An Adult with Untreated Isolated Cleft Palate Since Birth: A Rare Case Report
Abstract
Introduction: Orofacial clefts are one of the most common congenital anomalies involving the craniofacial region. An isolated cleft palate is the rarest (33% of all orofacial clefts) among individuals with female predominance. Individuals born with these clefts manifest craniofacial, functional, and psychological anomalies. Sometimes, patients cannot receive the required therapies due to a lack of awareness and lack of medical access or economic factors. Untreated clefts may adversely impact the patient’s life both physically and psychologically.
Case Description: This study presents a case report of a 45-year-old male with an untreated cleft palate since birth due to a low socioeconomic background, leading to several oro-dental anomalies, speech defects, and psychological and social challenges.
Results: Extraoral examination revealed mild facial asymmetry, dry and incompetent lips, and underdeveloped philtrum. Intraorally, there was a cleft palate, macroglossia, soft and edematous gingiva with bleeding on probing, gingival recession, and periodontal pockets, along with various dental anomalies. Full mouth orthopantomogram showed discontinuity of the palatal line, collapsed maxillary arch, root stumps, and crowding. The final diagnosis of isolated cleft palate was made. The patient was advised for surgery regarding the cleft palate, dental treatment, speech therapy, and psychological counseling. However, the patient refused all treatments except a few dental aids due to economic difficulties.
Conclusion: The present case report highlights the need for these patients to receive particular concerns. Patients must be motivated to get proper treatment at a suitable stage to prevent future complications. Cleft teams must be advised to initiate some encouraging steps in imparting treatment aids to such patients, especially in rehabilitation therapy, considering their surrounding environment, psychological makeup, socioeconomic status, and motivation. In addition, social groups should also treat these patients with a positive approach, helping them to live healthy and normal lives just like any other individual.
2. Burg ML, Chai Y, Yao CA, Magee W 3rd, Figueiredo JC. Epidemiology, aetiology, and treatment of isolated cleft palate. Frontiers in Physiology. 2016; 7:67. [DOI:10.3389/fphys.2016.00067] [PMID]
3. Deshpande AS, Goudy SL. Cellular and molecular mechanisms of cleft palate development. Laryngoscope Investigative Otolaryngology. 2018; 4(1):160-4. [DOI:10.1002/lio2.214] [PMID]
4. Lee JS, Lee JY, Kim YD, Song JM, Choi WH. Primary repair of untreated cleft palate in an elderly patient: A case report. Journal of the Korean Association of Oral and Maxillofacial Surgeons. 2021; 47(1):47-50. [DOI:10.5125/jkaoms.2021.47.1.47] [PMID]
5. Fuller J, Drake D, Felstead A, Colbert S. Cleft repair in adults: A report on a case series. The Cleft palate-craniofacial Journal: Official Publication of the American Cleft Palate-Craniofacial Association. 2018; 55(7):1030-4. [DOI:10.1597/16-38] [PMID]
6. van Aalst JA, Kolappa KK, Sadove M. MOC-PSSM CME article: Nonsyndromic cleft palate. Plastic and Reconstructive Surgery. 2008; 121(1 Suppl):1-14. [PMID]
7. Bekele KK, Ekanem PE, Meberate B. Anatomical patterns of cleft lip and palate deformities among neonates in Mekelle, Tigray, Ethiopia; implication of environmental impact. BMC Pediatrics. 2019; 19(1):254. [DOI:10.1186/s12887-019-1624-2] [PMID]
8. Meyer-Marcotty P, Gerdes AB, Reuther T, Stellzig-Eisenhauer A, Alpers GW. Persons with cleft lip and palate are looked at differently. Journal of Dental Research. 2010; 89(4):400-4. [DOI:10.1177/0022034509359488] [PMID]
9. da Silva Freitas R, Lopes-Grego AB, Dietrich HL, Cerchiari NR, Nakakogue T, Tonocchi R, et al. Weight gain in children with cleft lip and palate without use of palatal plates. Plastic Surgery International. 2012; 2012:973240. [DOI:10.1155/2012/973240] [PMID]
10. Ravi MS. Oral and craniofacial characteristics of untreated adult unilateral cleft lip and palate individuals. Journal of Health and Allied Sciences. 2012; 2(3):16-20. [DOI:10.1055/s-0040-1703582]
11. Galitesi TRL, Foger D, Velasco SRM, Esper LA, HonĂ³rio HM, Almeida ALPF, et al. Dental caries and oral health-related quality of life in cleft lip and palate patients: A pilot study. World Journal of Dentistry. 2015; 6(3):123-8. [DOI:10.5005/jp-journals-10015-1327]
12. Smarius BJA, Haverkamp S, de Wilde H, van Wijck-Warnaar A, Mink van der Molen AB, Breugem CC. Incidence of cleft-related speech problems in children with an isolated cleft lip. Clinical Oral Investigations. 2021;25(3):823-31.[DOI:10.1007/s00784-020-03367-5] [PMID]
13. Murthy J, Sendhilnathan S, Hussain SA. Speech outcome following late primary palate repair. The Cleft palate-Craniofacial Journal: Official Publication of the American Cleft Palate-Craniofacial Association. 2010; 47(2):156-61. [DOI:10.1597/08-230.1] [PMID]
14. Chung KY, Sorouri K, Wang L, Suryavanshi T, Fisher D. The impact of social stigma for children with cleft lip and/or palate in low-resource areas: A systematic review. Plastic and Reconstructive Surgery. Global Open. 2019; 7(10): e2487. [DOI:10.1097/GOX.0000000000002487] [PMID]
15. Millar K, Bell A, Bowman A, Brown D, Lo TW, Siebert P, et al. Psychological status as a function of residual scarring and facial asymmetry after surgical repair of cleft lip and palate. The Cleft Palate-Craniofacial Journal: Official Publication of the American Cleft Palate-Craniofacial Association. 2013; 50(2):150- -7. [DOI:10.1597/10-222] [PMID]
16. Farmani H, Sayyahi F, Soleymani Z, Zadeh Labbaf F, Talebi E, Shourvazi Z. Normalization of the non-word repetition test in Farsi-speaking Children.Journal of Modern Rehabilitation. 2018; 12(4):217-24. [DOI:10.32598/JMR.V12.N4.217]
Files | ||
Issue | Vol 18 No 1 (2024) | |
Section | Case Report(s) | |
DOI | https://doi.org/10.18502/jmr.v18i1.14737 | |
Keywords | ||
Birth Cleft palate Rehabilitation Speech |
Rights and permissions | |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |