Cleft Lip And Palate

Clefts of the lip and/or palate (CL/P) affect approximately one out of 600 live births, making it among the most common birth defects in the United States (Cleft Palate Foundation, 2014). CL/P is a congenital abnormality necessitating numerous medical interventions, such as lip, palate, and or nose reconstruction, and behavioral interventions addressing feeding, speech, and language difficulties from infancy through late adolescence (Lockhart, 2003). When parents are faced with serious decisions regarding their child’s medical care from different medical professionals, they can often feel overwhelmed. As a child with CL/P gets older, he or she will become more aware of the physical and emotional challenges associated with living with a
Infants with cleft lip and/or palate have historically had difficulty feeding, primarily with creating enough negative intraoral pressure to express liquid from a nipple. In order to create this pressure, infants need to be able to seal around the nipple completely using lips, tongue, and palatal structures. The oral cavity also needs to be able to seal off from the nasal cavity to create the negative pressure needed. If a child has a cleft lip and/or palate, he may not be able to seal around the nipple, compress the nipple between the tongue and palate, or create appropriate suction needed to express the liquid. Infants having difficulty properly feeding are observed to give up or refuse to finish a feed. Reid et al (2006) used a prospective, observational experimental design, to observe forty 2-week-old infants with cleft lip (CL), cleft palate (CP), and cleft lip & palate (CL/P) with parental consent. Efficiency was also measured in mL of fluid expressed per minute of feeding. Only 3 infants were able to express 1 mL of liquid per minute over the 5 minute assessment; 1 infant had a cleft lip, while the other 2 had a cleft of the soft palate only. Overall, this study found that infants with unrepaired CL were able to generate normal levels of suction and thus effectively feed, while infants with CP or CL/P had abnormal suction results. Compression of the nipple, and sucking
Individuals may have hypodontia, or missing dentition, hyperdontia, or extra dentition, or malocclusion. Individuals with cleft lip and palate often have hypodontia on both the cleft and non-cleft side. Hypodontia on the cleft side is often excluded as being counted as a dental anomaly, and attributed instead to the lack of structures on that side. Thus, hypodontia on the non-cleft side is the most common dental anomaly found among individuals with cleft lip and/or palate (de Lima Pedro, Faria, & de Castro Costa, 2012)(Jamilian, Jamilian, Darnahal, Hamedi, Mollaei, & Toopchi, 2015). Jamilian et al (2015) found 64.1% of 201 individuals with cleft lip and palate with hypodontia, and 4.9% of the 201 individuals had hyperdontia. Maxillary lateral incisors, as well as mandibular and maxillary second premolars, are the most significantly affected dentition in individuals with cleft lip and palate. No significant difference was noted between unilaterally and bilaterally affected inidividuals (Schwartz, Somensi, Toshizaki, Reis, de Cassia, Lauris, de Silva Filho, Dalben, & Garib,