Understanding

A cleft lip is a disorder in the form of a gap in the upper lip. This cleft can occur on the roof of the oral cavity (cleft palate), it can also only be on the lips (cleft lip). In some cases, it can also occur in both parts. But in general, almost half of cases of cleft lip involve a gap in the upper lip and roof of the mouth.

This abnormality can be detected through an ultrasound procedure from the first trimester of pregnancy. At that time, you can see if there is a disturbance in the process of developing the facial area – including the roof of the mouth. That is why this condition is classified as a birth defect.

Diagnosis

A cleft lip can be detected during pregnancy or known as antenatal diagnosis. The examination process is carried out using an ultrasound procedure – both 3-dimensional and 4-dimensional ultrasound.

Doctors can see any difference in the development of the facial structure of the fetus during the first-trimester antenatal examination. When you see this, the doctor may offer you to do a fluid test.

The fluid test procedure is carried out by taking a sample of amniotic fluid from the uterus. This test will show whether the fetus has inherited a genetic syndrome that can cause other birth defects.

Symptoms

The main symptom of cleft lip can be seen immediately, namely the presence of a gap in the upper lip or the roof of the oral cavity. In addition, there are also several other symptoms, such as:

• Difficulty sucking breast milk
  Babies with cleft lips will have difficulty sucking milk, because the mouth conditions make it difficult to make sucking movements. This can be overcome by using special bottles recommended by pediatric dentists and pediatricians.
• Difficulty speaking
  Depending on the severity, in some conditions cleft lip can also cause difficulty speaking. However, the size of the gap is not an indicator of how serious the speech impediment is. Even a small gap can cause speech difficulties.
• Hearing loss
  All normal children’s ears produce thick, sticky ear fluid. However, a gap in the cleft lip can cause the fluid to accumulate in the eardrum. This causes impairment or even temporary hearing loss.
  In addition, the accumulation of fluid in the middle ear can also affect the eustachian tube, which is the tube that connects the ear to the oral cavity. This can result in ear infections.
• Impaired growth of the jaw and teeth
  Cleft lips can also affect the growth of the jaw and the process of growing teeth. The arrangement of teeth can be crowded due to underdeveloped jaws, resulting in speech disorders. Therefore, fast and appropriate treatment is needed to improve the condition of the cleft lip.

Treatment

Handling a child with a cleft lip requires a special team of doctors. The team consists of dentists specializing in oral surgery, plastic surgeons, speech therapists, audiologists (hearing specialists), pediatricians, pediatric dentists, orthodontists, psychologists, and geneticists.

Surgery is commonly performed to treat cleft lip. The operating time varies, depending on the condition of the cleft lip. Usually, the operation used in this case is by means of general anesthesia.

Surgery to close clefts in the lips can be done when the baby is three months old and has sufficient body weight. Meanwhile, surgery to close the gap in the roof of the oral cavity can be done at about six months of age.

As the child gets older, other surgeries may be needed to improve the appearance of the lips and nose, as well as the function of the roof of the mouth. If there is a gap in the gums, bone implants can be done to overcome it.

Meanwhile, to improve speech difficulties, children can undergo speech therapy with experts. In addition, pediatric dentists and orthodontists can provide care related to child dental care.

Prevention

Cleft lip prevention can be started during pregnancy, such as:

• Eat nutritious foods.
• Avoid smoking and drinking alcohol.
• Visit your obstetrician regularly for monitoring.
• Consume 400 micrograms of folic acid daily, at least one month before conception and during the first two months of pregnancy.

You also need to pay attention to the consumption of drugs that can increase the risk of this disorder, namely antiepileptic drugs such as phenytoin and sodium valproate.

Not only that, the consumption of steroid tablets and the drug methotrexate, which is usually used in the treatment of cancer and certain inflammatory diseases, can also increase the risk. If you are taking these drugs, you should first consult with your doctor before becoming pregnant.

Reason

Until now the cause of cleft lip is still unknown. However, research shows that the process of forming this disorder has started since the early weeks of pregnancy.

When the gestational age reaches 6 weeks, the upper lip and roof of the baby’s mouth cavity in the womb will begin to form. The lips and oral cavity are formed from tissue that runs on both sides until they unite in the middle of the mouth. If these tissues fail to unite, a fissure will form in the upper lip or roof of the oral cavity.

Although the exact cause of cleft lip is not known, experts suspect that a combination of genetic and environmental factors play a role. If a parent suffers from a cleft lip, the child’s risk of having this disorder will be even higher.

Meanwhile, environmental factors that can trigger cleft lip in babies are the mother’s lifestyle during pregnancy. For example due to side effects of drugs, illness or infection suffered by the mother, smoking or consumption of alcoholic beverages during pregnancy. In fact, a deficiency of folic acid can also trigger this disorder.