Cleft Palate
A cleft palate may occur in
combination with a cleft lip. Cleft palate is an in-born separation of the
roof of the mouth which puts a barrier between the mouth and the nasal
cavity. The palate or the roof of the mouth has a hard and soft part. When
you roll your tongue upwards you can feel the hard palate. The soft palate
is way at the back, it is integral for speech. Affected children have
hypernasal speech with difficulty with certain words. Other impairments
associated with cleft palate include: maldevelopment and malpositioning of
the teeth, difficulty of feeding, and abnormal collection of fluid in the
middle ear which may result to a chronic ear infection.
Generally cleft palate occurs in
one (1) for about every 2500 births. Asians are more affected than the
Caucasians and the Blacks (least affected). The most frequent combination is
a cleft lip and a cleft palate, which is more common in boys than girls, and
often occurs on the left side. A high incidence of clefts in some families
suggests a genetic cause. When a parent has cleft palate, there is a 2%
probability that the offspring will be affected. The same 2% probability is
expected for the next child when a sibling is affected without the parent.
When two of the children are affected, there is a 9% probability that the
next sibling will be affected; and when the child is affected with the
parent, the probability increases to 15% for the next child. This is where
genetic counseling becomes relevant. Cleft palate can occur as part and
parcel of a multiple congenital syndrome - a complex form of deformities at
birth. It is imperative that the effected baby be screened for other in-born
deformities. In fact, the incidence of a cleft palate (without a cleft lip)
carries a 40% chance to be associated with a congenital syndrome. On the
other hand, environmental agents such as alcohol, anticovulsants, cis-retinoic
acids were identified but have yet to be convincingly associated with
prenatal exposure in order to be considered as the definite causative
factors.
The objective of the surgical
repair is to return the functions of the palate. Timing is very important -
before the affected child develops his speech. Although speech develops as
early as less than a year old, there is a technical difficulty to carry out
the operation at this age. Palatal repair is a formidable operation – the
surgery is done on a small hole (the orifice of the mouth). Thus, surgery is
done at its best at around one year to one year and a half (1-1 ˝ year old).
However, when surgical correction is delayed, speech development becomes
retarded. In fact, the older the child attains surgery, speech
rehabilitation becomes poorer; and at an older age, results become very
disappointing – almost no speech improvement despite the surgical repair.
Palatoplasty
or cleft palate surgery remains to be in the forefront of Plastic Surgery’s
quest against physical deformities with concomitant functional impairments.
However, rigorous speech rehabilitation is still needed after the operation.
With proper timing of surgery and diligent compliance to rehabilitation,
best results are achievable. These affected children can continue to be
productive citizens of our society without the stigma of being labeled as
defective and impaired. |