Cleft Lip Surgeries at Age 8 to 10 Linked to Later Depressive Symptoms and Anxiety
Sun, April 18, 2021

Cleft Lip Surgeries at Age 8 to 10 Linked to Later Depressive Symptoms and Anxiety


Cleft lip and cleft palate (CLP) are birth defects that occur when the baby’s lip or mouth do not form properly while in the womb. These happen in about 1 in 700 births. Children born with CLP occasionally undergo multiple surgical operations between the first years of life and adolescence to support normal speech and facilitate the feeding of the child. These procedures help completely close the opening in the roof of the mouth or change the palate to achieve normal speech.

Cleft surgeries and teens’ psychosocial functioning

A new study has, however, found that having an increased number of cleft lip or cleft palate surgeries between ages 8 and 10 is linked to later depressive symptoms and anxiety in teenagers with the CLP.

In the July issue of the medical journal Plastic and Reconstructive Surgery, the study found that teenagers who had more cleft surgeries during 8 to 10 age ranges report worse long-term psychosocial functioning. American Society of Plastic Surgeon member Justine C. Lee, MD, Ph.D., of UCLA, senior author of the study, commented that their findings are in conjunction with the previous study that also identified 8-10 age range an at-risk period for poor psychosocial functioning – reflects a person’s ability to perform daily activities and engage in relationships with other people that are gratifying to others and him.

The researchers said that more than 50% of all CLP surgeries among teens were done between infancy and age 7 years. The most common surgeries were close to the CLP. At older ages, though, the most common procedures were bone grafts to augment the alveolar, the bone under the gums. The authors said that these surgeries should supposed to be done before the permanent teeth grow.




Fifty-five CLP patients aged 14 to 17 years and an age-matched unaffected cohort of 14 were prospectively enrolled from two institutions. Co-author Hi’ilani M.K. Potemra and UCLA team administered depressive symptoms, anxiety, and anger instruments from the Pediatric Patient-Reported Outcomes Measurement Information System. They then evaluated the total number of operations and they stratified these by age groups, which are 0 to 7, 8 to 10, 11 to 13, and 14 to 17. Stratified sampling is a method of sampling from a group that can be partitioned into subpopulations. Independent tests, descriptive statistics, multiple linear regression analyses, and Pearson correlations were then performed.

In overall psychosocial functioning, the team found no differences between the CLP groups. There was also no association for the total quantity of childhood surgeries with the psychosocial functioning of teens with CLP. However, an increased number of surgeries among the 8-to 10-year-old range predicted increased depressive symptoms and anxiety in teens as shown in their multiple linear regression analyses.

The findings highlight that an increased number of CLP operations during ages 8-to 10 could result in long-term consequences for CLP patients. They continued that the present treatment of patients born with CLP is more focused on improving the quality of life by reconstructing the patients’ hearing, appearance, speech, dentition, feeding, and speech. Addressing mental health should also be an important component of multidisciplinary CLP care.



Cleft lip and palate: incidence and prevalence

American Speech-Language-Hearing Association (ASHA) shares that oral clefts, in any form, occur in about 1 in every 7000 live births. Worldwide estimates that are limited to cleft lip with or without cleft palate vary from 7.94 to 9.92 per 10,000 live births. CLP is the second most common birth defect in the US and it affects one in every 940 births.

Although birth defects have no known cause or prevention as yet, some can be prevented by taking appropriate measures before and during pregnancy. These include adopting a healthy lifestyle, avoiding alcohol and smoking in pregnancy, achieving a healthy weight, adequate intake of folic acid and other minerals and vitamins, and vaccination, among others.

Finland, Saxony-Anhalt (German state), Odense (Denmark), Malta, and the Czech Republic have the highest prevalence of Orofacial clefts per 10,000 births. Data is taken from the population-based registries for the epidemiological surveillance of congenital anomalies, EUROCAT.

In Malta alone, the distribution of congenital anomalies between 1996 to 2015 are as follows: congenital heart defects (42%), limb defects (12%), chromosomal anomalies (8%), digestive system defects (7%), nervous system defects (7%), urinary defects (6%), oro-facial clefts (6%), and all other anomalies (12%), as detailed by the Malta Congenital Anomalies Register within the Directorate for Health Information and Research.

On the other hand, those with the lowest prevalence of orofacial clefts per 10,000 births were French Western Indies (France), Portugal, Spain Hospital Network, Sicily (Italy), East Midlands & South Yorkshire (UK), and Barcelona (Spain).



Orofacial clefts may be diagnosed during pregnancy using antenatal ultrasound examination but many babies are diagnosed only after birth. Treatments for CLP often involves reconstructive surgery and key support services. Kids born with a unilateral cleft lip usually need a lip-nasal adhesion and such kind of operation is performed at about 3 months of age. The procedure involves a simple closure of the lip, the first stage of nasal correction, and closure of the cleft in the upper gum, if possible. The operation usually lasts for 1 to 2 hours and most babies have to stay in hospitals for 1 to 2 days.

After the operation, the child’s nose, face, and lip will be swollen for a few days and his scar may be red. It will take another six to 12 months for the scar to soften and fade. This may never completely fade but doctors say that it will become difficult to see. Some children will need another procedure before they begin school to improve their jaw function and bite. Such kind of operation is called the alveolar bone graft. A child’s first tooth may appear between 4 and 14 months and those with CLP may have poorly formed enamel and their teeth in the affected region may be out of alignment. Some need the second operation to correct their nasal-sounding speech.

CLP patients even up to today spend their childhood undergoing multiple nonsurgical interventions and reconstructive operations. The UCLA study highlights the relationships between the timing of operations, the number of operations, and the long-term psychosocial functioning in teens with CLP.