An opening in the upper lip is many a time a genetic problem that can affect feeding, speech and disfigure the face of the person bearing the condition. This condition can affect self-esteem of both the parents and the child born with it, hence increasing the risk of trauma in the family. In most cases, people with this defect are isolated and viewed as outcasts.

The condition is referred to as cleft lip and palate. A cleft lip is a separation of the two sides of the lip, which can include the bone of the upper jaw, while a cleft palate is an opening in the ‘roof’ of the mouth because the two sides of the palate have not joined properly.

According to Epimaque Kayiranga, a stomatologist at the University Teaching Hospital Kigali (CHUK), they receive about three cases a month of children born with a cleft lip palate at the hospital.

He adds that there are three common types of cleft lip and palate - cleft palate, unilateral cleft lip and palate and bilateral cleft lip and palate.

What causes cleft lip and palate?

Kayiranga says the condition is normally passed on to the offspring from either one of the parents with a cleft lip and palate chromosome.

"Clefts of the lip and palate are mainly hereditary anomalies that always result in severe functional deficits of speech, mastication and deglutition. Normally, the patients with this condition have high risk of having congenital malformation, feeding problems, as well as learning disabilities,” he says.

Disruption of normal patterns of facial growth while in the womb, including deficiencies of any of the facial processes, may also lead to maldevelopment of the lips and the palate.

According to Kayiranga, this disruption normally occurs in the sixth and seventh week of the foetus development, whereby the facial parts of the foetus fail to fuse together completely.

"Some medication taken by pregnant mothers to treat conditions like arthritis and cancer can result into a child being born with cleft lip and palate. Also, exposure to harmful chemicals by pregnant women increases the chances of a baby to be born with the condition,” he says.

How to treat it

Patients with this birth defect can be treated and leave a normal life as other people through surgery.

According to Alexander Manzi, an otolaryngologist (ear, nose and the throat) at CLNG Clinic in Kicukiro, Kigali, the treatment depends on the severity of the cleft disorder.

The bilateral cleft is more risky to operate compared to unilateral one since it requires a lot of keenness because one can end up messing with the patient’s hearing and speech if not well-handled.

"Generally, the children with cleft lip and palate are at high risk of getting ear infection, which if left untreated can result into loss of hearing partially or completely. Such children should be provided with special tubes that aid in preventing food from entering the middle ear,” he says.

Gonzalue Niyigaba, a dentist at CHUK, says such children need to be checked regularly to make sure they do not have dental problems.

"Most people with cleft lip and palate always have displaced teeth that require close checkups. For instance, their upper gum is not always proportional, making the teeth to be displaced, which makes them to have cavity problems,” he explains.

"Cleaning, good nutrition and fluoride treatment should be applied in order to ensure healthy teeth. However, the cleaning of the teeth should start as soon as the teeth start growing using soft bristled toothbrush ,” Niyigaba adds.

He also says a toothette can be used to clean the teeth if the normal small toothbrush is not working appropriately.

The best time to correct the condition, according to medics, is when one is still young (between three to six months). They explain that when the condition is treated at an early stage, it helps normal speech development and the scars and bones also tighten as one grows, rendering the effects of the surgery almost invisible in older stage.

It is particularly recommended to treat infants who have to be fed through the nasal cavity as early as possible.

Prevention

In most cases there is no prevention of cleft lip palate, as most of the time it results from genetic chain. However, doctors’ advise that medication causes can be avoided.

According to Manzi, pregnant mothers should avoid taking any type of drugs without the prescription from the doctors, and that, regular checks ups should be adopted in order to detect any abnormalities so that, immediate medication is done as soon as the child is born with the condition.

Problems associated with the condition

Infection of the ear: This is because patients are more prone to fluid buildup in the middle ear, so frequent checkups should be done on the ears of children with this condition.

Difficulties in speech: Their speech may be distorted, which may make it difficult for other people to understand what they are saying.

Dental problems: People with the condition normally have larger cavities with missing or displaced teeth that require treatment.

Diagnosis

Late prenatal ultrasound can be done to establish if the child has any cleft lip palate. Physical examination of the mouth, nose and palate can also be done immediately after birth.