Jonathan Alexander Abt is an orthodontist who previously served as resident’s representative on the NYU Orthodontic Program admissions committee. This article will look at clefting, a congenital abnormality affecting around 1,200 babies born in the UK annually.
Globally today, one in 700 infants is born with a cleft, which ranks as the most common craniofacial abnormality in newborns. Affecting the lip and potentially the gums where teeth come through, a cleft lip can range in severity from a small notch in the colored area of the lip to the upper lip’s total separation, extending up and into the nose. This can be unilateral, affecting one side of the mouth, or bilateral, affecting both sides. With a complete cleft, the cleft goes up into the nose, whereas with an incomplete cleft it does not. Where the cleft also affects the gums, this can range from a small notch to total separation, with the gum in two parts.
A cleft palate is a split that exists between parts of the face that have not fused together during development in early pregnancy. The most common type affects the roof of the mouth only, with this form of the condition accounting for 45% of clefting cases. Bilateral cleft lip and palate is the least common form, accounting for just 10% of cases and affecting both sides of the lip, as well as the roof of the mouth. A cleft palate can affect both the soft palate at the front of the mouth and the hard palate at the back.
A baby may be born with a cleft palate, a cleft lip, or a cleft palate and lip. A cleft palate by itself is commonly referred to as an isolated cleft palate. Although scientists have yet to discover what exactly causes a cleft, it is commonly accepted that they are unlikely to occur as a result of something the mother did or did not do. Rather, researchers believe they are attributable to a combination of genetic and environmental factors. Sometimes, babies born with a cleft palate also have a smaller lower jaw. In some infants, this can cause breathing difficulties. This combination of anomalies is associated with Pierre Robin Sequence.
Individuals born with a cleft lip and palate can suffer from dental anomalies, impaired facial growth, poor hearing, speech disorders, and difficulties in social relationships and psychological wellbeing. The care pathway for these babies extends from pre-birth to adult life, with the condition often picked up in antenatal scans. Babies born with a cleft palate are treated by regional specialist teams who provide surgery and specialist care to help patients feed well from birth. Specialists also focus on helping affected individuals to achieve satisfactory hearing, a good facial appearance, normal speech and psychosocial wellbeing. Management of clefting requires the involvement of many specialties throughout development until adulthood and beyond, with routine care sometimes continuing for several decades.
Care for patients with cleft lip and/or palate is orchestrated by a lead consultant orthodontist, who is responsible for coordinating orthodontic treatment. Care is designed to provide high-quality orthodontic treatment, forming part of an integrated treatment plan incorporating the various other specialties required for effective cleft care. Orthodontists working in cleft teams may provide ancillary services such as speech plates to aid speech where surgery is not a viable option. They may also advise on other aspects of dentistry and prevention of dental disease, for example dental caries, which are more of a problem for people with cleft.
Infants born with a cleft will need several treatments as they grow up. The usual route is surgery. Other treatments may also be beneficial, for example dental care and speech therapy. Treatment plans are tailored to the individual needs of each child, typically spanning 12 to 15 years in duration.