If you have ever watched Gladiator or M. Night Shyamalan’s Signs, you will most certainly have been captivated by Joaquin Phoenix’s acting. You also probably noticed the scar above his lip which, while it seemed a device of characterization in Gladiator, stood out a little in his other movies. Contrary to what some may think about what ensued during the filming of the stunts in Gladiator, Phoenix has what is called a microform cleft. It is a cleft defect that affects 1 in 600 children in America. Like others like him, Phoenix was born with it.
Cleft lips and cleft palates are birth defects. They are facial and oral malformations. The condition develops in utero during an extremely early part of the pregnancy. A cleft signifies that there is not enough tissue in the mouth or around the lip. Therefore, the areas do not join together as they should.
A cleft lip means that the lip is split into two parts instead of being one. It causes a gap to appear between the two parts of the lip. It can even extend beyond the base of the child’s nose. Because of the lack of tissue, the split in the lip can also mean that there is less bone and gum tissue in the mouth. The area behind your upper top teeth is known as your palate. A cleft palate is when there is a split in the palate like in the lip. It can happen at the front of the palate in the bony area or it can occur toward the back of the palate in the softer area.
Cleft lips and palates can be an extremely serious condition. They can affect only one side of the lip and palate or both sides. A cleft palate is the fourth most common birth defect in the United States. It occurs in around 1 of every 700 births.
Clefting is something that is quite obvious at birth. That makes diagnosing a cleft lip and palate easier than other types of birth defects. Often, it can even be diagnosed through ultrasound before the baby is born. This is important because there are times when a cleft lip and palate may be indicators of other abnormalities.
Treating Cleft Lip and Palate
Generally, treatment for cleft lip and palate requires surgical correction. Craniofacial orthodontics is a specialization in the treatment of this condition. However, it can be rather challenging to estimate the number of surgeries that could be required to correct it. Naturally, treatment depends on the severity of the disorder. The optimal time for treatment of cleft lip and palate is between three and six months of age.
The first surgery is designed to repair the palate. The goal of this surgery is to minimize the likelihood of liquids to develop in the ears. This surgery will also help the child’s jaws and teeth grow into the right places.
Often, children undergo another surgery for cleft lip and palate when they are around 8 years old. The goal of this surgery is to perform a bone graft (although this isn’t always needed). The bone graft supports the permanent teeth and may also be used to fill in the upper gums.
Further surgeries for cleft lip and palate that occur from this point are often done to help the child improve their speech. Generally, future surgeries are only needed by around 1/5 of the children diagnosed with cleft lip and palate.
Sometimes, the additional surgeries do not serve the sole purpose of improving speech only. There are times when future surgeries are needed for functional and/or cosmetic reasons. Some children need surgery to help them improve the way that they are able to open and close their mouths. Or they may need surgery simply to improve the appearance of the skin. In other cases, they may need surgery to help improve breathing.
Complications from Cleft Lip and Palate
Thankfully, when cleft lips and cleft palates are treated using craniofacial orthodontics at an early enough age, they could very well achieve a normal appearance, giving the patient normal speech patterns and the ability to eat without issues. When children with cleft lips and cleft palates are not treated, serious complications can occur including:
- difficulty feeding as babies
- difficulty eating as they get older
- ear infections as a result of fluid build-up
- hearing loss
- future dental problems
- speech difficulties
- low self-esteem
Treatment Plan for Cleft Lip and Palate
If your child is born with cleft lip and palate, you should consult with a craniofacial orthodontist. One of the keys to successfully treating clefting is early dental intervention. Your craniofacial orthodontist will show you the proper way to care for your child’s mouth. If your child’s mouth and teeth cannot be properly cleaned with a soft bristled toothbrush, your child’s craniofacial orthodontist can recommend a tool known as a toothette. Your child’s routine dental care (check-ups, cleanings, and fluoride treatment) should begin around their first birthday.
Craniofacial orthodontics is a specialized area of orthodontics that focuses on treating cleft lips and palates, as well as other birth defects that affect the development of the teeth and jaws. Specialists in the field do not work on their own. Rather, they most often partner with other specialists including speech therapists, oral surgeons and plastic surgeons who specialize in craniofacial repairs. Craniofacial orthodontics handles the non-surgical portion of treating cleft lip and palate.
This specialized treatment should begin before your child’s teeth begin to emerge from the gums. Early surgical intervention usually occurs around three to six months of age. This is crucial for future oral development. The other benefit to early contact with an orthodontist is having an expert who can answer your questions. Your child’s facial development will be assessed and a plan will be made to best treat your child’s cleft lip and/or cleft palate. Additionally, after your child’s permanent teeth have come, the orthodontist can help align the teeth.
Post-care may include speech, plastic surgery and the use of dental appliances to help make up for any missing teeth. Your child may also need a palate lift or a speech bulb. The craniofacial orthodontist will work directly with the speech therapist if your child requires either of these dental appliances to help normalize their speech.
Children diagnosed with cleft lips and palates can deal with serious complications. Let any of our three orthodontists review your treatment history today. Let Orthodontists Associates of WNY make your smile healthy and beautiful.