What are cleft lip and cleft palate?

Cleft lip and cleft palate are birth defects that occur when a baby’s lip or mouth does not form properly during early pregnancy [1]. A baby may be born with either condition separately, or with both together [3]. Collectively, these defects are known as "orofacial clefts" [1].

What is a cleft lip?

The upper lip forms between the fourth and seventh weeks of pregnancy. A cleft lip occurs when the tissues that form the upper lip do not close completely before birth, leaving an opening [1]. This opening can be small or extend through the lip into the nose [1]. A cleft lip may appear on one side of the lip, on both sides, or rarely, in the middle of the lip [3]. Children born with a cleft lip may also have a cleft palate [1].

What is a cleft palate?

The roof of the mouth (palate) forms between the sixth and ninth weeks of pregnancy [1]. A cleft palate occurs when the tissues that form the roof of the mouth do not fuse together completely [1]. For some children, both the front and back parts of the palate are open, while for others, only one part is open [1]. A cleft palate can occur with or without a cleft lip [1]. In some cases, certain types of cleft palate, such as a submucous cleft palate or a bifid uvula, may not be diagnosed until later in life [1].

Causes and Risk Factors

The causes of orofacial clefts remain unknown in most cases [1]. They are thought to result from a combination of genetic and environmental factors [1]. Research has shown that certain factors may increase the risk of having a baby with a cleft lip or cleft palate, including smoking during pregnancy, having diabetes before pregnancy (type 1 or type 2), and the use of certain anti-seizure medications during pregnancy [1]. These conditions can also be part of broader genetic syndromes, such as 22q11.2 deletion syndrome, which may also involve heart problems, immune system issues, and distinct facial features [2].

Diagnosis and Treatment

Orofacial clefts, particularly cleft lip, can be diagnosed during pregnancy through a routine ultrasound scan, or after the baby is born [1]. Treatment depends on the severity of the cleft, the child’s age, and their needs, and may include several procedures [1]. Cleft lip repair surgery is usually performed in the first few months of life, and is recommended within the first 12 months [1]. Cleft palate repair surgery is recommended within the first 18 months of life, or earlier if possible [1]. Many children may need additional surgical procedures as they grow older [1].

The goal of surgery is to restore the function of the lips and mouth, which can help improve breathing, hearing, and speech and language development [1]. In addition to surgery, children born with these conditions may require special dental or orthodontic care, and speech therapy [1]. With appropriate treatment, most children with cleft lip and cleft palate lead healthy lives [1]. For more information about the support available to families, you can visit Cleft Lip and Cleft Palate: Understanding the Condition, Treatment, and Family Support (Arabic).

Medical references

• Cleft Lip/Cleft Palate
• Cleft Lip and Palate
• 22q11.2 deletion syndrome: MedlinePlus Genetics