Clefts of the Lip and Palate

Chapter 3: Clefts of the Lip and Palate

• Clefts are abnormal openings or fissures in anatomical structures, usually due to abnormal fusion of parts during fetal development.

• Embryological development of the face and skull begins with the formation of neural crest cells that migrate to form various structures, including the lip and palate.

• The lip and palate develop independently, with the fusion of the lip and palate following embryological suture lines.

• Causes of clefts are usually multifactorial, including genetic and environmental factors such as teratogens, drugs, viruses, and maternal nutritional deficiencies.

• Clefts can vary in type, length, and width, with primary palate clefts affecting the lip and alveolus, and secondary palate clefts affecting the hard palate, velum, and uvula.

• Clefts of the primary palate can vary in severity and affect the structure and function of the lips, nose, and dentition.

• Clefts of the secondary palate can also vary in severity and affect the structure and function of the velopharyngeal mechanism, leading to speech and feeding difficulties.

• Submucous clefts occur when the oral surface of the secondary palate is completely formed while the nasal surface or uvula is incomplete, and can affect muscle function and cause velopharyngeal insufficiency.

• Facial clefts can also occur, affecting the midface or orbit, and can range from mild to severe.

• Treatment for clefts involves a multidisciplinary approach, including surgery, speech therapy, and dental and orthodontic care.

• Early intervention and ongoing care can improve outcomes for individuals with clefts, including speech and language development, feeding, and social-emotional well-being.

• Cleft and craniofacial centers can provide specialized care and support for individuals with clefts and their families.Facial Clefts: Types, Causes, and Effects

• Facial clefts can be oblique or midline (median) and can be caused by genetic defects or amniotic bands.

• Amniotic bands occur when the inner membrane of the amniotic sac ruptures, causing fibrous and sticky amnion tissue (bands) to float in the waters of the uterus, which can entangle a body part, reducing blood supply.

• Facial clefts can cause various deformations, including facial or oral deformations.

• Facial clefts can affect the structure and function of the face, skull, cognition, language, speech, resonance, hearing, and feeding/swallowing.

• Cleft lip/palate is the fourth most common birth defect and the most common congenital defect of the face, with a prevalence of about 1/600 in the United States.

• Nonsyndromic cleft lip with/without cleft palate has a recurrence risk for parents and child of 3% to 5%, with racial differences.

• Cleft lip (with/without cleft palate) occurs twice as often in males, while cleft palate occurs twice as often in females.

• Submucous cleft occurs essentially unknown because it often does not cause any problems, but it may become symptomatic after adenoidectomy, while facial cleft is very rare.

• Treatment of clefts includes cheilorraphy (lip repair) and palatoplasty (palate repair).

• Clefts of the primary palate can include the lip and alveolar ridge, while clefts of the secondary palate can include the hard palate, velum, and uvula.

• Submucous clefts can be overt or occult, and a bifid uvula may be indicative of a submucous cleft.