Cleft Palate

Overview

Cleft palate is a birth defect where there is an opening (cleft) in the roof of the mouth (palate), which can occur with or without a cleft lip. The cleft palate can lead to difficulty in swallowing, potential for liquids or foods to come out of the nose, and a nasal speaking voice. Cleft palate can be associated with other genetic conditions, such as 22q11.2 deletion syndrome, and may also be accompanied by distinct facial features. If your child has signs and symptoms of a submucous cleft palate, it is important to consult with your child's doctor.

Understanding the disease

Symptoms

The symptoms of cleft palate include difficulty with feedings, difficulty swallowing with the potential for liquids or food to come out of the nose, nasal speaking voice, and chronic ear infections.

Risk Factors

Risk factors that may increase the likelihood of a baby developing a cleft lip and cleft palate include:

1. Family history: Parents with a family history of cleft lip or cleft palate face a higher risk of having a baby with a cleft.
2. Exposure to certain substances during pregnancy: Cleft lip and cleft palate may be more likely to occur in pregnant women who smoke cigarettes, drink alcohol, or take certain medications.

Development

Cleft palate can develop in different ways, including:

1. Complete cleft palate: This type of cleft palate involves a complete separation of the roof of the mouth (palate), creating an opening (cleft) that extends from the front of the mouth to the back. It can affect one or both sides of the palate, and may include the gums and the junction between the mouth and the nose.
2. Incomplete cleft palate: In this type of cleft palate, the separation is only partial or incomplete, resulting in a cleft that doesn't extend through the entire length of the palate. This may involve only a small opening or a split that doesn't reach the back of the mouth.
3. Submucous cleft palate: This is a rare type of cleft palate where the cleft occurs only in the muscles of the soft palate (the part of the palate at the back of the mouth). It is often not visible at birth and might not be detected until later, when signs or symptoms appear. These may include difficulty with feedings, difficulty swallowing, nasal speaking voice, or chronic ear infections. Each of these types of cleft palate can occur on one or both sides of the face. The type of cleft palate a baby is born with depends on the complexity of the developmental process and the specific genetic and environmental factors involved.

Assessment and Diagnosis

Triage

If your baby has signs and symptoms of a submucous cleft palate, such as difficulty with feedings, difficulty swallowing with potential for liquids or foods to come out the nose, a nasal speaking voice, and chronic ear infections, you should make an appointment with your child's doctor. Submucous cleft palate is a type of cleft palate that affects the muscles of the soft palate and may not be noticeable at birth but can develop signs and symptoms later on.

Diagnosis

Cleft palate can be difficult to detect through ultrasound, especially when it occurs alone. However, prenatal ultrasound can help detect cleft lip as early as the 13th week of pregnancy. If the prenatal ultrasound shows a cleft, doctors may recommend amniocentesis to check for genetic syndromes that could cause other birth defects. In most cases, the cause of cleft lip and cleft palate is unknown.

Management and Treatment

Complications

Potential complications of cleft palate may include difficulty feeding, ear infections and hearing loss, dental problems, speech difficulties, and social, emotional, and behavioral challenges due to differences in appearance and the stress of intensive medical care.

Prevention

While many cases of cleft lip and cleft palate can't be prevented, consider these steps to increase your understanding or lower your risk:

1. Consider genetic counseling: If you have a family history of cleft lip and cleft palate, consult with a genetic counselor to determine your risk of having children with cleft lip and cleft palate.
2. Take prenatal vitamins: If you're planning to get pregnant soon, ask your doctor if you should take prenatal vitamins. Cleft palate occurs when tissues in the baby's face and mouth don't fuse properly during development. The causes are typically a combination of genetic and environmental factors, and in many cases, no definite cause is identified.

Treatment

Treatment for cleft palate typically involves a series of surgeries and other interventions to improve function and appearance. The goal is to restore normal function and achieve a more normal appearance with minimal scarring. Treatments may include:

1. Surgical repair: The most common initial treatment is surgery to close the cleft palate. This is usually done when the child is around 10 to 12 months old. The surgeon will use tissue from the roof of the mouth or a synthetic material to create a new palate, which will help improve speech, feeding, and prevent ear infections.
2. Speech therapy: Children with cleft palate may require speech therapy to improve their ability to pronounce words correctly and develop normal speech patterns. Speech therapists work with the child to strengthen the muscles used for speaking and to teach alternative speech techniques.
3. Feeding therapy: Infants with cleft palate may have difficulty feeding due to issues with swallowing and sucking. Feeding therapy can help the child learn how to eat effectively and safely, which is crucial for their overall growth and development.
4. Ear tube insertion: Children with cleft palate may be prone to chronic ear infections due to the connection between the nose and the middle ear. Ear tube insertion can help prevent or alleviate these infections.
5. Regular follow-up appointments: It's essential to monitor the child's progress and development regularly. This allows the healthcare team to address any new issues that may arise and make adjustments to the treatment plan as needed. Consult with a healthcare professional for personalized advice.

Preparing for medical consultation

To prepare for an appointment for a child diagnosed with cleft palate, you should:

1. Find out any pre-appointment restrictions: Ask the doctor or healthcare provider if there are any specific things you should do before the appointment, such as modifying the child's diet.
2. Make a list of signs and symptoms: Note down any symptoms your child is experiencing, even if they seem unrelated to the cleft palate.
3. Bring a family member or friend: Consider bringing someone along to help remember information discussed during the appointment.
4. Prepare a list of questions: Compile a list of questions to ask the doctor, prioritizing the most important ones. Some questions may include inquiries about the cause, tests needed, treatment plan, alternative options, restrictions, and whether a specialist consultation is necessary.
5. Ask about resources and support: Inquire about brochures, printed materials, or recommended websites for further information. Also, ask if there are community and financial resources available, as well as any educational programs.
6. Address your emotions: Recognize and accept your feelings, and remember that it's normal to feel overwhelmed or sad. Seek support from a hospital social worker or other resources.
7. Support your child: Focus on your child as a person, encourage positive body language, and help them gain confidence by involving them in decision-making. Be prepared to address any teasing or self-esteem issues that may arise. Remember to prioritize your child's needs and well-being during the appointment, and make the most of your time with the doctor by preparing in advance and asking relevant questions.