Pathophysiology
Cleft lip and palate (CL/P) is a facial and oral malformation that occurs between the fourth week and seventh week of pregnancy while the baby is still developing. This occurrence is caused when the tissues that make up the lip or the roof of the mouth do not join completely before birth, resulting in an opening in the upper lip in form of a slit (cleft), which is immediately identified at birth (Cobourne, 2017).
Epidemiology
Epidemiological studies have found that incidences of CL/P depend on sex and ethnic background. Clefts occur most commonly in Native American and Asian populations with least dominance in African heritage. Cleft of the lips are associated with palatal clefts in approximately two-thirds of the affected individuals (Malek, 2018). The male are usually associated with CL with or without palate whereas, females have isolated CP. Finally, CL with or without palate is always frequent than CP alone.
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Physical Exam Findings
A cleft lip may be detected through a prenatal ultrasound, though; diagnosing a CL/P is a more difficult and may not be easily identified. The diagnosis and the extent of CL/P should be confirmed by physical examination after the birth of the child. An infant with a CP for instance may have difficulties in feeding since they cannot create suction needed to draw milk out of the breast.
Differential Diagnoses and Rationale
Cases of oro-facial cleft (OFC) are characterized as either syndromic or isolated cases. Syndromic clefts are usually accompanied with abnormalities in an organ system such as craniofacial or skeletal abnormalities. Intrauterine exposures and genetic exposures are the most common factors resulting, to clefts (Malek, 2018). Additionally, prenatal exposures to alcohol, isotretinoin, cigarette smoking, maternal diabetes and antiepileptic drugs are some of the contributing factors of OFC. While genetic factors can be contributing factors to craniofacial clefts, the clefting is an isolated flinging in two-thirds of individuals with CL or without CP and in half of the individual with CP only.
Management, Therapy and Follow-Up
Majority CL/P centers apply a team-based approach for the management of craniofacial problems. Specialists in plastic surgery, dentistry, otolaryngology, and neurosurgery all come together to address the clinical problems associated with clefts. Lip clefts are usually repaired at approximately 10 weeks of age. Palatal clefts are repaired later with approximate nine months to one year period.
References
Berkowitz, S. (2016). Cleft lip and palate: Diagnosis and management . Berlin: Springer.
Cobourne, M. T. (2017). Cleft lip and palate: Epidemiology, aetiology, and treatment . Basel: Karger.
In Bennun, R. D., In Harfin, J. F., In Sándor, G. K. B., & In Genecov, D. (2016). Cleft lip and palate management: A comprehensive atlas .
Malek, R. (2018). Cleft lip and palate: Lesions pathophysiology and primary treatment . London: Martin Dunitz.
