Cleft Lip & Cleft Palate: What's the Difference?
National Cleft & Craniofacial Awareness and Prevention Month⁽¹⁾ is a time to educate and raise awareness about the various conditions that affect many individuals worldwide. Among these conditions, cleft lip and cleft palate are some of the most common congenital anomalies. While they often occur together, they are distinct conditions with different implications and treatment approaches.
Prevalence
A recent comprehensive systematic review and meta-analysis(²) investigated orofacial clefting prevalence in the United States among individuals born between 2012 and 2022. The study revealed the following key findings:
Prevalence: The study found a prevalence of 19.9 per 10,000 live births, which is slightly higher than previous estimates.
Racial Disparities: The prevalence was highest among Asian (27.5 per 10,000) and Native American (32.8 per 10,000) populations, while African American populations had the lowest prevalence (12.96 per 10,000).
Other Factors: The study also found that males and Hispanics had a higher prevalence of clefting compared to females and non-Hispanics.
Diagnosis
Ultrasound imaging during pregnancy, often around 13-16 weeks, can sometimes detect a cleft lip, especially if it's a larger cleft. However, isolated cleft palate (without cleft lip) is harder to see on ultrasound. After birth, a pediatrician will perform a thorough physical exam of the baby's face and mouth. In some rare situations, a cleft palate might be smaller and go unnoticed initially. Signs like feeding difficulties or speech problems later in life might lead to a diagnosis.
What is a Cleft Lip?
A cleft lip is a physical separation or gap in the upper lip. This gap can vary in size, ranging from a small notch to a large opening that extends into the nose. Cleft lips can occur on one side (unilateral) or both sides (bilateral) of the lip(³).
Causes
Cleft lips result from incomplete fusion of the tissues that form the lip during early pregnancy, typically between the fourth and seventh weeks of gestation. While the exact cause is unknown, genetic and environmental factors, such as maternal smoking or certain medications, can increase the risk.
Implications
Aside from the visible gap, a cleft lip can cause difficulties with feeding, speech development, and dental issues. It may also have an impact on social interactions and self-esteem due to its visible nature.
What is a Cleft Palate?
A cleft palate is an opening or gap in the roof of the mouth (palate). This condition can involve only the soft palate (the back of the mouth) or extend forward to the hard palate (the front of the mouth). It can also occur on one or both sides of the palate.
Causes
Cleft palates form due to incomplete fusion of the tissues that make up the roof of the mouth, usually occurring between the sixth and ninth weeks of pregnancy. Similar to cleft lips, a combination of genetic and environmental factors can contribute to the development of a cleft palate.
Implications
Cleft palates can lead to significant issues with feeding, as the gap allows food and liquids to pass from the mouth into the nasal cavity. Speech difficulties are also common, as the palate is essential for proper speech production. Additionally, children with cleft palates may experience frequent ear infections and hearing problems.
Treatment and Support for Cleft Lip & Cleft Palate
Cleft lip and palate are typically treated with a combination of palatoplasty, speech therapy, orthodontics, and other interventions. Cleft lips and palates can be repaired in adults, although the optimal timing for cleft lip surgery is typically during early childhood within 3-6 months of birth(⁴), and cleft palate repair at around 10-12 months(⁵). Multiple surgeries may be required as the child grows to ensure optimal results.
REFERENCES
(1) Centers for Disease Control and Prevention. (n.d.). Announcement: National Cleft and Craniofacial Awareness and Prevention Month - July 2015. Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6425a5.htm
(2) Brydges HT, Laspro M, Verzella AN, Alcon A, Schechter J, Cassidy MF, Chaya BF, Iturrate E, Flores RL. Contemporary Prevalence of Oral Clefts in the US: Geographic and Socioeconomic Considerations. J Clin Med. 2024 Apr 27;13(9):2570. doi: 10.3390/jcm13092570. PMID: 38731101; PMCID: PMC11084882.
(3) Mayo Foundation for Medical Education and Research. (2022, September 15). Cleft lip and cleft palate. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/cleft-palate/symptoms-causes/syc-20370985
(4) Caring for babies born with cleft lip or cleft palate: AAP report explained. HealthyChildren.org. (n.d.). https://www.healthychildren.org/English/health-issues/conditions/Cleft-Craniofacial/Pages/Cleft-Lip-and-Palate-Parent-FAQs.aspx
(5) Kellogg, B. C. (Ed.). (2023, June). Cleft palate (for parents) | nemours kidshealth. KidsHealth. https://kidshealth.org/en/parents/cleft-palate.html
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