygiene is so important.
- Alterations in the Palate Musculature and Speech: such as hyper-nasality in speech, when the air comes out through the nose when it should not and sounds different.
- Alterations in the Lingual Function: both in swallowing and at rest.
- Alterations in Hearing: due to the accumulation of liquid and mucus in the ear; and the consequent repeated infections that this causes.
- Alterations of the musculature around the mouth: a very everted lower lip (protruding) or an upper lip with little mobility due to the scar.
- Alterations of the Body Position
Cleft lip, a multidisciplinary treatment
For a good final result in the treatment of this pathology, a multidisciplinary approach is essential. Different health professionals must be coordinated: pediatric surgeons, maxillofacial surgeons, plastic surgeons or microsurgeons. In addition to a team of orthodontists, pediatric dentists, prosthodontists, physiotherapists, osteopaths, speech therapists, ENT specialists or geneticists. The work of psychologists or psychiatrists is also important, as there may be a negative impact on the patient’s psycho-social development and self-esteem.
The role of orthodontics in the treatment of the patient with cleft lip or cleft lip and palate covers a wide range of aspects. Orthodontic follow-up should be carried out from the time they are babies until they reach adulthood, always within a multidisciplinary environment. The orthodontist takes care of:
- The motivation in the oral-dental hygiene of the patient, from newborns even if there is no erupted tooth; as well as guiding the eruption of teeth, often altered.
- Perform maxillofacial orthopedics at very early ages, such as 5 years, if the child cooperates and the deformity requires it. There are even protocols of hospital teams where orthopedics is performed on infants for a better outcome of certain surgeries.
- Assist the surgeon, speech therapist, physiotherapist, osteopath in their work.
- Obtain a healthy masticatory function, and of course a better smile aesthetics.
- During the treatments it is the responsibility of the health professionals to communicate to the patient and his family the real expectations, personalized in each case, and always with the illusion of visualizing the end of the tunnel.
- The patient and his or her family are the center of this team. We must pay attention to their needs in an individualized manner, in the same way that they must allow themselves to be advised by the health professionals.