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$Unique_ID{BRK03609}
$Pretitle{}
$Title{Cleft Palate and Cleft Lip}
$Subject{Cleft Palate and Cleft Lip Hare Lip Cheiloschisis}
$Volume{}
$Log{}
Copyright (C) 1984, 1985, 1986, 1989, 1990, 1992 National Organization
for Rare Disorders, Inc.
32:
Cleft Palate and Cleft Lip
** IMPORTANT **
It is possible that the main title of the article (Cleft Palate and Cleft
Lip) is not the name you expected. Please check the SYNONYMS listing to find
the alternate name and disorder subdivisions covered by this article.
Synonyms
Hare Lip
Cheiloschisis
General Discussion
** REMINDER **
The Information contained in the Rare Disease Database is provided for
educational purposes only. It should not be used for diagnostic or treatment
purposes. If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.
Cleft Lip and Palate are common malformations that are noticeable at
birth (congenital). A cleft is an incomplete closure of the palate or lip,
or both. This defect is caused when the pair of long bones that form the
upper jaw (maxillae) do not fuse properly during the development of the
embryo. The cleft may be barely noticeable or result in severe deformities
requiring surgical correction.
Symptoms
There are several varieties of Cleft Lip and Palate malformations. Over 200
syndromes have cleft lip and/or palate as a feature. The most severe types
involve the lip, gum, bone, and the soft and hard palates. Less severe
clefts may involve only one of these structures. Clefts may occur on one or
both sides of the lip and/or palate.
Children with Cleft Lip and Palate usually have a flat nose and lips that
appear spread out or splayed. Generally there are abnormalities in dental
development such as absent, extra or deformed teeth. Other features may
include abnormal growth of the cartilage on one or both sides of the nose
(ipsilateral alar nasal cartilage), and a wider than normal space between the
eyes (mild ocular hypertelorism). Children with this disorder are at
increased risk for middle ear infections (otitis media) and hearing loss.
Speech may be impaired.
Causes
When Cleft Lip and Palate occur as part of another syndrome, the cause is
that of the syndrome. (For disorders that have Cleft Palate as a symptom of
the disorder, choose "Cleft Palate" as your search term in the Rare Disease
Database).
When Cleft Lip and Palate occur in isolation, the cause is less clear.
Both a genetic change (mutation) and environmental factors may be involved.
Affected Population
Cleft Lip and Palate affect more than 5500 newborns each year in the United
States. The frequency in newborn infants is 1:700, but this ratio varies
according to ethnic background. Orientals are the most likely to be affected
while Americans of African descent are the least likely to be affected.
Males are at least twice as likely as females to be affected by cleft lip,
but females are more prone to cleft palate.
Therapies: Standard
The treatment of Cleft Lip and/or Palate requires the coordinated efforts of
a team of specialists. Pediatricians, dental specialists, surgeons, speech
pathologists, psychologists and others must systematically and
comprehensively plan the child's treatment and rehabilitation.
Cleft lip may be surgically corrected. Generally surgeons repair the lip
when the child is still an infant. A second surgery is sometimes necessary
for cosmetic purposes when the child is older.
Cleft palate may be repaired by surgery or covered by an artificial
device (prosthesis) that closes or blocks the opening. Surgical repair can
be carried out in stages or in a single operation, according to the nature
and severity of the defect. The first palate surgery is usually scheduled
during the toddler period.
With adequate assistance, many children with cleft palates speak as well
as other children by the time they enter school. Speech and language
development need to be assessed by a speech pathologist during the preschool
years.
Dental problems associated with cleft palate are generally correctable.
Braces and orthodontic appliances are frequently needed later to straighten
teeth that have grown in crooked.
Routine testing of hearing should be scheduled for all preschool children
with clefts of the palate. They may require tubes placed in their ears to
drain congestion and improve hearing.
Therapies: Investigational
Researchers continue to study the genetic causes of Cleft Lip and Palate. New
surgical and dental corrective procedures are being researched and developed.
