Cleft lip and palate

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Last reviewed: June 2019

Last updated: January 2018

Summary

Oro-facial clefts are among the most common birth defects.

Cleft lip with or without cleft palate is approximately twice as common as isolated cleft palate.

The majority of cleft lip deformities are associated with a varying degree of nasal deformity.

Oro-facial clefts can occur in isolation or as a component of an identifiable syndrome.

The aetiology of cleft lip and palate involves a variety of genetic and environmental factors that result in variable expressions of oro-facial clefting.

Comprehensive care involves a multi-disciplinary cleft team with specialists from fields such as facial plastic surgery, genetics, nursing, speech-language pathology, orthodontics, dentistry, oral surgery, audiology, and paediatrics.

Definition

An oro-facial cleft is an abnormal opening secondary to developmental failure in utero. Cleft lip with or without cleft palate can be unilateral or bilateral, and occurs in a variety of combinations with variable expression in the nose, lip, alveolus, and primary and secondary palates. Diminutive expressions of cleft lip and/or palate are known as microform, occult, minor, or forme fruste (aborted form).

History and exam

Key diagnostic factors

presence of risk factors
bilateral cleft lip ± palate
unilateral cleft lip ± palate
isolated cleft palate
microform cleft lip
isolated sub-mucous cleft palate
positive antenatal ultrasound

Full details

Other diagnostic factors

difficulty feeding
poor weight gain
airway obstruction

Full details

Risk factors

genetic predisposition
dysmorphic syndrome
anticonvulsant drugs
maternal tobacco use
maternal alcohol consumption
folic acid deficiency

Full details

Diagnostic investigations

1st investigations to order

audiogram

Full details

Investigations to consider

auditory brain stem response (ABR) test
vertebral spine x-rays
renal ultrasound
fluorescence in situ hybridisation (FISH)

Full details

Treatment algorithm

ONGOING

complete cleft lip and palate

isolated cleft palate

isolated cleft lip

Contributors

Authors VIEW ALL 

Travis T. Tollefson, MD, MPH, FACS

Travis T. Tollefson

Professor and Director

Facial Plastic and Reconstructive Surgery

Otolaryngology - Head and Neck Surgery

Cleft and Craniofacial Team

University of California Davis

Sacramento

CA

Disclosures

TTT is an author of studies referenced in this monograph.

David A. Shaye, MD

Instructor

Facial Plastic and Reconstructive Surgery

Massachusetts Eye and Ear

Harvard University

Boston

MA

Disclosures

DAS declares that he has no competing interests.

Peer reviewers VIEW ALL 

Oren Friedman, MD

Assistant Professor to Director

Division of Facial Plastic and Reconstructive Surgery

Mayo Clinic

Rochester

MN

Disclosures

OF declares that he has no competing interests.

Philip Fischer, MD

Professor of Pediatrics

Mayo Clinic

Rochester

MN

Disclosures

PF declares that he has no competing interests.

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