What Is Cleft Lip?


Cleft lip is a condition of congenital abnormalities characterized by a gap or cleavage on the upper lip. The gap may be in the middle, left, or the right side of the lips. In addition to the upper lip, cleft can also occur on the roof of the mouth. This condition is commonly called the cleft palate. Cleft lip and cleft palate occur because the tissue on the baby's lips or in the baby's palate when in the womb does not coalesce, leaving a crack. Normally the unification process occurs in the second and third months of pregnancy.

Cause of Cleft Lip
Until now not known exactly what causes cleft lip and palate cleft. But experts believe that this condition occurs due to a combination of genetic and environmental factors.

Some of the following factors may increase the risk of having a baby born with a cleft. Among others are:
  • Genetic. Babies born to elderly people with cleft lip and cleft palate or having relatives with these conditions are more at risk of experiencing the same condition.
  • Gender. A baby boy is twice as likely to have this birth defect as a baby girl. In male infants, cleft lip can occur with or without a cleft palate. While cleft palate without cleft lip is more common in baby girl.
  • Diabetes. There is some evidence to suggest that women diagnosed with diabetes before pregnancy have a high risk of delivering babies with cleft lip.
  • Obesity during pregnancy. Babies of obese mothers are at risk of being born with cleft lip or cleft palate.
  • Exposure to certain substances during pregnancy. Mothers who smoke and consume alcohol during pregnancy are at risk of delivering babies with cleft lip and palate. In addition, consumption of corticosteroid tablets and antikejang drugs in early pregnancy was also associated with some cases of cleft lip.
  • Lack of folic acid during pregnancy.
In some cases, cleft lip is part of conditions that can also cause birth defects, such as DiGeorge syndrome, Pierre Robin syndrome, and Van der Woude syndrome.

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Symptoms Cleft Lip
Generally, cleft lip and cleft palate can be seen immediately at birth, marked by:
  • The presence of a gap in the upper lip or in the palate can affect one or both sides of the face.
  • The presence of a gap in the lips that can look like a small tear or a tear extends from the lips to the upper gums and the palate down to the nose.
  • The existence of a gap in the palate that does not affect the look of the face.
Children with cleft palate tend to have more frequent recurrent ear infections and fluid accumulation in the ears. This is because the muscles on the ceiling are connected to the middle ear. When the muscle is not functioning properly, fluid will accumulate in the ear and may result in decreased hearing. It is important to check with your doctor to monitor your child's hearing on a regular basis.

There is also a rare type of cleft, the submucosal cleft. This cleft is found only on the soft palate and covered by the lining of the mouth. This type of cleft is not visible at birth and can not be diagnosed until the signs appear, such as:
  • Difficulty receiving food intake.
  • Difficulty swallowing food (food and drink consumed can get out of nose).
  • Chronic ear infections.
  • The nasal voice.

Diagnosis of Cleft Lip
Cleft lip can be known through the ultrasound examination of pregnancy at the 18th week until the 21st week of pregnancy. If undetected by the examination, the cleft lip will be visible as soon as the baby is born or through a physical examination in the first 72 hours since the baby is born.


Treatment of Cleft Lip
Cleft lip can be treated with surgery. The goal of cleft lip surgery is to improve the child's ability to eat and drink, to talk and listen normally, and to have normal facial appearance. In general, surgical procedures performed include:
  • Cleft lip surgery . To close the gap on the lips, the doctor will make an incision on both sides of the crack and create a tissue fold which is then put together by sewing. This operation will make the appearance and function of the lips to be better. The right time for cleft lip surgery varies, depending on the child's body condition, weight, and age of the child. Usually cleft lip surgery performed when the child aged 10 weeks - 1 year. When necessary, surgery on the nose is also done at the same time.
  • Operation of cleft palate . Surgery may be performed several times to close the gap and fix the palate, both soft and hard parts. The doctor will make an incision on both sides of the crack and rearrange the tissue and muscle position of the palate, then stitched. Cleft palate surgery is recommended for 6-18 months. Then, continued surgery for cleft palate can be done at the age of 8-12 years. The follow-up surgery is bone grafting for the palate to support the maxillary structure and articulation of speech.
  • Ear tube mount operation. For children with cleft palate, ear tubes are installed at 6 months of age. This action is done to reduce the risk of hearing loss and can be done simultaneously with cleft lip surgery or cleft palate surgery.
  • Surgery to improve appearance. Additional surgery may be needed to improve the appearance of the mouth, lips and nose. This operation can be performed until the age of adolescence before adulthood.
Monitoring and treatment of cleft lip is advisable to continue until the child is 21 years old, when growth has stopped.


Cleft Lip Complications
Some of the complications that may be experienced by babies who suffer from cleft lip are:
  • Hearing disorders. Stacking of fluid in the ear and recurrent ear infections is at risk for hearing loss .
  • Dental growth problems. If the cleft extends to the upper part of the gum, the baby's teething will be disturbed.
  • Difficulty in sucking milk. 
  • Difficulty in communicating. Cleft lips can make the sound of the child's voice disturbed and will sound nasal.
To overcome the complications that occur, can be given additional treatment, among them are:
  • Treatment of ear infections.
  • Orthodontic treatment, such as braces.
  • Speech therapy to improve speech difficulties.
  • Hearing aids for children who are hearing loss.
  • Use special bottles or other tools to feed the child.
Children with cleft lip may have problems in their emotions, behavior, and social life because of their different looks and stress undergoing a variety of medical procedures. Consultation with a psychologist can help the child to deal with this situation.

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