Understanding Cleft Lip and Palate Care and Impact

Cleft Lip

Can range from a slight notch in the lip to complete separation in one (unilateral) or both (bilateral) sides of the lip extending up and into the nose.

How common is cleft in New Zealand?

Global average of cleft = 1/700 (live births). New Zealand average = ~1/550. Māori population have the highest incidence of isolated Cleft Palate in the world (~1/460).

Threshold Theory

Genetic predispositions + environmental factors combine until they exceed a threshold, leading to the birth of a child with a cleft.

Environmental Factors implicated with Cleft

Include maternal exposure to certain infections, alcohol intake during pregnancy, lifestyle choices like smoking, and the use of certain prescription medicines.

Cleft Care in Aotearoa

Involves a multidisciplinary team and 5 units in Aotearoa, with some regional outpatient services available.

Primary Surgical Repairs

Done for speech, feeding, and hearing, designed to seal the gap between oral and nasal cavities.

Secondary Surgical Repairs

Include procedures like Grommets, Orthognathic Surgery, Rhinoplasty, and Lip revisions, addressing issues such as middle ear infections and changing the shape of the nose or lips.

What about Teeth?

Upper teeth can grow at unusual angles and may require orthodontic and/or surgical remediation.

Hypodontia

Condition characterized by missing teeth

Hyperdontia

Condition characterized by extra teeth, which may be located in the palate rather than the alveolar gum area

Malocclusion

Misalignment of the teeth, where the teeth in the bottom jaw may be in unusual positions to accommodate the upper jaw teeth position

Orthognathic Surgery

A major surgical procedure associated with cleft lip and palate cases, aimed at fixing class III malocclusion, improving mid-face aesthetics, and enhancing airway opening by cutting and repositioning the maxilla to articulate correctly with the bottom jaw, followed by the insertion of screws and metal plates to hold the bone in position during healing

Breastfeeding

Feeding method where children with cleft palate may face challenges due to the inability to create the necessary suction for breastfeeding, but techniques like holding the child at a 90° angle can help create the suction needed

Impact of Cleft on Feeding

The impact of cleft palate on feeding, often requiring special bottles like Dr. Browns, MAM, Pigeon, or Haberman feeder, and the importance of establishing a safe suck, swallow, breathe pattern

Impact on Hearing

Increased risk of otitis media for children with cleft palate due to the exposure of the Eustachian tube, with grommets often used to help with resulting conductive hearing loss

Considerations for Aotearoa

Unique considerations for New Zealand, including high rates of cleft lip and palate (CLP), particularly among Māori, and the absence of routine Clinical Psychology provision for cleft cases

Cleft Palate Speech

Speech issues related to cleft palate, including normal articulation errors post lip repair completion and potential issues with lip rounding if asymmetry or weakness in the obicularis oris persists

Velopharyngeal Insufficiency (VPI)

Condition caused by anatomical defects like cleft palate, short velum, deep pharynx, irregular adenoids, or enlarged tonsils, leading to nasal air emission and/or nasal turbulence affecting oral consonants

ñ̥

a nasalised, voiceless /n/ sound - used as a replacement for /s/

VPI

Velopharyngeal insufficiency

PROMs

Patient Reported Outcome Measures

SLT

Speech Language Therapist

Biofeedback

Using behavioral techniques/tools to monitor and adjust speech patterns

Phoneme hierarchy

Order of training sounds in therapy, typically starting with front and voiceless sounds

Quality of Life

Subjective measure of well-being and satisfaction with various aspects of life

UK Adult Services Project

A three-year project (2018-2021) investigating the needs of adults born with cleft

Emotional Wellbeing

Mental and emotional state of an individual

Physical Health

Overall bodily condition and wellness

Interpersonal Relationships

Connections and interactions between individuals

Treatment Experiences

Individual encounters and outcomes related to medical interventions

SLT Treatment

Speech Language Therapy indicated for various speech disorders

Compensatory Articulation

Speech production adjustments to compensate for physical limitations

Policy Recommendations

Suggestions for the development and improvement of healthcare policies

Clinical Psychology

Branch of psychology focused on diagnosing and treating mental disorders

Cleft Provision

Services and support provided for individuals with cleft conditions

Cleft Teams

Multidisciplinary groups involved in the care of individuals with cleft conditions

Cleft Surgeon

Medical professional specializing in surgical treatment of cleft conditions

Summer Reading

Recommended reading materials for further understanding of cleft conditions

Cleft Talk Panel Discussions

Series of discussions covering various aspects of cleft conditions and treatments

Cleft Lip and Palate

Structures move towards the midline and fuse together starting at the lip around 6 weeks and progressing to the soft palate which will be sealed by around the 16th week.

Cleft Palate

Occurs when the roof of the mouth has not joined completely. Can range from a bifid uvula to complete separation of the roof of the mouth (soft and hard palate) and running through the alveolar ridge.

Submucous Cleft

A cleft of the soft palate that is covered by a layer of skin.

Bifid Uvula

A cleft of the uvula only.

Cleft Classification

Includes Cleft Lip (CLO), Cleft Palate (CPO), Cleft Lip and Palate (CLP), Submucous Cleft, and Bifid Uvula.

Antenatal Identification of CLP

Cleft Lip is generally detectable during the 20-week anomaly scan, while Cleft Palate is difficult to locate on an antenatal scan.