CLEFT PALATE (cheiloschisis) is a condition in which the

two palates of the skull that form the hard palate are not
completely joined. The soft palate in these cases are cleft
as well.

CLEFT LIP (palatoschisis) is a physical split or separation of

the two sides of the upper lip and appears as a narrow
opening or gap in the skin of the upper lip. This
separation often extends beyond the base of the nose
and includes the bones of the upper jaw and/or upper
gum.
• Between the 6th and 12th weeks of fetal gestation,the left and right
sides of the face and facial skeleton fuse in the midddle. When they do
fail to do so, the result is a craniofacial cleft.

• Cleft palate without cleft lip occurs more in females (57%) than males
(43%). Cleft lip with or without cleft palate occurs twice as many males
than females.

• It is possible that facial clefts are caused by a disorder in the

migration of neural crest cells.

• Another theory is that facial clefts are caused by failure of the fusion
process and failure of inwards growth of the mesoderm.
A mild form of a cleft lip is a microform cleft. A microform cleft can
appear as small as a little dent in the red part of the lip or look like
a scar from the lip up to the nostril.

Incomplete cleft lips can take on a variety of appearances. There

may be just a small gap or cleft in the vermillion or it may slightly
extend into the skin above the lip or extend almost to the nostril.

As with a complete cleft lip deformity, the nose has some

distortion. The distortion is usually to a lesser degree. The nostril
may be widened, but the floor of the nostril is intact.
In a bilateral incomplete cleft lip deformity, the
nose is affected, although not to the same degree
as with a bilateral complete cleft lip deformity.

A bilateral complete cleft lip affects both the right

and left sides of the lip. There are no philtral
columns, no philtral dimple, and there is no
orbicularis muscle in the central segment. On both
sides, the cleft extends from the vermillion to the
nostril.
GENETIC FACTORS – a study has identified that
• Orofacial
clefts can be detected
4 different regions of the human genome
contains genes controlling risk for cleft lip and during pregnancy by ROUTINE
palate: ULTRASOUND.
• IRFG Gene on chromosome 1
• MAFB gene on chromosome 20
• ABCA4 on chromosome 1 • Usually,orofacial clefts are
• a region on chromosome 8 diagnosed when the baby is
born.
ENVIRONMENTAL FACTORS
• Maternal smoking
• Maternal alcohol abuse • Minor clefts might not be
• Maternal diet and vitamin intake diagnosed until later in life.
• Medications take during pregnancy
• Exposure to viruses in chemicals of fetus • Diagnosis
can also be made by
• Women with diabetes diagnosed before PHYSICAL EXAMINATION.
pregnancy
MAY APPEAR AS:
• A split in the lip and roof of
the mouth and palate that can
affect both sided of the face
• A split in the lip that can
appear as only a small notch
in the lip or can extend from
the lip through the upper gum
and palate into the bottom of
the nose
• A split in the roof of the that
doesn’t affect the appearance
of the face.
 Difficulty in swallowing
 Nasal Speaking voice
 Recurring ear infections
 Change in Nose shape
 Poorly aligned teeth
PROBLEMS ASSOCIATED WITH
OROFACIAL CLEFT:
• Failure to gain weight
• Feeding problems
• Flow of milk through nasal passage
during feeding
• Poor growth
• Speech difficulties
• SURGERY - to close the cleft lip
is often done when the child is
between 6 weeks and 9 months
old. Surgery may be needed later
in life if the problem has a big
effect on the nose area.
• A cleft palate is usually closed
within the first year of life so that
the child's speech develops
normally. Sometimes a prosthetic
device is temporarily used to
close the palate so the baby can
feed and grow until surgery can
be done
•Children born with orofacial clefts also
might need different types of
treatments and services, such as special
DENTAL OR ORTHODONTIC CARE or
SPEECH THERAPY.
• Because children and individuals with
orofacial clefts often require a variety of
services that need to be provided in a
coordinated manner, services and
treatment by cleft team is
recommended. These team usually
consist of experienced and qualified
physicians and health care providers
from different specialties.
A Team Approach is Required
The cleft lip and palate team must work together for the benefit of the
young patient. The team usually consists of the following members:
the pediatrician, plastic surgeon, oral & maxillofacial surgeon, dentist,
orthodontist, ENT physician, psychiatrist, psychologist, prosthodontist,
speech therapist, audiologist, and coordinator.
• Dentists recommend that the first dental visit be scheduled at about
one year of age or even earlier if there are special dental problems.

• A cleft of the lip and/or palate in the front of the mouth can produce
a variety of dental problems. These may involve the number, size,
shape, and position of both the baby teeth and the permanent teeth.

• The teeth most commonly affected by the clefting process are those
in the area of the cleft, primarily the lateral incisors. Clefts occur
between the cuspid (eye tooth) and the lateral incisor. In some cases
the lateral incisor may be entirely absent.
•In other cases there may be a “twinning” (twin = two) of the lateral
incisor so that one is present on each side of the cleft.

• Finally, the teeth in the area of the cleft may be displaced, resulting
in their erupting into abnormal positions.
 A Partial List of Oral Problems in Children with Cleft Lip & Palate

•Feeding Problems
•Missing teeth- 50%
•Supernumerary Teeth- 20%
•Dystrophic (hypoplastic) teeth- 30%
•Disturbances of tooth eruption
•Ectopic tooth eruption
•Malocclusion- 100%
•Dental caries and gingivitis
Genetic disorders may also be complex, multifactorial, or polygenic, meaning they
are likely associated with the effects of multiple genes in combination with lifestyles
and environmental factors. Multifactorial disorders include heart disease and
diabetes. Although complex disorders often cluster in families, they do not have a
clear-cut pattern of inheritance. This makes it difficult to determine a person’s risk of
inheriting or passing on these disorders. Complex disorders are also difficult to study
and treat because the specific factors that cause most of these disorders have not
yet been identified.

On a pedigree, polygenic diseases do tend to “run in families”, but the inheritance

does not fit simple patterns as with Mendelian diseases. But this does not mean that
the genes cannot eventually be located and studied.
Multifactorial inheritance, also called complex or polygenic
inheritance. Multifactorial inheritance disorders are caused by a
combination of environmental factors and mutations in multiple
genes.

Some common birth defects can occur as a single isolated condition

and are often caused by many factors. With one affected child in the
family, the chances of having the condition reoccur are one to five per
cent depending on the type of birth defect.
Common Examples of Multifactorial Birth Defects are:

• Cleft lip/and palate

• Club foot
• Congenital Heart Defects
• Neural Tube Defects (Spina Bifida)