Hairlip, Cheiloschisis, Palatoschisis.

In the womb there is a hole or opening in the upper lip in the process of mouth formation, but in normal situations, it fuses together in the first three pre-natal months. In babies with this condition the fusion does not take place or if it is partial. The cause behind this cannot be found out in every case but it is believed that genetic as well as environmental factors are involved.

Generally a gene responsible for cleft is inherited from one of the parents and its expression takes place due to environmental factors. In the environmental factors exposure of the fetus to cigarette smoke, alcohol, illicit drugs or some viruses are responsible for cleft. Folate deficiency in mother is also believed to be playing role in the development of cleft.

Clefts are more prevalent in children of Hispanics, American Indians and Asians. Black children rarely have clefts. Incidence of cleft lip is double in males as compare to females and incidence of cleft palate is double in females than in males.

Race, sex and family history are the risk factors for cleft lip or cleft palate. Also exposure to cigarette smoke, alcohol and illicit drugs in early pregnancy can cause cleft lip or cleft palate.

Hidden or sub mucosal cleft is not seen. Problems in feeding, nasal regurgitation, nasal sounding voice and lots of nasal discharge are the symptoms of sub mucosal cleft.

The clefts are seen after birth by physical examination but with ultrasound techniques they can be diagnosed in pregnancy also. Genetic testing can find out whether the cleft is due to some genetic factor and accordingly treatment options may be considered. Genetic testing also indicates the possibility of cleft lip or cleft palate in future children.

After initial surgery for cleft, follow up surgeries may also be done. They are for cosmetic purposes and speech improvements. The follow up surgeries may be done between the ages of two years to late teen age. Along with surgery behavioral and psychological therapies are also given.

The outcome of cleft is good.

Feeding is an immediate problem due to insufficient suction, lack of air tight latch and nasal regurgitation. If the cleft is throughout the upper lip then tooth development and dental care becomes difficult. Hearing loss due to frequent ear infections is possible. There may be speech problems due to hearing problems. Children may suffer from social, behavioral and emotional problems due to abnormal look.

If a baby is born with cleft or if there is a family history of cleft then it is better to get medical counseling from doctors and measures to avoid it.

Taking vitamin supplements especially folic acid supplements before getting pregnant and in the early stages of pregnancy reduces the possibility of baby being born with a cleft defect.

Certain blood tests and family history can predict the possibilities of having babies with cleft. Accordingly steps can be taken to avoid it.