Health Report: Cleft palates, cleft lips require life-changing surgeries

They are called orofacial clefts but are better known as cleft lips or cleft palates. They are among the most common birth defects in the world, affecting about one in 500 to 700 births, according to the World Health Organization.

The rate varies across different ethnic groups and geographical areas, according to WHO.

In the United States, about 7,000 babies are born with a cleft palate, cleft lip or both each year, according to the Centers for Disease Control and Prevention. Birth defects like these are usually corrected during infancy with surgery, and the child continues to live a normal life. But in other parts of the world where access to health care is a problem, children with orofacial clefts can face a lifetime of social and health problems.

“In the U.S., a child born with a cleft palate or cleft lip is generally treated immediately, with good follow-up care,” said Thomas Vecchione, plastic surgeon and longtime member of the Scripps Mercy Outreach Surgical Team (M.O.S.T.) volunteer medical group. “But that’s not the case in many parts of the world where there is a lack of treatment facilities and children who are born with birth defects go untreated.”

M.O.S.T. has traveled to Mexico’s interior yearly for nearly three decades to provide free surgeries to thousands of children and adults to correct cleft lips, cleft palates, burn scars, crossed-eyes and a variety of other conditions. The surgical teams usually number more than 50 and are made up of volunteer physicians, including plastic surgeons and anesthesiologists, nurses and support staff. The majority are from Scripps, which supports the community benefit program.

Since orofacial cleft patients usually require follow-up care, many M.O.S.T. patients have been following the group for years, often traveling long distances to make an appointment.

Cleft lip and cleft palate occur when a baby’s lip or mouth does not form properly during pregnancy. A cleft lip happens when the tissue that makes up the lip does not join completely before birth, resulting in an opening in the upper lip that can go as far as into the nose. In the U.S., about 4,440 babies are born with a cleft lip.

A cleft palate happens when the tissue that makes up the roof of the mouth does not join together completely during pregnancy, resulting in an opening in the roof of the mouth. In the U.S., about 2,650 babies are born with a cleft palate, which may include a cleft lip, according to the CDC.

What are the symptoms? Complications?

A cleft in the lip or palate is usually identifiable at birth or can be detected during pregnancy using ultrasound.

A cleft in the mouth may go unnoticed when it occurs in the muscles of the soft palate, also known as submucous cleft, which are in the back of the mouth’s lining. Symptoms of submucous cleft palate may include difficulty with feedings, difficulty swallowing, nasal speaking voice, chronic ear infections, which are signs for parents to schedule a visit with their child’s physician.

Unless treated orofacial clefts can affect feeding, speech development and hearing.

Risk factors

Several factors increase the chances of a baby developing a cleft lip or cleft palate. This includes genetics or family history, exposure to certain substances during pregnancy and the mother’s medical condition especially if she is diabetic or obese.

According to the CDC, women with diabetes diagnosed before pregnancy are more at risk of having a child with a cleft lip or cleft palate or both. Women who smoke during pregnancy or who are obese face the same risks.

Treatment

Treatment can vary according to the complexity of the cleft. Additional surgeries may be necessary after the initial cleft repair to help improve speech or the appearance of the lip and nose.

“Depending on the severity of the problem, one surgical procedure and one small revision can repair the cleft lip or palate and bring about life-changing results” said Dr. Vecchione, who recently returned from a M.O.S.T. mission in Irapuato in the Mexican state of Guanajuato.

“Cleft lip surgery can be done on infants as young as 1 or 2 months old, while cleft palate repair is usually performed when the child is a year or year-and-a-half old,” Dr. Vecchione said.

In the U.S., the CDC recommends surgery to repair a cleft lip take place within the first 12 months of life, and surgery to repair a cleft palate take place within the first 18 months. Follow-up surgeries may continue into late teen years.

Surgical repair can improve the appearance of a child’s face in addition to improving breathing, hearing and speech and language development.

“Not only does this affect their appearance, but it improves their self-confidence, removes negative self-image and can greatly impact the opportunities they may encounter throughout their lives,” Dr. Vecchione said.

Since 1988, M.O.S.T. has provided corrective surgeries to more than 12,000 patients thanks largely to philanthropic support to fund trips to Mexico. On May 21, M.O.S.T. is hosting its fifth annual Mariachi Festival fundraiser at the Kitchens for Good at the Jacobs Center, 404 Euclid Ave., San Diego. For more information visit: www.scripps.org/mostfestival.

For more information about Scripps Health, visit http://www.scripps.org/KUSI or call 858-240-5075.

Categories: Health