life

Oral clefting occurs when the tissues of the lip and/or palate of a fetus don't grow together early in pregnancy. Children with clefts often don't have enough tissue in their mouths, and the tissue they do have isn't fused together properly to form the roof of their mouths.

A cleft lip appears as a narrow opening or gap in the skin of the upper lip that extends all the way to the base of the nose. A cleft palate is an opening between the roof of the mouth and the nasal cavity. Some children have clefts that extend through both the front and rear part of the palates, while others have only partial clefting.

There are generally three different kinds of clefts:

• cleft lip without a cleft palate
• cleft palate without a cleft lip
• cleft lip and cleft palate togeth

Doctors don't know exactly why a baby develops cleft lip or cleft palate, but believe it may be a combination of genetic (inherited) and environmental factors (such as certain drugs, illnesses, and the use of alcohol or tobacco while a woman is pregnant). The risk may be higher for kids whose sibling or parents have a cleft or who have a history of clefting in their families. Both mothers and fathers can pass on a gene or genes that cause cleft palate or cleft lip.

A child with a cleft lip or palate tends to be more susceptible to colds, hearing loss, and speech defects. Dental problems - such as missing, extra, malformed, or displaced teeth, and cavities - also are common in children born with cleft palate.

Many children with clefts are especially vulnerable to ear infections because their eustachian tubes don't drain fluid properly from the middle ear into the throat. Fluid accumulates, pressure builds in the ears, and infection may set in. For this reason, a child with cleft lip or palate may have special tubes surgically inserted into his or her ears at the time of the first reconstructive surgery.

Feeding can be another complication for an infant with a cleft lip or palate. A cleft lip can make it more difficult for a child to suck on a nipple, while a cleft palate may cause formula or breast milk to be accidentally taken up into the nasal cavity. Special nipples and other devices can help make feeding easier; you will probably be given information on how to use them and where to buy them before you take your baby home from the hospital. And in some cases, a child with a cleft lip or palate may need to wear a prosthetic palate called an obturator to help him or her eat properly.

Members of a child's cleft lip and palate treatment team usually include:

• a geneticist
• a plastic surgeon
• an ear, nose, and throat physician (otolaryngologist)
• an oral surgeon
• an orthodontist
• a dentist
• a speech pathologist (often called a speech therapist)
• an audiologist
• a nurse coordinator
• a social worker and/or psychologis

Surgery is usually performed during the first 12 to 18 months to repair cleft lip and/or cleft palate. Both types of surgery are performed in the hospital under general anesthesia.

Cleft palate surgery involves drawing tissue from either side of the mouth to rebuild the palate. It requires 2 or 3 nights in the hospital, with the first night spent in the intensive care unit. The initial surgery is intended to create a functional palate, reduce the chances that fluid will develop in the middle ears, and help the child's teeth and facial bones develop properly. In addition, this functional palate will help your child's speech development and feeding abilities.

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http://www.kidshealth.org/parent/system/surgical/cleft_lip_palate.html