Cleft lip, cleft palate
By Penelope A. Domogo, MD
Cleft lip is an opening or split in the upper lip. We call it “gungis” in Igorot. Cleft palate is an opening or split in the roof of the mouth. Usually a cleft lip occurs together with a cleft palate. These inborn or congenital defects generally occur as isolated birth defects but can also be a part of a mix of inborn defects. Cleft lip and palate are easily identifiable at birth. Rarely, the split occurs at the soft palate area at the back of the mouth so it is not easily visible. It is only when the baby has difficulty feeding that the defect is discovered.
Why do these structural defects occur? Normally, the tissues of the baby’s lip and palate fuse during the second or third month of pregnancy. But in babies with cleft lip and palate, this fusion does not take place or occurs partially, leaving an opening or a cleft. Just like many other birth defects, there’s no one identified cause of this non-fusion. It is theorized that environmental factors play a role. Environmental factors include unhealthy diet and this is the biggest risk as food is where we take in a lot of artificial chemicals that may disrupt the normal development of babies inside the womb and perhaps even cause mutation of genes. Other possible risk factors are certain medications, cigarette smoking and alcohol.
Depending on the severity of the cleft lip or palate, the baby can have the following complications:
1. Difficulty of sucking, especially for babies with cleft palate.
2. Ear infections and hearing loss
3. Dental problems. If the cleft extends to the upper gum, it may affect tooth development.
4. Speech difficulties. Since the lip and palate are involved in forming sounds, a cleft palate will affect speech and make it sound too nasal (ngongo). A cleft lip may not produce words clearly so listeners would have difficulty deciphering the sounds.
5. Challenges of coping with a medical condition. Children with cleft lip/palate and their families may encounter social, emotional and behavioral problems due to their different appearance and speech and the stress of intensive care at birth.
Given these many challenges that babies with cleft lip/palate may encounter, it is important for the parents, family and community including the school to give utmost support to the child and parents.
Cleft lip and palate are repaired surgically, meaning these clefts are closed. For cleft lip because it is crucial for sucking, the goal is to repair it during the 3rd to 6th month of the baby. For cleft palate, the goal is to repair it before the child develops speech so between 6 months to 12 months. But depending on the status of the baby, the surgery may be delayed. We now have hospitals all over the Philippines, so affected families should consult the doctor as often as advised. There are missions that offer free surgery for cleft lip/palate. Just ask your nearest government doctor.
Just like in any other disease, prevention is better than cure. Even if we are not sure of the exact causes of cleft lip/palate, it is always wise to take general preventive measures as these will cover all diseases. We cannot underestimate the need for pregnant women to really take care of their diet and exposure and overall health as their baby’s health depends on them. Whatever situation the mother is in, she should always bear in mind that she is taking care of another life. That said, it is also important for the father or partner to give utmost support to the pregnant woman so that she is happy and relaxed and follows a healthy lifestyle. And also the family and community around the pregnant woman will also do their part. If we see a pregnant woman eating unhealthy food, then it is our responsibility as adults to point it out gently to her. That’s how indigenous communities work. We take care of each other because we want to promote health and wellness in the community. Happy Indigenous Peoples’ Month!
“ How good and pleasant it is when brothers and sisters live together in unity.” Psalm 133:1**