Cleft lip and palate is the most common congenital malformation in children in Europe. At the USZ, treatment begins with parents being advised by a specialized team during pregnancy.
“Cleft formation is often detected during an ultrasound examination during pregnancy,” says Harald Essig, oral and maxillofacial surgeon at the USZ and specialist in the treatment of cleft lip, jaw and palate. “For the parents, this is initially associated with anxiety and many questions about their unborn child. That’s why support and advice are important at this early stage.” At the USZ, an experienced team of specialists from the Department of Obstetrics, the Department of Oral and Maxillofacial Surgery and the Department of Neonatology work together to achieve this.
If necessary, a human geneticist is also consulted for advice. “We meet with the parents to discuss the expected extent of the cleft, answer questions and explain treatment options. Because all cleft shapes can be treated with a very good functional and esthetic result. We can use it to dispel many concerns. With comprehensive information and support, parents can prepare themselves emotionally for their child during pregnancy and look forward to the birth with confidence,” says Harald Essig.
One of the most common malformations
Cleft lip, jaw and palate are among the most common congenital malformations in Europe. Around one in 500 children is born with a cleft, and boys are affected slightly more often than girls. In those affected, the upper lip, upper jaw and palate are partially or completely crossed by a cleft. The type and severity of the malformation can be assessed prenatally using special, high-precision 3D ultrasound images; in some cases, additional genetic tests are carried out to clarify whether symptoms of other impairments are present. However, cleft lip and palate usually occur as isolated malformations and are only rarely part of a genetic syndrome. Some are familial, i.e. caused by defective hereditary factors, while others are spontaneous malformations.
Very different characteristics
The different cleft forms can occur on one or both sides. The manifestations of all forms are individual, and the functional disorders and impairments caused by cleft formation also vary depending on the form. They make it difficult to eat and can cause breathing difficulties. The malformation itself and also growth disorders that can occur after the necessary surgical interventions often lead to malpositioning of the teeth or even underdevelopment of the midface. If the soft palate is affected, difficulties with speech articulation and ventilation disorders of the middle ear can occur.
The altered appearance caused by the cleft is an additional burden for those affected. A cleft is usually diagnosed at the first examination after birth, if not already prenatally. Only a submucosal cleft palate, i.e. a cleft palate located under the mucous membrane, is sometimes only suspected and recognized by the paediatrician, speech therapist or often also by the paediatrician or school dentist, especially if a child suffers unusually often from middle ear infections.
In experienced hands from day one
Depending on its extent, the treatment of a cleft can take place in several stages until the end of growth in young adulthood. “The aim of every step and at the end is to avoid functional restrictions and growth disturbances with an esthetically pleasing result. To ensure that every child receives the best treatment, this begins immediately after birth,” says Harald Essig, explaining the concept at the USZ. “If the cleft is only recognized after birth, an oral surgeon or orthodontist is called in to examine the child. The treatment team then discusses the next steps with the parents.” First of all, the focus is on practical issues, especially the child’s diet. Breastfeeding is possible in most cases, especially if there is only a cleft lip.
Nurses and midwives specializing in newborns with clefts guide the mothers through the process. If necessary, the orthodontist will make a palatal plate in the first few days, which separates the oral and nasal cavities, serves as a sucking and drinking aid and also facilitates breathing. Because the palatal plate is inserted in the first few days of life, children quickly get used to it. “Most children can then be discharged home with their mother after a few days. If problems or questions arise, parents can contact us at any time.”
