Cleft

Cleft is the medical term for a clearly visible gap in the lip, jaw and/or palate.

In this health file, you will get information about clefts and the different treatments children with clefts receive. However, this defect is different in every child, so treatment may also vary from child to child.

What is Cleft?

The lip, jaw and palate cleft is called "schisis" in medical terms. There are different forms of cleft schisis. Some babies have only a cleft in the lip (cheiloschisis). Others have a cleft in both the lip and jaw (cheilognathoschisis). Finally, a cleft may also occur in both the lip, jaw and palate (cheilognathopalatoschisis). The cleft can be on the left or right. Then we speak of a single-sided (unilateral) cleft. A double-sided (bilateral) cleft is also possible.

The cleft often extends into the nose. Sometimes there is only a cleft in the palate, usually nothing unusual can be seen on the child's face. There are many variants of a cleft palate. Each cleft is different: you cannot say that one is more severe and the other less severe. In fact, it is very difficult to predict in advance what the result of treatments will be. A child grows and how it will develop later is hard to say.

Cleft and Heredity

Development of the face and palate takes place in the first 3 months of pregnancy. The palate as well as the upper lip and nose are created by the fusion of different structures in the face. When this process does not take place or is incomplete, clefts remain.

A cleft occurs in 1-2 in 1,000 births and more often in boys than in girls.

A cleft can occur in isolation, i.e. without additional abnormalities, or it can be part of a wider disorder. In the latter case, one speaks of a syndromal form of cleft. A lip cleft (with or without palate cleft) is isolated in about 95% of cases. With a palate cleft, about 15% involve a syndromal form.

The cause of an isolated cleft is multifactorial, i.e. the result of a combination of hereditary and environmental factors. Which environmental factors are not known exactly. The recurrence risk to a subsequent pregnancy in this case is about 3-5%.

The recurrence risk in syndromic cleft depends on the syndrome. For a large number of syndromes, it is possible to detect the causative fault. However, there are also many cases of cleft with associated abnormalities where an exact diagnosis cannot be made.

To check whether a child has an isolated or syndromal form of cleft and to determine the likelihood of recurrence for any subsequent child, you can consult a clinical geneticist. In hereditary counselling, the person with a cleft will be examined, a family tree will be drawn up and, if necessary, additional examinations of other organ systems (e.g. ultrasound of the heart, radiography of the vertebral column, eye examination...) or a blood test will be carried out.

Possibilities for possible prenatal diagnosis in subsequent pregnancies can also be discussed.

Treatment

Treatment for a child with a congenital facial malformation begins shortly after birth. Treatment extends over a series of years. After all, the child goes through tremendous growth from baby to adult. Within this period, we try to choose the best time for each part of the treatment protocol.

It is not possible to give the child a "normal" appearance and teeth at any age. This is related to the child's growth and the changes that occur as a result. We aim to have the best possible result when the child is an adult. This requires a lot of patience from all involved. As all children are different, the treatment plan will differ from child to child in some respects.

More information

Feeding and care

One of the first things you will have to deal with is feeding your baby. At Ghent University Hospital, the social nurse guides parents on feeding children with a cleft.