Cleft lip and Cleft palate

Cleft lip and Cleft palate are most common congenital birth defects which result from failure to close facial structure that are developing in utero.

Clefts of the lip, alveolus, hard and soft palate are the most prevalence congenital abnormalities of the orofacial structures. Usually present at birth.

They mostly occurs as an isolated diformities , but they can be also associated with another medical conditions, mostly congenital heart disease besides this these features also associated with more than 300 others recognized syndromes too.

Thus baby who born with those features must be initially evaluated or examined by pediatrician in order to rule out and find the other congenital abnormalities. As a certain instant genetic councelling must be done if those incident occurs.

Incidence of Cleft lip and Cleft palate

1:600 live births and of isolated cleft palate is 1:1000 live births . Mostly increases in Oriental groups ( 1:500) and reduces in the black people (1:2000) . In Indian tribes of Montana , USA there reported highest incidence of cleft lip and palate .
Sub – groups exists such as cleft lip with / without cleft palate , cleft palate alone and submucous cleft palate .

Cleft types typical distribution such as 
• Cleft lip alone include 15%.• Isolated  cleft palate include 40%.• Cleft lip and palate include 45%.
Note :- Cleft lip /palate most prevalence in case of male , where as cleft palate in females alone. In 60 % cases unilateral cleft lip definitely is in left side.

Cleft lip and Cleft palate cause

Unknown ,  however genetic and environmental factors play major role.Family history of cleft lip and palate where 1st degree relative is  affected and increase the risk to 1:25 live births.

Genatic factor influence mostly in cleft lip/palate than cleft palate alone. In cleft palate alone environmental factors plays major role .

Environment factors that causes clefting lips in maternal epilepsy condition and certain drugs such as dizepam , phenytoin and corticosteroids. Antenatal folic acid supplemental is given to pregnent lady in order to prevent cleft lip and palate as well.

As well know most clefts of the lip and palate occurs as a isolated deformity the most important is Pirre Robin sequence and there comprises isolated cleft palate , retrognathia and glossoptosis ( posteriorly displaced tongue ) which is accociated with initial respiratory and feeding problems.

Cleft lip and Cleft palate Risk factors 

• Smoking in pregncy time 

• Obesity 

• Diabetes 

•  Elderly mother

•  Certain medications such as anticonvulsant ( phenytoin, lamotrigin , valporic acid etc) , corticosteroids , Diazepam, Alcohol .

Cleft lip 

Dissipations of the muscles of the upper lip and nasolabial region . It  contains an opening in the upper lip that can  extend into the nose and  opening can be on one side, both sides, or in the middle as well .
• Unilateral cleft lip 
Here the nasolabial and bilabial muscles ring disrupted on one side that result in asymmetrical deformity including the external nasal cartilages , nasal septum and premaxilla .
• Bilateral cleft lip 
This deformity more profound but symmetrical . Here 2 superior muscles rings are disrupted on both sides,  occuring a flaring of the nose , a protrusive premaxilla and prolabium .

Cleft palate 
Embrologicaly primary palate anterior to incisive foramen where as secondary palate is behind the incisive foramen i.e divided into the hard palate and more posteriorly , the soft palate.
Cleft palate occurs due to failure of fusion of two Palatine shelves and the failure may be confined to the soft palate or include both soft as well as hard palate. 
Incomplete cleft palate :- It is the condition where the cleft of the hard palate remains attached to the nasal septum and vomer .

Complete cleft palate :- It is the condition where the nasal septum and vomer are completely separated from the palatine processes.
In cleft of the soft palate the muscle  fibers are oroentated in an anteroposterior direction, inserting the posterior edge of hard palate.
Normal hard palate divided into 3 anatomical and physiological zones 
A. The  central palatal fibromucosa :-  which is thin and lies directly below the floor of nose .
B. The maxillary fibromucosa:-  which is thick and contains the greater palatine neuromuscular bundle.
C. The gingival fibromucosa which lies more lateral and adjacent to the teeth.

cleft lip and palate Treatment

Surgical repair , speech therapy and dental care .
Prognosis 
Good when treatment is done in appropriate time with appropriate and related doctors.

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