Cleft Lip and Palate: The Importance of Early Diagnosis and Timely Treatment

By Dr. Nitin Mokal, Plastic Surgeon and Project Director, Smile Train at Shushrusha Citizens Cooperative Hospital, Mumbai, Maharashtra.

For every 700 hundred babies born in India, one is born with a cleft lip or/and palate. With more than 35,000 cases annually, orofacial clefts are one of the most common and heart-breaking health conditions in the country.??

Cleft is a facial birth difference that occurs when certain body parts do not fuse together during the first six weeks of pregnancy.? The exact cause of why a cleft occur is still not clearly known, however, most experts agree that causes are multifactorial and are often caused by environmental and genetic factors.?

If left untreated, clefts in children can lead to significant challenges related to feeding, breathing, hearing, and speech development. Moreover, affected children may frequently suffer from ear, nose, and throat infections, hearing impairments, and dental issues. Feeding is a big challenge, and this can often result in infant malnutrition and other development delays.?

However, clefts are among the few congenital anomalies that can be effectively treated through timely surgical intervention, supplemented by non-surgical care such as speech therapy and orthodontic treatment. For most infants, appropriate cleft treatment can restore normal function, leaving minimal facial scarring. Early diagnosis and timely treatment are crucial for achieving optimal functional, aesthetic, and psychosocial outcomes. A coordinated, multidisciplinary approach is vital to ensure comprehensive care from infancy through adolescence.?

The Importance of Early Diagnosis

Early diagnosis allows for the effective coordination of a multidisciplinary team, including pediatricians, surgeons, orthodontists, speech therapists, nutritionists, and other specialists, to develop a comprehensive short-term and long-term treatment plan. Infants with cleft often face feeding challenges, which can result in inadequate nutrition intake and delay the surgery timeline. Early diagnosis during pregnancy provides an opportunity to educate and support parents, reducing their anxiety and helping them understand the condition and its management. Interventions such as the use of specialized feeding bottles and feeding techniques can ensure proper nutrition.

The Importance of Timely Treatment

Surgery is crucial for treating a cleft. Cleft lip surgery can be performed as early as in the fourth month of age, while palate surgery is typically done around the ninth month. Timely surgical repair is also essential to minimize the risk of complications and improve outcomes, including reducing speech and hearing distress. Delayed treatment can lead to complications such as speech difficulties, ear infections, and dental problems, which are more challenging to address later in life.?

Children with untreated cleft palate are at a higher risk of speech disorders and may require more intensive therapy. Speech and language assessment can begin at the time of palate repair, with the child often requiring a series of sessions to fully correct the speech. Untreated cleft can also lead to social stigma and psychological challenges. Timely intervention can greatly enhance the child’s appearance and function, which is critical for their self-esteem and social integration. Early intervention and treatment can also address dental issues and help in the growth and development of the teeth and jaws, improving both function and appearance. Addressing these issues early can help ensure a full and healthy recovery for the child.

In India, affordability and availability of cleft treatment is a significant challenge. However, apart from public health institutions, global charities like Smile Train work in several states and union territories to provide free and comprehensive high-quality cleft care to those in need. Despite these efforts, awareness remains a major hurdle, especially in rural areas where superstitions about cleft conditions, such as beliefs related to lunar eclipses and karma, discourage families from seeking medical help.?

I remember treating a patient in his early teenage years whose parents did not take him for treatment before due to superstitions and he had dropped out of school because of constant bullying and rejections. When I met him, the boy had severe speech imparities, however with our treatment and comprehensive care support he has shown improvements over time. As much as early diagnosis and timely treatment of clefts are essential for optimizing functional, aesthetic, and psychosocial outcomes, I personally feel that more awareness drives are required to make people aware of this condition and its treatment options. Educated parents, informed healthcare providers, and supportive communities can ensure that cleft affected children receive the care they need at the earliest and can live a fulfilling life.