You'll find hundreds of files on cleft lip, cleft palate here on widesmiles.org.

This one is about: The Isolated Cleft


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THE ISOLATED CLEFT

Cleft lip and/or palate is one of the more common birth defects. It occurs in approximately one in 700 births. It is not evenly distributed racially. Cleft occurs more often proportionally among the Asian populations and less often among Blacks. However, it does occur among peoples of every race.

Many factors contribute to cleft conditions. Among them are heredity, pre-natal nutrition, drug exposure, and other environmental factors, etc. A cleft occurs when something interrupts the normal development of the face. Since the face develops in the fourth to the eighth weeks of pregnancy the condition is realized early on - - sometimes even before the mother knows she is pregnant.

In the overwhelming majority of cases, when a cleft occurs, it is considered an isolated cleft. That is, it is a cleft in the absence of a syndrome. The child is normal in every respect except one - the lip and/or palate did not close during gestation.

The alternative to an isolated cleft is a syndromic cleft, or a cleft associated with a syndrome. Most syndromes are genetic aberrations that can be identified by the presence of a number of anomalies. There are enough known syndromes to quite literally fill a library with information about them. A handful of those syndromes may or may not include a cleft lip or palate as one of the anomalies associated with that syndrome. It is important when discussing the isolated cleft that you realize that most clefts do not occur with an accompanying syndrome. A child with a particular syndrome might have a cleft, but a child with a cleft does not necessarily have that particular syndrome - - and with the absence of other anomalies, probably does not.

A child with an isolated cleft is just like any other child. As such, a child with an isolated cleft may or may not have another problem that is not associated with the cleft, except that they are both occurring in the same child. For instance, a child may be born with a cleft and be born with cerebral palsy. A cleft may have been caused by heredity and the cerebral palsy caused by a lack of oxygen during birth. Neither condition is associated with the other. They just both happened to happen to the same child. The child could have had one condition and not the other just as
easily.

A child with an isolated cleft is not more likely to be mentally retarded or learning disabled or in any other way impaired than any other child. Geneticists are always looking for physical factors that may link to cleft, such as clumsiness, short stature, scoliosis, heart problems and other midline defects, etc. However, as yet there is no conclusive evidence that a cleft can be considered a marker for any other problem.

There are, however, some problems that may be associated with an isolated cleft. Most parents of cleft-affected children are aware of the problem of chronic or recurring ear infections. The ears of a child with a cleft have a tendency to collect fluid because the Eustachian tubes, which connect the middle ear to the mouth do not drain the fluids effectively. Pressure can build up and infection can occur. Most children with isolated clefts suffer from recurring ear infections until a myringotomy with tubes is done to alleviate the situation. Most children with clefts have a number of ear tubes put in over the course of their childhood.

Related to the problem of chronic ear infections is hearing loss. Children who suffer from a lot of untreated ear infections over a period of time may face the inevitability of permanent hearing loss. Even temporary hearing loss experienced while an infection is occurring can result in the child being unable to learn as easily as a child whose ears are unaffected. In years past children with clefts were identified as being at risk for learning disabilities because chronic infections rendered them mildly to moderately hearing impaired. Proper preventive care can virtually eliminate that threat.

A child with an isolated cleft will need orthodontia. While it is true that children without clefts may also need orthodontia, a cleft-affected child's needs will differ greatly from the needs of a child with an overbite. A complete cleft will involve the gum ridge and therefore the dental arches. It will be likely that an orthodontist will be needed to realign the entire structure for there to be a complete repair.

A child with an isolated cleft will probably need speech therapy. The oral and nasal cavities are extremely important structures in the production of speech. For a cleft-affected child those structures are quite different than those of a non-cleft-affected child. Not only does the cleft-affected child have to learn how to make the same sounds as everyone else using a different structure, but after each surgery he has to learn to use new equipment.

A child with an isolated cleft may also face some emotional challenges. If she is very self-conscious about her cleft scar or her speech differences, she may become introverted and her self esteem may plummet. Children who were born with clefts may feel 'different; from their peers when being different is the worst fate that can happen to a child. Occasionally, professional counseling may be needed to help the child identify her strengths and put the cleft scar into its proper perspective.

A child with an isolated cleft faces a promising future. Reconstructive surgery can all but completely erase the physical reminders of the cleft. Speech therapy can erase any reminders of cleft-affected speech. With the structures repaired and the function restored, the child with an isolated cleft can go on to enjoy a completely normal life.

People with isolated clefts have gone on in life to become doctors, lawyers, politicians, public speakers, ministers, movie stars, beauty queens, and more. The child with an isolated cleft is no different from his peers, except that he was born with a cleft. And the cleft can be repaired.


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