Cleft lip and palate are related to these factors during pregnancy! It can be cured, don't give up easily!

Author: Ma Lian, chief physician at Peking University Stomatological Hospital

Reviewer: Wang Lixiang, Chief Physician, Third Medical Center, PLA General Hospital

The 10th Chairman of the Science Popularization Branch of the Chinese Medical Association

Cleft lip and palate is a congenital disease, a facial cleft deformity occurring in the oral and maxillofacial area, including cleft lip and cleft palate.

From the perspective of anatomical morphology, cleft lip is commonly known as hare lip, which is actually the lip not connected. It is divided into unilateral cleft lip and bilateral cleft lip, which can be completely or partially cleft. Cleft palate is the split of the upper palate of the mouth, that is, the split of the upper mouth, commonly known as wolf throat.

Figure 1 Original copyright image, no permission to reprint

During the development of the embryo, especially in the first three months, the tissue and organ structure of the oral and maxillofacial region is formed by the fusion of several protrusions. Abnormalities occur during the fusion process, leaving some gaps, leading to the occurrence of cleft lip and palate. This is the mechanism of cleft lip and palate.

Clinically, cleft lip and palate are divided into two major categories. One category is syndromic cleft lip and palate, which may also have other deformities of the head, eyes, limbs, trunk, and internal organs. The other category is non-syndromic cleft lip and palate, which is the only deformity present and there are no deformities of other important organs.

1. What factors are related to cleft lip and palate?

There is currently no particularly clear cause of cleft lip and palate. Possible causes can be roughly divided into three categories: biological factors, physical factors, and chemical factors.

Biological factors, such as viral infection, especially in the first three months of pregnancy, if the mother is infected with viruses such as influenza virus and herpes zoster virus, the risk of cleft lip and palate in the fetus will be higher, because the first three months are the most important period for the formation of the fetus's face. Drugs are also biological factors. Taking some drugs during pregnancy, especially diphenhydramine and anti-epileptic drugs, may also cause cleft lip and palate in the fetus.

Physical factors mainly refer to radiation. You should avoid exposure to radiation and take good protection during the first three months of pregnancy.

Chemical factors generally refer to toxic and harmful gases, such as gases produced by decoration, which have the risk of causing teratogenicity.

In addition, studies have shown that increased maternal adrenaline secretion during pregnancy may also cause cleft lip and palate in the fetus; children born to older pregnant women are more likely to suffer from congenital malformations, including cleft lip and palate, which may be related to decreased egg quality; malnutrition during pregnancy, repeated vomiting, and folic acid deficiency may also cause cleft lip and palate in the fetus.

Regarding whether cleft lip and palate is hereditary, it is generally believed that syndromic cleft lip and palate is strongly related to genetics. If a child with cleft lip and palate has already been born, the probability of conceiving a child with cleft lip and palate is definitely higher than if there is no history of cleft lip and palate.

With the application of three-dimensional and four-dimensional color ultrasound, cleft lip can usually be detected when the pregnancy is five or six months old, but cleft palate cannot be confirmed at present.

Figure 2 Original copyright image, no permission to reprint

2. What should I do if the prenatal examination reveals that the fetus has cleft lip and palate?

Cleft lip and palate is a curable disease, unless there are other particularly serious deformities in the body. Simple cleft lip and palate can be cured as long as you persist in treatment. So here is an appeal, if you find that your fetus has cleft lip and palate during prenatal examination, don't give up easily.

Some pregnant women come to consult, they are quite entangled, such as how effective is the treatment of cleft lip, whether it is clear whether there is cleft palate, whether to keep the child... Whenever pregnant mothers ask these questions, I feel a heavy responsibility, and I still don’t know how to answer them. I can only tell them what I know and the percentage. Because cleft palate itself is not easy to see under B-ultrasound, I can only say that the probability of cleft lip accompanied by cleft palate is 30%, the probability of cleft lip alone is 30%, and the probability of cleft palate alone is 30%.

3. What should we pay attention to when feeding a child with cleft lip and palate after birth?

For children with simple cleft lip, feeding problems should not be serious, and breastfeeding is recommended. For children with cleft lip, the lip closure may be slightly worse, but it will not affect sucking. For children with bilateral cleft lip, the mouth cannot be closed, and feeding can be done with a spoon or bottle.

Children with cleft palate will have difficulty sucking. Cleft palate causes the mouth and nose to communicate. When swallowing, milk may enter the trachea or flow out of the nasal cavity. The incidence of pneumonia is relatively high, so you need to be more careful when feeding. Hold the baby at a 45-degree angle and feed the baby in small amounts and multiple times, because the baby will inhale air. Be sure to burp the baby after feeding. When breastfeeding, the mother can help with a little more strength, put her hands on the breasts and squeeze the breasts outwards, so that the milk can flow into the baby's mouth.

Children with syndromic cleft lip and palate have difficulty swallowing and feeding since birth. If the weight loss is obvious, gastric tube feeding is needed. However, gastric tube feeding is not a long-term solution. The use of gastric tube for a long time is not possible in this case. The child must have swallowing function, otherwise the swallowing function will be lost.