Cleft lip and palate are developmental defects of the upper lip and roof of the mouth that are present at birth (congenital malformations).

• Cleft lip and palate may occur separately and in combination.
• Both malformations occur as a consequence of incomplete fusion of the developing lip (normally occurs by 35 days of gestation) or of incomplete fusion of the hard or soft palate (normally occurs by the eighth to ninth week of gestation).

What is a cleft lip? What is a cleft palate?

A cleft lip is an opening extending through the upper lip. It may be in the midline (center) or left and/or right side of the lip. A cleft palate is an opening of the hard palate (the bony front portion of the roof of the mouth) or the soft palate (the muscular non-bony region in the rear of the roof of the mouth. Similar to a cleft lip, a cleft palate may be midline and/or to either right of left side of the palate. A cleft palate may extend from the upper jawbone to the rear of the throat.

Since development of the lip and palate occur at different times during gestation, an infant may have either a cleft lip or cleft palate or clefting of both regions.

Usually, a split (cleft) in the lip or palate is immediately identifiable at birth. Cleft lip and Cleft palate may appear as:

• A split in the lip and roof of the mouth (palate) that affects one or both sides of the face
• A split in the lip that appears as only a small notch in the lip or extends from the lip through the upper gum and palate into the bottom of the nose
• A split in the roof of the mouth that doesn't affect the appearance of the face

Less commonly, a cleft occurs only in the muscles of the soft palate (submucous cleft palate), which are at the back of the mouth and covered by the mouth's lining. This type of cleft often goes unnoticed at birth and may not be diagnosed until later when signs develop. Signs and symptoms of submucous Cleft palate may include:

• Difficulty with feedings
• Difficulty swallowing, with potential for liquids or foods to come out the nose
• Nasal speaking voice
• Chronic ear infections

When to see a doctor

A Cleft lip and Cleft palate are usually noticed at birth, and your doctor may start coordinating care at that time. If your baby has signs and symptoms of a submucous cleft palate, make an appointment with your child's doctor.

Cleft lip and cleft palate occur when tissues in the baby's face and mouth don't fuse properly. Normally, the tissues that make up the lip and palate fuse together in the second and third months of pregnancy. But in babies with cleft lip and cleft palate, the fusion never takes place or occurs only part way, leaving an opening (cleft).

Researchers believe that most cases of cleft lip and cleft palate are caused by an interaction of genetic and environmental factors. In many babies, a definite cause isn't discovered.

The mother or the father can pass on genes that cause clefting, either alone or as part of a genetic syndrome that includes a cleft lip or cleft palate as one of its signs. In some cases, babies inherit a gene that makes them more likely to develop a cleft, and then an environmental trigger actually causes the cleft to occur.

Successfully treating an infant or child with cleft lip and/or palate requires patience by both the parents and ultimately the patient. Several years of multiple surgical procedures are generally necessary to provide a satisfactory outcome. The repair of a cleft lip is usually addressed at approximately 3 months of age. One or two surgical procedures may be necessary to achieve both effective lip function and cosmetic repair. Cleft palate repair is a multistep series of surgical procedures starting at about 6 to 12 months of age and finalized in the later teen years. The first procedure is typically repair of the defect in the palate, which allows better feeding and weight gain and reduces the frequency of hearing loss and recurrent ear infections. Repair of the palate defect also encourages appropriate development of the upper jaw (maxilla) and other facial bones. At approximately 8 years of age, a bone graft is performed to further support the upper jaw structure and aid in speech articulation. Braces are generally required to straighten permanent teeth and plastic surgical scar revision (removal) is done after the majority of adolescent growth has occurred.

Several factors may increase the likelihood of a baby developing a cleft lip and cleft palate, including:

• Family history. Parents with a family history of cleft lip or cleft palate face a higher risk of having a baby with a cleft.
• Exposure to certain substances during pregnancy. Cleft lip and cleft palate may be more likely to occur in pregnant women who smoke cigarettes, drink alcohol or take certain medications.
• Having diabetes. There is some evidence that women diagnosed with diabetes before pregnancy may have an increased risk of having a baby with a cleft lip with or without a cleft palate.
• Being obese during pregnancy. There is some evidence that babies born to obese women may have increased risk of cleft lip and palate.

Males are more likely to have a cleft lip with or without cleft palate. Cleft palate without cleft lip is more common in females. In the United States, cleft lip and palate are reportedly most common in Native Americans and least common in African-Americans.