A crack is a gap or division in the upper lip and / or roof of the mouth (palate). It is present from birth.
The gap is there because some parts of the baby’s face do not come together properly during development in the uterus.
Cracked lip and palate are the most common congenital facial defects in the UK, affecting 1 in 700 babies.
How are your lips and palate cracked?
Babies can be born with a cracked lip, a cracked palate, or both.
A cracked lip can only affect one side of the lip or there can be 2 cracks.
It can range from a small notch to a wide gap that reaches the nose.
A cleft palate may be just an opening in the back of the mouth or it may be a division of the palate that runs all the way to the front of the mouth.
It can sometimes be hidden by the roof covering of the mouth.
Problems related to the cleft lip and palate
A cracked lip and a cracked palate can cause a variety of problems, especially during the first few months after birth, before surgery.
Problems may include:
- difficulty feeding: a baby with a cracked lip and palate may not be able to breastfeed or feed on a normal bottle because it cannot form a good seal with its mouth
- hearing problems: Some babies with a cracked palate are more vulnerable to ear infections and fluid buildup in the ears (tail ear), which can affect their hearing.
- dental problems: a cracked lip and palate can mean that a child’s teeth are not developing properly and may be at increased risk of caries
- Speech problems: If a cracked palate is not repaired, it can cause speech problems, such as blurred speech or nasal sounds when a child is older.
Most of these problems will improve after surgery and with treatments such as speech and language therapy.
Causes of cracked lip and palate
A fissured lip or palate occurs when the structures that make up the upper lip or palate do not come together when a baby develops in the womb.
It is often not clear the exact reason why this happens to some babies. It is very unlikely that you were caused by anything you did or did not do during your pregnancy.
In some cases, the cleft lip and palate are associated with:
- smoking during pregnancy or drinking alcohol during pregnancy
- obesity during pregnancy
- lack of folic acid during pregnancy
- take certain medications in early pregnancy, such as some seizure medications and steroid tablets
- the genes a child inherits from their parents
In some cases, a cracked lip or palate may present as part of a condition that causes a wider range of birth defects, such as 22q11 deletion syndrome (sometimes called DiGeorge or velocardiofacial syndrome) and the Pierre sequence. Robin.
Diagnosis of cracked lip and palate
A cracked lip is usually collected during the scan of mid-pregnancy abnormalities that is performed when you are 18 to 21 weeks pregnant. Not all cracked lips will be obvious on this scan and it is very difficult to detect a cracked palate on an ultrasound.
If a cracked lip or palate does not appear on examination, it is usually diagnosed immediately after birth or during the newborn’s physical examination performed within 72 hours after birth.
When a cracked lip or palate is diagnosed, you will be referred to a specialist NHS team who will explain your child’s condition, discuss the treatments you need and answer any questions you may have.
It may also be helpful to contact a support group, such as the Cleft Lip and Palate Association, who can offer advice and contact parents in a similar situation.
Treatments for cracked lips and palate
Cracked lips and cleft palate are treated at special NHS crack centers.
Your child usually has a long-term care plan that describes the treatments and assessments they will need as they grow older.
The main treatments are:
- surgery: an operation to correct a cracked lip is usually done when your baby is 3 to 6 months old and an operation to repair a cracked palate is usually done at 6 to 12 months
- feeding support: You may need advice on how to place your baby on his chest to help him feed, or you may need to feed him with a special type of bottle.
- Hearing supervision: A baby born with a cracked palate is more likely to strain his ear, which can affect hearing. It is important to keep a close eye on your hearing and if the glue ear significantly affects your hearing, a hearing aid can be installed or small tubes called ears can be placed in your ears to drain the fluid.
- language and language therapy: A language and language therapist will monitor your child’s language and language development during childhood and help you with any speech and language problems.
- Good Dental Hygiene and Orthodontic Treatment: You will be given advice on caring for your child’s teeth, and they may need braces if their adult teeth do not go properly
Perspectives for the cleft lip and palate
Most children treated for cleft lip or palate grow up to have a completely normal life.
Most affected children will not have any other serious medical problems and treatment can usually improve the appearance of the face and eating and speaking problems.
Surgery to repair a cracked lip can leave a small pink scar over the lips. This will fade over time and become less noticeable as your child grows.
Some adults who have had a repair of cracked lips or palate may be self-aware or unhappy with their appearance. Your GP can refer you to an NHS cracking center for further treatment and assistance if there are ongoing problems.
Will a cracked lip and palate occur again?
Most cases of cleft lip or palate are punctual and you are unlikely to have another child with this disease.
The risk of having a child with a cleft lip or palate increases slightly if you have already had a child with this disease, but it is believed that the chances of this go from 2 to 8%.
If you or your partner were born with a cracked lip or palate, your chance of having a cracked baby is also 2 to 8%.
The chances of another child being born with a cleft or a parent passing the disease on to their child may be higher in cases related to a genetic disease.
For example, a parent with 22q11 suppression syndrome (DiGeorge syndrome) has a 1 in 2 chance of transmitting the disease to their child.
SOURCE: NHS