A cleft lip is a congenital anomaly that occurs in the face during fetal development. A cleft can be visible and lead to medical, behavioral and social difficulties.
A cleft lip formation occurs due to non-union of facial tissues at the center of the face. Many factors such as family history may lead to the development of cleft lip.
An ultrasound is a diagnostic procedure which is done routinely during the antenatal care of your growing baby. As it gives you the glimpses of your baby, it also helps in diagnosing any visible congenital disabilities.
Continue reading this article to find out more about cleft lip ultrasound in detail.
Formation of lip takes place between the fourth and seventh week of pregnancy. The facial tissues from each side of the head grow towards the center of the face and join together to form the face.
The joining of tissues forms facial features such as lips and mouth. Failure in the joining of lip tissues leads to the formation of cleft lip.
A cleft lip affects the upper lip. The opening of the cleft can be a small slit, or it can extend through the nose. A cleft lip can be present on one or both the sides of the lip. They can also be present in the middle of the lip, which occurs very rarely.
According to the Center for Disease Control and Prevention (CDC), around 4,440 babies are born with cleft lip each year, with or without cleft palate. (1)
Causes of cleft lip
The exact reason for cleft lip formation is unknown. But there are certain combinations of factors such as environmental and genetic that may increase the chances of developing cleft lip in your baby. (2)
- Family history – A strong familial history of cleft lip or palate may increase the chances in the newborn. However, sometimes a child is born with a defect without any family history and unknown cause of the condition. Such cases are known as ‘sporadic.’ (3)
- Smoking – Women who smoke during their pregnancy are more likely to deliver a baby with an orofacial cleft than women who do not smoke.
- Diabetes – Diabetic women have an increased risk of having a child with a cleft lip, compared to non-diabetic women. (4)
- Use of certain medicines – Women who used certain medication to treat epilepsy, such as topiramate or valproic acid, during the first trimester of pregnancy have an increased risk of having a baby with cleft lip, compared to women who didn’t take these medicines.
Diagnosis of cleft lip via ultrasound
A prenatal ultrasound uses sound waves to create pictures of the developing fetus. When analyzing these pictures, your doctor may detect a difference in the facial structures.
Ultrasonography performed in the second trimester helps in the diagnosis of cleft lip.
Three-dimensional imaging is introduced in prenatal ultrasonography to aid in detecting cleft anomalies more precisely. (5)
If your baby has a cleft lip, amniocentesis is the next diagnostic step. This procedure includes the collection of amniotic fluid to detect the inheritance of a genetic syndrome that causes the cleft lip. (6)
Ultrasounds do not provide a reliable assessment of the cleft as the sonographic appearance of a cleft can underestimate the severity compared to the actual post-natal anatomic appearance.
Therefore, complete assessment cannot be made until the birth of the child.
After the diagnosis, the reports get forwarded to a multidisciplinary team of doctors that guide the treatment of the baby from prenatal to the postnatal period.
Advantage of prenatal diagnosis
Early diagnosis of the cleft lip can have the following benefits:
- Time for parental education.
- Time for parental psychological preparation. (7)
- Opportunity to investigate other associated anomalies.
Treatment of cleft lip
Therapy for children with orofacial clefts can vary depending on the severity of the cleft; the child’s age and needs; and the presence of associated syndromes or other congenital disabilities, or both.
Surgery to repair a cleft lip occurs in the first few months of life and should take place within the first 12 months of life. Surgical repair can improve the look and appearance of the face and improve breathing, speech and language development.
A primary lip repair takes place around the age of 3 months and a lip revision surgery around 3-5 years. The cosmetic results with cleft lip alone are excellent.
Types of cleft lip
Based on the extent and the side involvement, cleft lip has the following types:
Forme fruste unilateral cleft lip
A subtle cleft present on one side of the upper lip. May appear as a small indentation.
Incomplete unilateral cleft lip
A cleft present on one side of the upper lip, not extending into the nose region.
Complete unilateral cleft lip
A cleft present on one side of the upper lip that extends into the nose region.
Incomplete bilateral cleft lip
Clefts present on both sides of the lip, not extending to the nose.
Complete bilateral cleft lip
Clefts present on both sides of the upper lip, extending into the nose region.
A routine ultrasound during pregnancy can detect cleft lip. If your child has a cleft lip, it can be stressful and upsetting.
But an early diagnosis will help you to take some critical decisions related to your child’s health.
Proper consultation with a doctor before planning a child and discussing the genetic and environmental influences that can affect your baby can help prevent the risks.
With the help of modern technology, it is easy to detect cleft lip anomaly in your child during pregnancy.
Early diagnosis of the cleft lip will help you to prepare mentally and plan the sequence of treatments with the concerned team of doctors.
Be prepared and informed before you welcome your bundle of joy into your family.