Other studies continue to concentrate in the areas of facial and
psychological development and other associated problems with speech, chewing
and swallowing.
Although the palate of cleft palate patients generally closes during
early childhood, difficulties may persist if the palate is excessively short
in relation to the throat (pharynx). Researchers are studying a teflon-
glycerine paste that is applied to the rear of the pharynx in a minor
surgical procedure. A rounded bump or ledge is formed, bringing the pharynx
and palate into the proper relationship with each other. The hardened paste
remains in place indefinitely; no side effects have been observed. Children
as young as eight years old have been treated with this procedure.
For further information on this procedure contact:
William N. Williams, D.D.S.
University of Florida
College of Dentistry
Box J-424
Gainesville, FL 32610
(904) 392-4370
Research on birth defects and their causes is ongoing. The National
Institutes of Health (NIH) is sponsoring the Human Genome Project that is
aimed at mapping every gene in the human body and learning why they sometimes
malfunction. It is hoped that this new knowledge will lead to prevention and
treatment of genetic disorders in the future.
This disease entry is based upon medical information available through
October 1992. Since NORD's resources are limited, it is not possible to keep
every entry in the Rare Disease Database completely current and accurate.
Please check with the agencies listed in the Resources section for the most
current information about this disorder.
Resources
For more information on Cleft Lip and Cleft Palate
National Organization for Rare Disorders (NORD)
P.O. Box 8923
New Fairfield, CT 06812-1783
(203) 746-6518
Forward Face
560 First Ave.
New York, NY 10016
(212) 263-5205
(800) 422-FACE
A Cleft Palate Team is a group of specialists who are primarily
interested in the care of children having clefts. For information about
local teams contact:
The Cleft Palate Foundation, Inc.
1218 Granview Ave.
Pittsburgh, PA 15211
(800) 24-CLEFT
(800) 23-CLEFT
FACES
National Association for the Craniofacially Handicapped
P.O. Box 11082
Chattanooga, TN 37401
(615) 266-1632
National Craniofacial Foundation
3100 Carlisle St., Suite 215
Dallas, TX 75204
(800) 535-3643
Craniofacial Family Association
170 Elizabeth Street
Suite 650, Toronto, Ontario MG5G1X8
Canada
Society for the Rehabilitation of the Facially Disfigured, Inc.
550 First Ave.
New York, NY 10016
(212) 340-5400
About Face
123 Edward Street
Toronto, Ontario M5G 1X8
Canada
Let's Face It
Box 711
Concord, MA 01742
(508) 371-3186
NIH/National Institute of Dental Research (NDR)
9000 Rockville Pike
Bethesda, MD 20892
(301) 496-4261
For Genetic Information and Genetic Counseling Referrals:
March of Dimes Birth Defects Foundation
1275 Mamaroneck Avenue
White Plains, NY 10605
(914) 428-7100
Alliance of Genetic Support Groups
35 Wisconsin Circle, Suite 440
Chevy Chase, MD 20815
(800) 336-GENE
(301) 652-5553
References
SMITH'S RECOGNIZABLE PATTERNS OF HUMAN MALFORMATION, 4th ed.: Kenneth
Lyons Jones M.D.; W. B. Saunders Company, 1988. Pp. 196-199.
MENDELIAN INHERITANCE IN MAN, 10th Ed.: Victor A. McKusick, Editor:
Johns Hopkins University Press, 1992. Pp. 230-231.
BIRTH DEFECTS ENCYCLOPEDIA, Mary Louise Buyse, M.D., Editor-In-Chief;
Blackwell Scientific Publications, 1990. Pp. 405-406, 410-411.
NELSON TEXTBOOK OF PEDIATRICS, 14TH Ed.; Richard E. Behrman, Editors;
W.B. Saunders Company, 1991. Pp. 926-927.
MANAGING THE CLEFT LIP AND PALATE PATIENT, F.L. Kaufman; Pediatr Clin
North Am (Oct 1991; 38(5)): Pp. 1127-1147.