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| Ultrasound image of Cleft Lip/ Cleft palate. Arrows point to the abnormality. |
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A cleft lip and/or a cleft palate occurs very early in fetal life when the plates of the fetal face come together. This process is complete by 10 weeks of gestation. It is a fairly common birth defect. Approximately 1: 1000 fetuses are affected. It occurs more often in male fetuses.
Approximately 60% of cleft lips and/or cleft palates are isolated. In other words, there are no other birth defects or syndromes. However 40% occur with other abnormalities. Chromosome abnormalities are seen in approximately 10% of cases. (see www.AskAnOB.com/downsyndromescreening) Over 300 syndromes have been associated with clefts, making exact diagnosis very difficult.
The recurrence risk for parents depends on the underlying etiology of the cleft. In the majority that are isolated, the recurrence risk is 3-5% with future pregnancies.
On ultrasound, a defect in the palate, or tooth buds is seen. This image is a 2-d "slice" through the head, going through the bone above the mouth. In other words, picture a plane slicing the head into a top and bottom, right above the mouth. You can see right and left designated. Then you can see whitish tooth buds along the right, that fall off where the arrow points. This is the area of the cleft lip.
The prognosis for cleft lip/ cleft palate depends on any associated syndromes. In cases of chromosome problems, the prognosis can be very grave. For this reason and amniocentesis is recommended to evaluate the fetal chromosomes (see www.AskAnOB.com/amniocentesisrisks). A detailed ultrasound should be performed by an expert in fetal ultrasound. Consideration for a fetal echo, to examine the fetal heart closely, is recommended.
The cleft lip/ cleft palate is surgically correctible. Typically, the repair begins typically in the first year of life. This repair may require a series of surgeries. Initially, the newborn can often have feeding issues that need to be addressed. Specialized pediatric care is required. Breastfeeding is possible, and recommended, however sometimes this must be accomplished with breast pumping and special nipples. The recurrence risk for an isolated cleft in a future pregnancy is about 3-5%. Therefore genetic counseling and detailed ultrasound if future pregnancies is recommended.
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Check out Joanne's photo gallery filled with pictures!
www.widesmiles.org
And Joanne also has a great book, featuring Lippy-Lion, for families welcoming in a baby with a cleft:
www.amazon.com
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