Cleft Lip and Palate Review Article

Cleft Lip and Palate: A Review

• Cleft lip and palate are common congenital anomalies affecting the orofacial region.
• They can occur alone or together, often with other congenital conditions (like heart defects).
• Timely treatment at the appropriate age is crucial for functional and aesthetic outcomes.
• Management needs coordinated care from various specialists (oral/maxillofacial surgery, otolaryngology, genetics, speech/language pathology, orthodontics, prosthodontics, etc.).
• Cleft lip is the failure of fusion of frontonasal and maxillary processes, causing a gap in the lip, alveolus, and nasal floor.
• Cleft palate is the failure of fusion of palatal shelves, leading to a gap in the hard and/or soft palate.
• Clefts develop during the fourth stage of embryonic development, at locations where facial processes fail to fuse.
• Clefts can be isolated or occur with other congenital deformities, including over 300 recognized syndromes.
• In developed countries, ultrasonography often detects CL/P prenatally.
• Parents in developing countries frequently attribute CL/P to religious or cultural beliefs.
• Typical incidence rates are estimated at 1 in 600 to 800 live births (1.42 per 1,000), with isolated cleft palate occurring less frequently.
• Cleft lip and palate are more common in males than females for isolated cleft lip, and more common in females than males for isolated cleft palate.
• Unilateral clefts are more common than bilateral clefts.
• Associated conditions include social challenges (e.g., feeding difficulties, speech impediments), malocclusion, and psychological issues.
• Treatment is multidisciplinary and may involve multiple surgical interventions.
• CL/P incidence is higher in Asian populations, followed by Caucasians, and lower in African populations.
• Familial tendency to CL/P exists.

Epidemiology

• Overall incidence of cleft lip and palate (~1.5 per 1000 live births) is variable. Differences in ethnic groups and geographic regions affect the incidence.
• Asian populations show higher incidence rates than Caucasians and Africans.

Etiology

• Etiology of CL/P is complex, involving genetic and environmental factors.
• Non-genetic factors include maternal conditions, habits (smoking, alcohol), and chemical/drug exposures.
• Genetic factors include syndromic and non-syndromic forms.
• Syndromic cases are related to specific genetic syndromes and diseases.
• Non-syndromic cases account for most cases (70% of CL/P).

Clinical Features

• Dental problems include neonatal teeth, microdontia, taurodontism, ectopic eruption, and enamel hypoplasia.
• Delayed tooth maturation also occurs.
• Speech difficulties and ear infections are frequent complications.
• Feeding problems are common due to the gap in the palate.

Treatment

• Treatment focuses on surgical correction to restore facial aesthetics and functionality.
• Management involves a multidisciplinary team including specialists like dentists, plastic surgeons, speech therapists, and audiologists.
• Surgical repair is typically multi-staged.
• Strategies like nasogalveolar molding (NAM) are sometimes considered.
• Robotic approaches in cleft surgery may be explored in future.

Ethical Considerations

• Ethical considerations like informed consent and research guidelines need attention.