Cleft Lip and Palate

Authors:

Peter A Mossey, Julian Little, Ron G Munger, Mike J Dixon, William C Shaw

Cite this Article as:

Mossey, P. A., J. Little, et al. (2009). "Cleft Lip and Palate." Lancet 374: 1773-1785.

http://www.tertiarypublishingonline.com/papers/cleft-lip-and-palate

Abstract

 Clefts of the lip and palate are generally divided into two groups, isolated cleft palate and cleft lip with or without cleft palate, representing a heterogeneous group of disorders aff ecting the lips and oral cavity. These defects arise in about 1·7 per 1000 liveborn babies, with ethnic and geographic variation. Eff ects on speech, hearing, appearance, and psychology can lead to longlasting adverse outcomes for health and social integration. Typically, children with these disorders need multidisciplinary care from birth to adulthood and have higher morbidity and mortality throughout life than do unaff ected individuals. This Seminar describes embryological developmental processes, epidemiology, known environmental and genetic risk factors, and their interaction. Although access to care has increased in recent years, especially in developing countries, quality of care still varies substantially. Prevention is the ultimate objective for clefts of the lip and palate, and a prerequisite of this aim is to elucidate causes of the disorders. Technological advances and international collaborations have yielded some successes.

Introduction

Non-syndromic orofacial clefts, which include cleft lip, cleft lip and palate, and cleft palate alone, comprise a range of disorders affecting the lips and oral cavity (figure 1), the causes of which remain largely unknown.
Eff ects on speech, hearing, appearance, and cognition can lead to long-lasting adverse outcomes for health and
social integration.

Affected children need multidisciplinary care from birth until adulthood and have higher morbidity and mortality throughout life than do unaffected individuals.1,2 Findings of studies have shown an increased frequency of structural brain abnormalities3 and that many children and their families are affected psychologically to some extent.4 Although rehabilitation is possible with good quality care, orofacial clefts inevitably pose a burden to
the individual, the family, and society, with substantial expenditure in terms of health and related services.

Care for children born with these defects generally includes many disciplines—nursing, plastic surgery,
maxillofacial surgery, otolaryngology, speech therapy,audiology, counseling, psychology, genetics, orthodontics, and dentistry—but it forms only a part of the clinical load of every area, meaning that care has tended to be fragmented. This fragmentation of care has led to substantial variations in management, which continue to
cause controversy. Furthermore, in both developing and developed countries, standards of care for patients with
cleft lip, cleft lip and palate, or cleft palate alone remain a cause for concern.