Cleft lip and palate

Cleft lip and palate affect around 1 in every 1,000 babies. They are the most common congenital deformity affecting the orofacial structures. Whilst they may be an isolated developmental malformation they are also a recognised component of more than 200 birth defects.

The commonest variants are:

• isolated cleft lip (15%)
• isolated cleft palate (40%)
• combined cleft lip and palate (45%)

Pathophysiology

• polygenic inheritance
• maternal antiepileptic use increases risk
• cleft lip results from failure of the fronto-nasal and maxillary processes to fuse
• cleft palate results from failure of the palatine processes and the nasal septum to fuse

Problems

• feeding: orthodontic devices may be helpful
• speech: with speech therapy 75% of children develop normal speech
• increased risk of otitis media for cleft palate babies

Management

• cleft lip is repaired earlier than cleft palate, with practices varying from repair in the first week of life to three months
• cleft palates are typically repaired between 6-12 months of age