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Health, Dr Tatenda Simango

JULY is international Cleft and Craniofacial Awareness and Prevention Month, a time to raise awareness and improve understanding of orofacial clefts (clefts of the lip and palate) and other conditions of the head and face. The children and mothers, in particular, face social rejection. This stigma disadvantages children in education, employment, marriage, community and is exacerbated by barriers to care.

The roof of the mouth is also called the palate. A cleft palate is when there is an opening or cleft in the roof of the mouth due to the palate not closing during development before birth. Other craniofacial birth defects include craniosynostosis (skull sutures fusing prematurely), anotia/microtia (ear is missing or underdeveloped) and anophthalmia/microphthalmia (missing or abnormally small eye).

The lip forms between the fourth and seventh weeks of pregnancy. As a baby develops during pregnancy, body tissue and special cells from each side of the head grow towards the centre of the face and join together to make the face. This joining of tissue forms the facial features, like the lips and mouth. A cleft lip happens if the tissue that makes up the lip does not join completely before birth.

This results in an opening in the upper lip. The opening in the lip can be a small slit or it can be a large opening that goes through the lip into the nose. A cleft lip can be on one or both sides of the lip or in the middle of the lip, which occurs very rarely. Children with a cleft lip also can have a cleft palate.

The roof of the mouth (palate) is formed between the sixth and ninth weeks of pregnancy. A cleft palate happens if the tissue that makes up the roof of the mouth does not join together completely during pregnancy. For some babies, both the front and back parts of the palate are open. For other babies, only part of the palate is open.

Children with a cleft lip with or without a cleft palate or a cleft palate alone often have problems with feeding and speaking clearly and can have ear infections. A baby with a cleft palate will probably need a special feeding bottle until the cleft is repaired. This is because the cleft prevents the baby from having a strong suction on the bottle or breast. Babies with a cleft lip do not usually need special bottles. They also might have hearing problems and problems with their teeth.

The causes of orofacial clefts among most infants are unknown. Some children have a cleft lip or cleft palate because of changes in their genes. Cleft lip and cleft palate are thought to be caused by a combination of genes and other factors such as things the mother comes in contact with in her environment, or what the mother eats or drinks, or certain medications she uses during pregnancy.

Centre of Disease Control reported on important findings from research studies about some factors that increase the chance of having a baby with an orofacial cleft:

• Women who smoke during pregnancy are more likely to have a baby with an orofacial cleft than women who do not smoke.
• Women with diabetes diagnosed before pregnancy have an increased risk of having a child with a cleft lip with or without cleft palate compared to women who did not have diabetes.
• Women who used certain medicines to treat epilepsy such as topiramate or sodium valproic acid, during the first trimester (the first three months) of pregnancy have an increased risk of having a baby with cleft lip with or without cleft palate compared to women who didn’t take these medicines.

Orofacial clefts, especially cleft lip with or without cleft palate, can be diagnosed during pregnancy by a routine ultrasound. They can also be diagnosed after the baby is born, especially cleft palate. However, sometimes certain types of cleft palate (for example, submucous cleft palate and bifid uvula) might not be diagnosed until later in life.

Services and treatment for children with orofacial clefts can vary depending on the severity of the cleft; the child’s age and needs and the presence of associated syndromes or other birth defects, or both.

Surgery to repair a cleft lip usually occurs in the first few months of life and is recommended within the first 12 months of life. Surgery to repair a cleft palate is recommended within the first 18 months of life or earlier if possible. Many children will need additional surgical procedures as they get older. Surgical repair can improve the look and appearance of a child’s face and might also improve breathing, hearing, and speech and language development. Children born with orofacial clefts might need other types of treatments and services such as special dental or orthodontic care or speech therapy.

With treatment, most children with orofacial clefts do well and lead a healthy life. Some children with orofacial clefts may have issues with self-esteem if they are concerned with visible differences between themselves and other children. Parent-to-parent support groups can prove to be useful for families of babies with birth defects of the head and face, such as orofacial clefts.

If you have a child with an isolated cleft, then the chance of you having another child with the same condition depends upon how many people in your family also have a cleft. The greater the number, the greater the risk. Some studies suggest taking folic acid when pregnant may reduce the chances of having a cleft. Folic acid is found in most multivitamins.

Volunteer surgeon through Operation of Hope provide free, life-changing surgery & health care for children in desperate need and create a self-sustaining programme of hope through education, so that every child has the hope of a normal life. Cleft lip patients must be at least 10 months old and in good health. Cleft palate patients must be at least 18 months old. May they keep up the good work.