Cleft lip and cleft palate are facial and oral malformations that occur very early inpregnancy, while the baby is developing inside the mother. Clefting results when there is not enough tissue in the mouth or lip area, and the tissue that is available does not join together properly.
A cleft lip is a physical split or separation of the two sides of the upper lip and appears as a narrow opening or gap in the skin of the upper lip. This separation often extends beyond the base of the nose and includes the bones of the upper jaw and/or upper gum.
A cleft palate is a split or opening in the roof of the mouth. A cleft palate can involve the hard palate (the bony front portion of the roof of the mouth), and/or the soft palate (the soft back portion of the roof of the mouth).
Cleft lip and cleft palate can occur on one or both sides of the mouth. Because the lip and the palate develop separately, it is possible to have a cleft lip without a cleft palate, a cleft palate without a cleft lip, or both together.
Cleft lip, with or without cleft palate, affects one in 700 babies annually, and is the fourth most common birth defect in the U.S. Clefts occur more often in children of Asian, Latino, or Native American descent. Compared with girls, twice as many boys have a cleft lip, both with and without a cleft palate. However, compared with boys, twice as many girls have cleft palate without a cleft lip.
In most cases, the cause of cleft lip and cleft palate is unknown. These conditions cannot be prevented. Most scientists believe clefts are due to a combination of genetic and environmental factors. There appears to be a greater chance of clefting in a newborn if a sibling, parent, or relative has had the problem.
Another potential cause may be related to a medication a mother may have taken during her pregnancy. Some drugs may cause cleft lip and cleft palate. Among them: anti-seizure/anticonvulsant drugs, acne drugs containing Accutane, andmethotrexate, a drug commonly used for treating cancer, arthritis, and psoriasis.
Cleft lip and cleft palate may also occur as a result of exposure to viruses or chemicals while the fetus is developing in the womb.
In other situations, cleft lip and cleft palate may be part of another medical condition.
Because clefting causes very obvious physical changes, a cleft lip or cleft palate is easy to diagnose. Prenatal ultrasound can sometimes determine if a cleft exists in an unborn child. If the clefting has not been detected in an ultrasound prior to the baby's birth, a physical exam of the mouth, nose, and palate confirms the presence of cleft lip or cleft palate after a child's birth. Sometimes diagnostic testing may be conducted to determine or rule out the presence of other abnormalities.
A cleft lip may require one or two surgeries depending on the extent of the repair needed. The initial surgery is usually performed by the time a baby is 3 months old.
Repair of a cleft palate often requires multiple surgeries over the course of 18 years. The first surgery to repair the palate usually occurs when the baby is between 6 and 12 months old. The initial surgery creates a functional palate, reduces the chances that fluid will develop in the middle ears, and aids in the proper development of the teeth and facial bones.
Children with a cleft palate may also need abone graft when they are about 8 years old to fill in the upper gum line so that it can support permanent teeth and stabilize the upper jaw. About 20% of children with a cleft palate require further surgeries to help improve their speech.
Once the permanent teeth grow in, braces are often needed to straighten the teeth. Additional surgeries may be performed to improve the appearance of the lip and nose, close openings between the mouth and nose, help breathing, and stabilize and realign the jaw. Final repairs of the scars left by the initial surgery will probably not be performed until adolescence, when the facial structure is more fully developed.
A tumor is a growth caused by an overproduction of cells. A cyst is similar to a tumor, except that it is filled with fluid. Both tumors and cysts can form in the bone of the maxillofacial region, most frequently in the lower jaw bone, or mandible.
Benign cysts and tumors of the jaw bone are most often odontogenic, meaning that they originate from tissue related to the teeth. The most frequent kind of odontogenic growth develops near impacted teeth and is called a dentigerous cyst or tumor. It occurs when the follicle of an impacted tooth continues to grow, although the tooth is unable to erupt. This growth can cause the formation of a cyst or tumor that can damage surrounding teeth and bone.
Another kind of odontogenic cyst is called an odontogenickeratocyte. This kind of cyst is most frequently located in the mandible, though it can sometimes appear in the maxilla. It can grow very quickly, and can be difficult to remove, often recurring after surgical removal.
Two kinds of benign non-odontogenic cysts are simple (traumatic) cysts and aneurismal cysts. These occur more frequently in adolescents or young adults, whose bones are still growing. They are sometimes thought to be caused by trauma, but often, their cause cannot be determined. They can form in any bone in the body, including the jaw. While e they are not in themselves dangerous, they can weaken the jaw bone and make it more susceptible to fractures.
Tumors are frequently benign, but can also be malignant (cancerous). Malignant bone tumors in jaw are either primary, meaning that the cancer originated there, or secondary, meaning that the cancer has metathesized, or spread to the bone of the jaw, from another area of the body. Primary bone cancer in the maxillofacial area is very rare. Malignant tumors in this region are more likely to have metathesized from elsewhere in the body.
Symptoms : Bone cysts and tumors very often do not have any symptoms. They are usually discovered during a routine x-ray, when a bone fracture occurs, or if they swell to a very large size. In some cases, however, they can cause bone pain.
Diagnosis : Physicians use x-rays to visualize the tumor or cyst in the jaw bone. A biopsy is often necessary to determine whether a tumor is benign or malignant.
Treatment : In some cases, benign tumors and cysts can be left untreated. However, they usually need to be closely monitored by your doctor. Cells within odontogenic cysts and tumors can occasionally become malignant. But even benign cysts and tumors can also weaken or cause damage to the surrounding bone and tissue if they continue to grow.
Benign cysts and tumors of the bone generally need to be surgically removed. Depending on the nature of the cyst or tumor, a small or a large area of bone may need to be removed. In some cases, bone reconstruction of the area may necessary. The area of the removed cyst or tumor will be monitored to make sure that it does not recur. Treatment of malignant tumors depends on the type and stage of malignancy.