Craniofacial conditions

Cleft Lip and Palate

Evidence-based information on causes, diagnosis, treatment steps and long-term care – for families and professionals.

Summary

Cleft lip and palate is one of the most common congenital conditions: about 1 in 500–700 newborns is affected (ICD-10 Q35–Q37). It results from incomplete fusion of the lip, jaw and/or palate between the 4th and 12th week of pregnancy. With modern interdisciplinary treatment – beginning shortly after birth – function and appearance can be restored very well.

Forms

What forms are there?

The spectrum ranges from a small notch in the lip to a bilateral cleft of all three structures:

Cleft lip (Q36) – only the lip is affected, one- or both-sided
Cleft lip and alveolus – lip and jawbone are cleft, palate intact
Cleft lip and palate (Q37) – complete cleft, the most common complex form
Isolated cleft palate (Q35) – only the palate is cleft; → dedicated page
Submucous cleft palate – hidden beneath intact mucosa, often recognised late

Syndromic vs non-syndromic About 70 % of clefts are non-syndromic (isolated). 30 % occur as part of syndromes – e.g. Apert, Crouzon or Pierre Robin sequence. Syndromic forms require extended genetic work-up.

Frequency & causes

How common is cleft lip and palate?

Orofacial clefts occur, depending on region and definition, in about 1 in 500–700 newborns – in Switzerland around 100–130 affected children per year.^[1]

The cause is multifactorial. Known risk factors:

Genetic: family history in about 20–30 %; recurrence risk 2–5 % depending on the form
Smoking during pregnancy (OR ~1.5–2.0)^[2]
Folate deficiency, certain medications (e.g. valproate), maternal diabetes

For parents In most cases no single cause can be identified. A cleft is not a failure of the parents. For questions about recurrence risk: genetic counselling is recommended.

Prevention

Folic acid 0.4 mg daily, from four weeks before the planned pregnancy until the end of the 1st trimester – demonstrably reduces the risk of non-syndromic clefts.^[3] Avoid smoking and alcohol.

Diagnosis

When is a cleft detected?

Prenatal: cleft lip and cleft lip/palate can be seen from the 18th–20th week on qualified ultrasound. Specialised centres detect first signs as early as week 14. The isolated cleft palate is barely detectable before birth – palatal structures are difficult to assess on ultrasound.^[4]

Postnatal: cleft lips are immediately visible. Isolated and submucous cleft palates are diagnosed by clinical inspection and palpation – this examination should not be missed in newborn screening.

A prenatal diagnosis gives families valuable preparation time: early contact with the treatment team, psychological support, gathering information before birth.

Treatment timeline

Treatment steps from birth to adulthood

Birth

Initial care & feeding advice. Feeding technique, special bottles (e.g. Medela SpecialNeeds), palatal plate. → nutrition page

1–3 months

Pre-surgical orthodontics (optional). Nasoalveolar moulding (NAM) or palatal plate to shape the dental arch and nasal cartilage before surgery.

3–6 months

Lip repair (cheiloplasty). Correction of the cleft shape, reconstruction of the orbicularis oris muscle. Established techniques: modified Fisher repair, Millard technique.^[5]

9–18 months

Palate repair (palatoplasty). Separation of oral and nasal cavities, enabling normal speech development. Timing influences the balance between speech development and jaw growth.^[6]

1–9 years

Speech therapy & speech checks. In velopharyngeal insufficiency: speech therapy or velopharyngoplasty. → speech therapy

9–11 years

Alveolar bone grafting. Bone graft (iliac crest) for canine eruption and upper-jaw continuity. → detail page

Adolescence

Orthodontics, possibly osteotomy or midface distraction in marked midface retrusion.

As needed

Rhinoplasty, scar revision, psychosocial support, further orthodontic measures.

Further topics

🦷 Isolated cleft palate
Specifics, submucous cleft 🍼 Nutrition
Breastfeeding, special bottles, palatal plate 🗣️ Speech therapy
Speech development, VPI, therapy 🦴 Alveolar bone grafting
Bone surgery at school age

Scientific sources

Mossey PA et al. (2009). Cleft lip and palate. Lancet, 374(9703):1773–85. DOI
Hackshaw A et al. (2011). Maternal smoking in pregnancy and birth defects. Hum Reprod Update, 17(5):589–604. DOI
Wilcox AJ et al. (2007). Folic acid supplements and risk of facial clefts. BMJ, 334(7591):464. DOI
Maarse W et al. (2011). Diagnostic accuracy of transabdominal ultrasound in detecting prenatal cleft lip and palate. Ultrasound Obstet Gynecol, 37(5):495–500. DOI
Fisher DM (2005). Unilateral cleft lip repair: anatomical subunit approximation technique. Plast Reconstr Surg, 116(1):61–71. DOI
Grunwell JR et al. (2021). Timing of palate repair and speech outcomes. J Craniofac Surg, 32(3):846–51. DOI