CLEFT LIP AND PALATE, SCOPING REVIEW

Abstract

Introduction: cleft palate cleft lip is the most common congenital craniofacial defect originated by a disturbed embryonic development of the soft and hard tissues around the oral cavity, as well as the surface of the face, resulting in severe limitations in chewing, swallowing and speaking, besides sometimes generating problems of insufficient space for teeth, adequate breathing and self-esteem problems due to facial appearance.

Objective: to detail the current information related to cleft lip and palate, description, incidence, epidemiology, etiology, embryology, clinical characteristics and surgical treatment.

Methodology: a total of 42 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 32 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: cleft lip, cleft palate, cleft palate, malformations, congenital anomalies.

Results: the overall incidence of cleft lip and palate is about 1 in 600 to 800 live births (1.42 in 1,000) and cleft palate only occurs in about 1 in 2,000 live births.  The incidence is high among Asian individuals at 0.82 - 4.04 per 1,000 live births, intermediate in Caucasians at 0.9 - 2.69 per 1,000 live births and low in Africans at 0.18 - 1.67 per 1,000 live births.

Conclusions: Cleft lip and/or palate occur in such a strategic area of the orofacial region, at an essential time prior to birth making it a complex congenital deformity. Clefts appear in the fourth stage of embryonic development. The individual affected with orofacial cleft deformity should be treated at the right time and at the right age to obtain functional and esthetic well-being. Clefts of the lip and palate can be solitary or linked in different combinations and/or linked with other congenital deformities. The etiological factors of cleft lip and palate can be associated with genetic and non-genetic factors. Correction consists of surgically fabricating a face that does not attract attention, a vocal apparatus that achieves intelligible speech and a dentition that maintains high quality function and esthetics.  To achieve success for the child born with cleft lip and palate requires coordinated collaboration by different specialties, including oral/maxillofacial surgery, plastic/reconstructive, otolaryngology, genetics/dysmorphology, speech/language pathology, orthodontics, prosthetics and others. Currently the use of autogenous bone is the most frequently used type of graft in bone regeneration defects. However, the availability of autogenous bone is limited. Robotic surgery, the use of stem cells and tissue engineering are in development and present a promising vision of the future.