Orofacial clefts are congenital defects affecting thousands of children globally. It is estimated that 1 in 700 babies is born with either a cleft lip, cleft palate or a combination of both. According to the World Health Organization, the pattern of occurrence and diagnosis rates vary across regions. A higher prevalence of clefts is noted in Asian and Latino populations, followed by Native American and Black populations.
A cleft lip occurs due to the failure of the fusion of facial processes responsible for normal growth and development. These are the median nasal processes and maxillary processes in the case of cleft lip, and the palatine processes in the case of palatal clefts. Clefts can occur in isolation or alongside other congenital deformities, particularly congenital heart diseases. They are also associated with over 300 known syndromes. Unilateral clefts are more common than bilateral clefts, and palatal clefts occur more frequently in females.
There is consensus among researchers that the etiology of orofacial clefts is multifactorial, and can be broadly classified into genetic and environmental causes. Environmental causes include smoking, alcohol, increased maternal age, maternal diseases, and indiscriminate medication use during pregnancy.
The conspicuous location of these defects and accompanying functional impairment makes them easily recognizable and a source of social stigma. Worried and embarrassed by the occurrence of clefts, parents and caregivers have been known to hide their babies from neighbours, extended family members, and health workers. Other factors responsible for the low reporting of cases include sociocultural myths about the aetiology of clefts and the lack of health services and qualified personnel.
The occurrence of clefts is associated with functional and esthetic challenges which can have a significant psychological impact on the patients and parents. These include feeding difficulties (especially with palatal clefts), recurrent ear infections and hearing loss, speech and language delay, dental problems, and psychological impairment.
The early diagnosis and successful management of clefts require coordinated and timely care across medical and dental specialties. Diagnosis is possible in utero by ultrasound scan or clinically at the time of birth.
Surgery remains the mainstay of treatment and the goals of surgical intervention include an improvement in aesthetics, restoration of intelligible speech, and a dentition that enhances optimal function. Beyond surgery, other aspects of rehabilitation involve diverse medical and dental specialties and allied health workers. Cleft lip repair (cheiloplasty) is done at about 3 months of age, while palatal cleft repair (palatoplasty) is done at about 15-18 months.
In recognition of the morbidity associated with cleft defects, the Smile Train organisation was established in 1999 with an absolute focus on training and funding medical personnel in over fifty countries to provide free surgeries and comprehensive cleft management. Since its inception, Smile Train has provided free treatments to over one million children and adults.
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