by Hadassah Ryan

Created on: March 25, 2009

Cleft lip and palate is a birth defect seen once every seven hundred births across the U.S. and Canada. The frequency is somewhat increased in other countries around the world. The only birth defect seen more commonly is Club Foot.

These two cleft defects can be seen together or separately. Cleft lip (in years past called a "hare" lip) is usually seen in two forms: unilateral and bilateral. The former is when the cleft, or separation in the upper lip is seen extending up into both nostrils. The latter is when the cleft only affects one side of the upper lip. Degrees of severity range with cleft lip, from a slight dimple in the upper lip to a wide open chasm that extends well into the nose, through the gum line and into the palate.

Cleft Palate is also seen in two main categories: cleft of the soft palate and cleft of the hard palate. Cleft of the soft palate is farther back in the mouth and only affects the soft tissue and muscle of the roof of the mouth. Cleft of the hard palate means that the opening has extended into the hard bone of the roof of the mouth. The cleft creates a hole that leaves the nasal cavities open to the child's' mouth.

Both of these birth defects are correctable with surgery but will take some adaptation on the part of the parent to care for the baby properly, especially when it comes to feeding the infant. Special bottles, feeding tubes and in some cases, dental plates are available to temporarily correct the issues caused by the cleft so that the child may feed adequately.

Cleft lip and palate have numerous causes, some more widely accepted than others. The one that is most readily agreed upon is the genetic factor. Cleft lip and palate is congenital, which means that it occurred during pregnancy due to parentage or environmental factors. Around the sixth to eighth week of pregnancy, while the embryo is undergoing massive changes, the two halves of its' microscopic body should be joining together. When a cleft lip and/or palate occurs, this fusing is not complete. This is why cleft lip and palate is often referred to as a "midline" issue. In a small number of cases (5%), cleft lip and palate is associated with an underlying syndrome such as Sticklers Syndrome, Pierre Robin Sequence or Distal Arthrogryposis. If either parent was born with cleft lip or palate, the risk of their child being born with the same rises to between 3 and 7%.

There are possible environmental causes to be aware of. Drug, alcohol and tobacco use all increase incidences of clefts dramatically. Some anti-acne drugs, antidepressants and drugs to treat seizures are associated with cleft lip and palate. All of these environmental causes are most dangerous to the fetus in the first 3 months of growth, which means that many women are not even aware they are pregnant when the deformity is occurring.

Cleft lip and palate is usually a distressing situation for a new parent to deal with, but the good news is that there is tremendous support and information available to aid in treatment. Many children's hospitals have a Cleft Lip and Palate Team in place which staff extremely knowledgeable and experienced health professionals. There has never been a better time in history to have a child with a Cleft Lip and Palate.

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