Summary
Definition
History and exam
Key diagnostic factors
- bilateral cleft lip ± palate
- unilateral cleft lip ± palate
- isolated cleft palate
- microform cleft lip
- isolated submucous cleft palate
- positive prenatal ultrasound
Other diagnostic factors
- difficulty feeding
- poor weight gain
- airway obstruction
Risk factors
- genetic predisposition
- anticonvulsant drugs
- maternal tobacco use
- maternal alcohol consumption
- folic acid deficiency
Diagnostic tests
1st tests to order
- audiogram
- genetics consult
Tests to consider
- auditory brain stem response (ABR) test
- vertebral spine x-rays
- renal ultrasound
- fluorescence in-situ hybridization (FISH)
- ophthalmic examination
Treatment algorithm
complete cleft lip and palate
isolated cleft palate
isolated cleft lip
Contributors
Authors
Travis T. Tollefson, MD, MPH, FACS
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 declares that he has no competing interests.
David A. Shaye, MD, MPH, FACS
Associate Professor
Facial Plastic and Reconstructive Surgery
Otolaryngology/Head & Neck Surgery
Massachusetts Eye and Ear
Harvard University
Director - Global OHNS
Boston, MA
Disclosures
DAS declares that he has no competing interests.
Peer reviewers
Jordan N. Halsey, MD
Pediatric Plastic and Craniofacial Surgeon
Assistant Professor of Plastic Surgery
Johns Hopkins University
Assistant Professor of Plastic Surgery
University of South Florida
Tampa, FL
Disclosures
JNH declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Veau V. Bec-de-lièvre; formes cliniques - chirurgie. Avec la collaboration de J Récamier. Paris, France: Masson et Cie; 1938.
Wyszynski DF, Beaty TH, Maestri NE. Genetics of nonsyndromic oral clefts revisited. Cleft Palate Craniofac J. 1996 Sep;33(5):406-17.Full text Abstract
Royal College of Paediatrics and Child Health. Palate examination: identification of cleft palate in the newborn - best practice guide. Nov 2025 [internet publication].Full text
American Cleft Palate-Craniofacial Association. Parameters for evaluation and treatment of patients with cleft lip/palate or other craniofacial differences. Jan 2018 [internet publication].Full text
Boyce JO, Reilly S, Skeat J, et al. ABM Clinical Protocol #17: Guidelines for breastfeeding infants with cleft lip, cleft palate, or cleft lip and palate-revised 2019. Breastfeed Med. 2019 Sep;14(7):437-44.Full text Abstract
Cutting C, Grayson B, Brecht L, et al. Presurgical columellar elongation and primary retrograde nasal reconstruction in one-stage bilateral cleft lip and nose repair. Plast Reconstr Surg. 2012 Sep;130(3):659-66. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Guidelines
- Palate examination: identification of cleft palate in the newborn - best practice guide
- Parameters for evaluation and treatment of patients with cleft lip/palate or other craniofacial differences
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