According to the World Health Organization and the National Institute of Dental and Craniofacial Research, cleft palate and cleft lip are ranked as the fourth most common congenital abnormalities in the United States, occurring about once per every 500 to 700 live births. When the two defects occur together, the combination is frequently referred to cumulatively as an orofacial cleft defect.
Causes of Cleft Lip and Cleft Palate
Though the U.S. Centers for Disease Control and Prevention are still constantly searching for a definitive cause of this form of birth defect, the reasons that it occurs are still unknown. Some research has shown a considerable correlation between children who are born with clefts and mothers with diabetes.
Smoking and drinking alcohol while pregnant has also been shown to potentially contribute to this and other birth defects. Genetics, maternal infection during the early stages of embryonic development, and other diseases may also play a role in the mutation.
Research and Statistics
A cleft of the lip is a significantly more common occurrence than a cleft palate. The CDC puts forth an estimate of approximately 2,651 children born with cleft palate in the United States while the number of newborns affected by cleft lip is estimated to reach 4,437. Approximately 70 percent of craniofacial defects like these are considered to be isolated abnormalities, occurring without the presence of any other congenital anomaly. The treatment costs for all U.S. children born with one or both defects over the course of a lifetime is approximately $697 million.
Treatment for Cleft Lip and Cleft Palate
Experts from the scientific, medical, and dental communities agree that surgical treatment of orofacial clefts should take place as early as possible in the infant’s life in order to achieve optimal results. Surgery for cleft lip alone is typically performed within the first three to six months of life while a cleft of the palate is generally repaired before the child reaches 18 months of age.
The actual age at which the surgery is performed may depend on a variety of factors, including other defects or syndromes, the financial ability of the family, and access to a qualified cleft repair team.
This team is usually comprised of the child’s pediatrician, an experienced oral and maxillofacial surgeon, a speech pathologist, an orthodontist, and a plastic surgeon, among others as needed. Bone grafting in the area of the maxilla, or upper jaw, is generally recommended for cases of orofacial clefts and is usually performed after age 5 and before the patient reaches the age of 10.
The process of bone grafting offers a number of advantages to children born with this type of defect, including the following:
- Improved facial symmetry, particularly involving the nose and mouth area
- Support for teeth that have not yet erupted from the gums
- The increasingly stable alveolar ridge
Bone graft procedures to repair cleft palate can be performed on individuals who are older than 10 but the results may not prove as effective. This is due in part to the development and eruption of permanent teeth in the front of the mouth. The decision as to when the surgery is most effective for each unique case is decided through collaboration among the members of the cleft repair team.