Cleft Lip and Palate

Although cleft lip and palate is the most common type of congenital defect and the most common type of facial development defect, it is yet the most treatable of all types of congenital defects.

At the same time, it should be emphasized that the patient’s intellectual development is mostly unaffected. As long as they receive comprehensive holistic medical care including plastic surgery, dentistry, ear nose and throat (ENT), speech therapy, clinical psychology, and social work, etc., the patients will be able to have an early recovery and become healthy individuals of sound mind and body.

Basic Understanding of Cleft Lip and Palate

 A. Cleft lip? Cleft lip and palate? Cleft palate?

During early embryonic development, the lips are gradually connected at the centerline of the body from the tissues on both sides. During this process of connection, if there are some errors such that the connection cannot be made according to a predetermined time, this may result in various types of clefts. If there is only a cleft in the upper lip, this is called "cleft lip." If the cleft extends to the hard palate inside the mouth or even further to the inner soft palate, it is called "cleft lip and palate." Sometimes only the upper palate or soft palate inside the mouth is cleft while the external appearance is normal. This is called "cleft palate."

B. Why did it happen?

Most of the reasons for the disorder are not clear and some are affected by genetic or environmental factors. Genetic factors refer to those caused by various defective genes in chromosomes. Environmental factors include:

1. A viral infection, such as rubella
2. Certain medicines, such as anti-cancer drugs, anti-epileptic drugs, steroids, etc.
3. Exposure to X-ray radiation
4. Nutritional imbalance

Folk legends saying that things like mothers picking up scissors, nailing nails, moving residence, and moving cabinets during pregnancy are causal factors are pure speculation and less than credible.

C. What is the prevalence?

According to statistics, about one in six hundred newborns has a cleft lip and palate. Therefore, each year in Taiwan, 300 to 400 "new patients" are born.

D. Is there a genetic problem?

1. If both parents are normal, the probability of their first child being born with a cleft lip and palate is one in six hundred.
2. If both parents are normal and one of their children has a cleft lip and palate, the probability of having a second child with a cleft lip and palate is one in twenty.
3. If both parents are normal and the first and second children have a cleft lip and palate, the probability of having a third child with a cleft lip and palate is one in four.
4. If both parents have a cleft lip and palate, the probability of having a child with a cleft lip and palate child is one in twenty.
5. If one parent has a cleft lip and palate and one child has a cleft lip and palate, the probability of having a second child with a cleft lip and palate is one in four.
6. If both parents have a cleft lip and palate: the probability of having a child with a cleft lip and palate is one in four.

The occurrence of cleft lip and palate is a matter of probability, because there are many aspects in the process of embryonic development that medical technology cannot prevent or detect. Having a child with a cleft lip and palate is not the fault of anyone, nor is it because their parents did anything wrong. What's more, everyone is more or less imperfect. Until medical research has found the real cause, parents should not feel any sense of guilt for having such a child.

(Source: Craniofacial Center, Chang Gung Memorial Hospital & NCF Taiwan)