What is Cleft Lip and Palate?

Cleft lip, cleft palate, or both is a congenital (birth) defect, which is present at birth. It will happen in approximately one in every 700 to 750 births and is probably the most common of congenital birth defects. It occurs in males and females and occurs in all races. All clefts are different. They can occur at one or more different sites on the face, such as the palate, the lips, or the alveolus (gums). Clefts can be different sizes and some are bigger than others.

Cleft Lip

A cleft lip is a developmental defect that occurs in the womb in the fourth to sixth week in utero. It occurs when areas of the upper lip do not join together resulting in a cleft of the lip between the mouth and the nose. A cleft lip can present itself in many different forms; from a small notch in the lip to a larger cleft, which completely separates the lip and extends into the nose and mouth. A unilateral cleft is one, which occurs on either the right or the left side. A bilateral cleft is one, which occurs on both the right and the left sides.

Cleft Palate

A cleft palate is a birth defect that occurs in the eight to twelfth week in the womb. If the structures that form the roof of the mouth and the nose do not come together, the result is an opening between the mouth and the nose. As with cleft lip, the separation can occur on either the right or left sides, or both. There are two parts to the roof of the mouth; the hard palate, and the soft palate. The hard palate is the bony, nonmoving part of the roof of the mouth behind the teeth. It provides a separation between the front portion of the mouth and the nose. Behind the hard palate is the soft palate. It is made up of muscles that move during swallowing and speech to separate the nose from the mouth. A cleft can occur only in the soft palate, or extend forward to include all of the hard palate was well. However most clefts of the palate involve both the soft and hard palates.
 

The bones of the hard palate and the muscles of the soft palate are covered by the oral mucosa. Sometimes the oral mucosa will not be divided, but the bones and/or the muscles underneath may be. This particular type of cleft is known as a submucous cleft.

The alveolar ridge is the area of the gums in front of the hard palate. It the area where your child’s upper teeth with develop and erupt through. When a cleft of the alveolar ridge occurs, it can cause problems with the eruption of your baby’s teeth. Clefts of the alveolar ridge can occur unilaterally (one side) or bilaterally (both sides).


Why Did It Happen?

No one knows the exact reason that clefts of the oral structures occur and no research has shown any specific cause. The most common theory is that the majority of clefts are due to a genetic predisposition, that when mixed with certain environmental factors, create the malformation. We know that clefting cannot be caused by events occurring in middle or late pregnancy, and there are no specific actions by parents that cause the condition. So therefore you, as a parent, do not need to feel responsible. Most babies born with a cleft are otherwise normal children with no other serious birth defects.
You may be concerned about the risk of having another child with a cleft condition. Future brothers and sisters of a child with a cleft run a greater risk than that of the general population. For most families the risk ranges from two percent to four percent, depending on the extent of the condition in your first child. The more extensive the cleft, the greater the chance that future siblings will be affected.
During your child's evaluation, the team will discuss your family history and the likelihood that you could have another child with cleft lip or palate. This counseling will help you make family planning decisions. If appropriate, you also will be seen by a geneticist, a physician who specializes in heredity.
 Glossary