Baby With Tape Over Mouth for Cleft Lip

Overview

What are fissure lip and scissure palate?

Cleft lip and cleft palate are malformations (defects) in the face and mouth that occur very early in pregnancy, while the infant is developing inside its mother. A crevice results when the tissues do not join together properly.

• A cleft lip is a physical separation of the two sides of the upper lip, and appears every bit a narrow or wide opening or gap in all layers of the upper lip. This separation can include the gum line or the palate.
• A crack palate is a split up or opening in the roof of the mouth. A cleft palate can involve the hard palate (the bony front portion of the roof of the oral fissure) and/or the soft palate (the soft back portion of the roof of the mouth), and can exist associated with a cleft lip

Crevice lip and fissure palate can occur on i or both sides of the oral cavity. Because the lip and the palate develop separately, it is possible to take a fissure lip without a cleft palate, a fissure palate without a cleft lip, or both a cleft lip and cleft palate together (the near frequently occurring defect).

An babe with fissure lip. The same child, age two, afterward cleft lip repair.

Who gets cleft lip and/or cleft palate?

Fissure lip and/or cleft palate affects 1 in 1,000 babies every year, and is the fourth almost common nativity defect in the United states. Clefts occur more than frequently in children of Asian descent.

Twice as many boys as girls take a fissure lip, both with and without a scissure palate. Nevertheless, twice equally many girls as boys have fissure palate without a cleft lip.

Symptoms and Causes

What causes a cleft lip and scissure palate?

In about cases, the causes of cleft lip and cleft palate are not known, and these conditions cannot be prevented. Virtually scientists believe clefts are caused by a combination of genetic (inherited) and environmental (related to the natural world) factors. There seems to be a greater hazard of newborn having a cleft if a sibling, parent or other relative has had the problem.

Another crusade of a cleft lip/palate may be related to a medication a mother may have taken during her pregnancy, including antiseizure/anticonvulsant medications, acne treatment medications containing Accutane®, or methotrexate, a drug commonly used for treating cancer, arthritis and psoriasis.

Other factors that can contribute to development of a cleft include:

• Vitamin deficiency (folic acid)
• Smoking during pregnancy
• Substance abuse

The condition may also occur equally a result of exposure to viruses or chemicals while the baby is in the womb. In other situations, cleft lip and crevice palate may be function of another medical status.

Diagnosis and Tests

How are fissure lip and/or cleft palate diagnosed?

Because clefts cause obvious physical changes, they are easy to diagnose. Prenatal ultrasound can diagnose most clefts of the lip. Isolated crack palate is detected only in 7 percent of the patients during the prenatal ultrasound.

If a scissure has not been detected in an ultrasound before the baby is born, a physical test of the mouth, nose and palate can diagnose scissure lip or cleft palate after a child's birth. Sometimes, other tests may be conducted to learn if in that location are any other abnormalities.

Management and Handling

What issues are associated with cleft lip and/or cleft palate?

• Eating problems: With a separation or opening in the palate, food and liquids can pass from the mouth back through the nose. Usually, babies quickly learn how to consume and feeding is not a problem.
• Ear infections and hearing loss: Children with crevice palate are at increased risk of ear infections since they are more than prone to fluid buildup in the middle ear. If they are not treated, ear infections can cause hearing loss.
• Voice communication problems: Children with cleft palate may too take trouble speaking. These children's voices don't carry well, the vocalization may have on a nasal sound, and the oral communication may be hard to understand after palate repair. Non all children have these problems, and surgery may fix these problems entirely.
• Dental problems: Children with clefts are prone to many dental problems, including:
  • A greater number of cavities;
  • Missing, actress, malformed or displaced teeth that need to be treated.
  • A defect of the alveolar ridge, the bony upper glue that contains the teeth. A defect in the alveolus can: readapt, tip, or rotate permanent teeth; prevent permanent teeth from appearing; prevent the alveolar ridge from forming; and, cause premature loss of erupting canine and incisor teeth.

Who treats children who have cleft lip and/or palate?

