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Cleft Lip & Palate Chapter 9
What is a cleft? An opening in an anatomical region that is
not normally open
 Clefting can occur anywhere a structure is formed by
fusion of two halves at midline.
 Cleft lip/palate are congenital defects, which means that
they occur in utero
Incidence: 1/750 live births
Embryology – science of the origin and development of the
organism from:
Cleft lip/palate occurs very early in development.
 When infant is four weeks old and about the size of a
pea, the facial area begins to form
 Around week 5, the lip and palatal shelves
_____________________ begin to form
 The halves of the lips fuse at the midline between 5-6
weeks of life _______________________________
 Between weeks 7-8, the palatal shelves and the nasal
septum fuse at the midline to form the secondary palate
 palatal growth is complete by 9 weeks
Cleft Classification:
See Figure 9.7 + Table 9.1 in your text.
Clefting can occur:
• In the lip and/or palate (either the soft palate, hard
palate, or both)
• Either unilaterally (to one side of nasal septum) or
bilaterally (on both sides)
• In the palatal muscles and bone of the hard palate
(creates a notch in the bone) while leaving the skin and
mucous membranes intact.
 Many underlying causes can lead to cleft lip/palate
 CL/P is a symptom and is often a part of larger
syndromes. It is associated with over 400 syndromes
including Apert’s syndrome, fragile X syndrome, and
velocardiofacial syndrome.
Categories of possible etiologies:
1. Chromosomal abnormalities:
• Clefting could be caused by
• Could also cause heart and limb defects, mental
2. Genetic abnormalities:
• This is where the syndromes mentioned earlier come
into play.
Two recessive genes from each parent are inherited
containing information leading to a syndrome that
involves clefting ________________________
one dominant gene is inherited from one parent
3. Teratogenic agents:
• Environmentally induced.
• External agents that pass from mother to child via
placenta; for example:
• Few teratogens lead to clefting so this is not a
frequent cause.
4. Mechanical influences:
 abnormal jaw development in the child hindering
development of the palate,
 uterine abnormality in the mother during pregnancy,
crowding in the uterus
5. Unknown
 No inheritance pattern; totally random.
Complications That May Occur with Cleft Lip/Palate
 Abnormal mid-face development – usually severe
deficiency of tissue in midline of the face, central
cartilaginous structure of nose (columella) is often
 Speech/Language impairment – will discuss later
 Feeding Impairment – will discuss later
 Abnormal Eustachian tube function – children with cleft
are particularly susceptible to otitis media due to the
shape of their Eustachian tubes (recall that the
Eustachian tube ventilates the middle ear and equalizes
 Dental Problems – related to misalignment of the teeth
and of the mandible.
Multidisciplinary Team Approach
Treatment is ideally provided by a variety of dental, medical,
and behavioral specialists. These specialists will all see the
patient and jointly decide on a treatment plan.
• Reconstructive surgeon – performs surgical repair of the
cleft lip and palate.
• Oral surgeon – performs surgery involving the teeth and
• Otolaryngologist (ENT) – performs ear, nose, and throat
evaluation and treatment.
• Orthodontist – aligns teeth and jaw.
• Prosthodontist - constructs prosthetic devices to replace
missing teeth and palate (palatal lift or obdurator for
• Pediatric dentist and dental hygienist - ensure
appropriate dental and oral health care.
• SLP - assists family with training in feeding techniques
at birth and management of dysphagia, provides
language, voice, resonance, and articulation therapy,
monitors for nasality, may also aid in oral aversion
therapy and train parents how to stimulate
speech/language development
• Audiologist - identifies hearing loss as early as possible
(nobody is too young to have their hearing tested), aids
in management/decisions of otitis media and whether
or not to place PE tubes
• Social worker/psychologist - provides support and
guidance for child and family members, helps with
adjustment issues, often mediates between busy
physicians and parents, may act as a case coordinator,
can aid in obtaining financial resources during all
stages of a child’s treatment program
• Geneticist – diagnoses and counsels for genetic
disorders and assesses likelihood of a syndrome
• Parents/caregiver – play a crucial role in intervention
planning and progression