Because of the number of oral wellness and medical issues associated with a cleft lip or fissure palate, a team of doctors and other specialists usually works together to develop a plan of intendance for each patient. Members of a cleft lip and palate team usually include:

• Plastic surgeon to evaluate and perform necessary surgeries on the lip and/or palate.
• Orthodontist to straighten and reposition teeth.
• Dentist to perform routine dental care.
• Prosthodontist to brand artificial teeth and dental appliances to improve the appearance and to make the changes needed for eating and speaking.
• Spoken communication pathologist to assess voice communication and feeding problems.
• Otolaryngologist (an ear, olfactory organ and throat doctor) to evaluate hearing issues and consider treatment options for hearing problems.
• Audiologist (a specialist in hearing disorders) to check and monitor hearing.
• Nurse coordinator to provide ongoing supervision of the child'due south health.
• Social worker/psychologist to support the family and take note of any adjustment problems.
• Geneticist to help parents and adult patients understand the chances of having more children with these conditions.

Treatment usually begins in infancy and often continues through early adulthood.

How are fissure lip and palate treated?

A cleft lip may crave 1 or ii surgeries, depending on the extent (complete or incomplete) and width (narrow or wide) of the cleft. The first surgery is commonly performed by the time a baby is 3 months old.

Several techniques can better the outcomes of cleft lip and palate repairs when used appropriately before surgery. They are not-invasive and dramatically change the shape of the infant's lip, olfactory organ and mouth:

• A lip-taping regimen can narrow the gap in the kid's fissure lip.
• A nasal elevator is used to help form the correct shape of the babe's nose.
• A nasal-alveolar molding (NAM) device may be used to help mold the lip tissues into a more favorable position in preparation for the lip repair.

The first surgery, to close the lip, normally occurs when the baby is between 3 and 6 months old. The second surgery, if necessary, is normally done when the child is half dozen months sometime.

Repair of a scissure palate is performed at 12 months and creates a working palate and reduces the chances that fluid will develop in the middle ears. To prevent fluid buildup in the middle ear, children with fissure palate usually need special tubes placed in the eardrums to aid fluid drainage, and their hearing needs to be checked once a twelvemonth. This is often washed at the time of palate repair.

Nearly 30-twoscore percent of children with a cleft palate need further surgeries to help amend their speech. Voice communication is usually assessed between ages iv and v. Oftentimes a nasopharyngeal scope is performed to check the movement of the palate and throat. A decision is and then made, together with the speech pathologist, if surgery is needed to improve the speech. This surgery is unremarkably performed around historic period 5.

Children with a cleft involving the glue line may also need a bone graft when they are about half-dozen-x years old to fill in the upper gum line and so that it can back up permanent teeth and stabilize the upper jaw. Once the permanent teeth grow in, a child will oftentimes demand braces to straighten the teeth and a palate expander to widen the palate.

Additional surgeries may be performed to improve the appearance of the lip and olfactory organ, shut openings betwixt the mouth and nose, assist breathing, and stabilize and straighten the jaw.

Outlook / Prognosis

What is the prognosis (outlook) for children who take crevice lip and/or palate?

Although treatment may have many years and require several surgeries, almost children affected by these weather can achieve normal appearance, spoken language and eating.

Living With

How should dental care needs of children with crevice lips or palates exist met?

Generally, the dental care needs of children who accept clefts are the same equally for other children. However, children with cleft lip and/or palate may have special problems related to missing, misshapen, or poorly positioned teeth that should be watched closely.

• Early on dental care: Like other children, children born with scissure lip and/or cleft palate require proper cleaning, expert nutrition, and fluoride treatment in gild to take salubrious teeth. Appropriate cleaning with a modest, soft-bristled toothbrush should brainstorm equally soon as teeth announced. If a soft children's toothbrush does not adequately make clean the teeth because of the dissimilar shape of the mouth and teeth, the dentist may recommend a soft, mouthwash-containing sponge on a handle to swab the child'south teeth. Many dentists recommend that the showtime dental visit be scheduled at about ane twelvemonth of age, or earlier if at that place are special dental bug. Routine dental intendance can begin effectually 3 years of age.
• Orthodontic care: A kickoff orthodontic evaluation occurs during the crack and craniofacial clinic. After teeth announced, an orthodontist can further evaluate a child's short and long-term dental needs. About children with a fissure palate will crave palatal expansion around age 6-7. After the permanent teeth erupt, an orthodontist tin align the teeth. Orthodontic care is required also in grooming for jaw surgery (orthognathic surgery).
• Prosthodontic care: A prosthodontist may make a dental bridge to replace missing teeth, or special appliances called "speech bulbs" or "palatal lifts" to help close the nose from the mouth and then that speech sounds more normal. The prosthodontist coordinates handling with the oral or plastic surgeon and the speech pathologist.

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Source: https://my.clevelandclinic.org/health/diseases/10947-cleft-lip-and-palate

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