Sage Journals: Discover world-class research

Abstract

The term ‘oral cleft’ describes a spectrum of oro-facial developmental malformations in which there is an abnormal anatomical opening or division of the lip, palate or both. There are three main types: cleft lip (CL) alone, cleft lip with cleft palate (CL/CP), and cleft palate (CP) alone. They represent the most common facial anomaly worldwide. This article describes the embryological theory, aetiology, diagnosis and management of oral clefting, focusing on the functional impact of the condition, how patients may present, and clinical findings which may raise suspicion in primary care.

Get full access to this article

View all access options for this article.

References

BAPRAS (2015) Cleft lip and palate. Available at: www.bapras.org.uk/public/patient-information/surgery-guides/cleft-lip-and-palate (accessed 10 January 2022).

Beaty

Marazita

ML and

Leslie

(2016) Genetic factors influencing risk to orofacial clefts: Today’s challenges and tomorrow’s opportunities. F1000Research 5: 2800. DOI: 10.12688/f1000research.9503.1.

Bernheim

Georges

Malevez

, et al. (2006) Embryology and epidemiology of cleft lip and palate. B-ENT 2(4): 11–19.

CLAPA (2015) CLAPA Conference 2015 videos. Available at: www.clapa.com/news-item/clapa-conference-2015-videos/ (accessed 15 November 2021).

Czeizel

Rockenbauer

Sorensen

, et al. (2001) Nitrofurantoin and congenital abnormalities. European Journal of Obstetrics, Gynecology and Reproductive Biology 95(1): 119–126. DOI: 10.1016/s0301-2115(00)00364-x.

Esenlik

Gibson

Kassam

, et al. (2020) NAM therapy – evidence-based results. The Cleft Palate-Craniofacial Journal: Official Publication of the American Cleft Palate-Craniofacial Association 57(4): 529–531. DOI: 10.1177/1055665619899752.

Fell

Dack

K and

Lewis

(2022) Maternal cigarette smoking and cleft lip and palate: A systematic review and meta-analysis. The Cleft Palate Craniofacial Journal 59(9): 1185–1200. DOI: 10.1177/10556656211040015.

Hopper

(2016) Cleft lip and palate: embryology, principles, and treatment. Available at: https://plasticsurgerykey.com/cleft-lip-and-palate-embryology-principles-and-treatment/ (accessed 26 October 2021).

Hunt

Russell

Smithson

, et al. (2008) Topiramate in pregnancy: Preliminary experience from the UK Epilepsy and Pregnancy Register. Neurology 71(4): 272–276. DOI: 10.1212/01.wnl.0000318293.28278.33.

10.

Huybrechts

Hernandez-Diaz

Straub

, et al. (2018) Association of maternal first-trimester ondansetron use with cardiac malformations and oral clefts in offspring. JAMA 320(23): 2429–2437. DOI: 10.1001/jama.2018.18307.

11.

Jackson

Bromley

Morrow

, et al. (2016) In utero exposure to valproate increases the risk of isolated cleft palate. Archives of Disease in Childhood. Fetal and Neonatal Edition 101(3): F207–211. DOI: 10.1136/archdischild-2015-308278.

12.

Kuo

Lien

Chu

, et al. (2013) Otitis media with effusion in children with cleft lip and palate: A narrative review. International Journal of Pediatric Otorhinolaryngology 77(9): 1403–1409. DOI: 10.1016/j.ijporl.2013.07.015.

13.

Leslie

EJ and

Marazita

(2013) Genetics of cleft lip and cleft palate. American Journal of Medical Genetics Part C: Seminars in Medical Genetics 163(4): 246–258. DOI: 10.1002/ajmg.c.31381.

14.

Mitchell

JC and

Wood

(2000) Management of cleft lip and palate in primary care. Journal of Pediatric Health Care 14(1): 13–19. DOI: 10.1016/s0891-5245(00)70039-3.

15.

Mossey

Little

Munger

, et al. (2009) Cleft lip and palate. Lancet (London, England) 374(9703): 1773–1785. DOI: 10.1016/S0140-6736(09)60695-4.

16.

NHS England (2013) NHS standard contract for cleft lip and/or palate services [including non-cleft velopharyngeal dysfunction (VPD) (all ages). Available at: www.england.nhs.uk/wp-content/uploads/2013/06/d07-cleft-lip.pdf (accessed 10 January 2022).

17.

NICE (2008) Managing OME in children with cleft palate. Available at: www.nice.org.uk/guidance/cg60/ifp/chapter/managing-ome-in-children-with-cleft-palate (accessed 5 September 2022).

18.

Niebyl

(2003) Antibiotics and other anti-infective agents in pregnancy and lactation. American Journal of Perinatology 20(8): 405–414. DOI: 10.1055/s-2003-45391.

19.

Phalke

N and

Goldman

(2022) Cleft Palate. Treasure Island (FL): StatPearls Publishing.

20.

RCGP. Clinical topic guide: Ear, nose and throat, speech and hearing. Available at: www.rcgp.org.uk/mrcgp-exams/gp-curriculum/clinical-topic-guides#ear (accessed 3 October 2022).

21.

Richards

McNinch

Martin H , et al. (2010) Stickler syndrome and the vitreous phenotype: Mutations in COL2A1 and COL11A1. Human Mutatation 31(6): E1461–1471. DOI: 10.1002/humu.21257.

22.

Rizos

M and

Spyropoulos

(2004) Van der Woude syndrome: A review. Cardinal signs, epidemiology, associated features, differential diagnosis, expressivity, genetic counselling and treatment. European Journal of Orthodontics 26(1): 17–24. DOI: 10.1093/ejo/26.1.17.

23.

Safra

MJ and

Oakley

(1975) Association between cleft lip with or without cleft palate and prenatal exposure to diazepam. Lancet, 2(7933): 478–480. DOI: 10.1016/s0140-6736(75)90548-6.

24.

Sharma

RK and

Nanda

(2009) Problems of middle ear and hearing in cleft children. Indian Journal of Plastic Surgery 42(Suppl): S144–S148. DOI: 10.4103/0970-0358.57198.

25.

Shaw

Richardson

D and

McMahon

(2003) Conservative management of otitis media in cleft palate. Journal of Cranio-Maxillo-Facial Surgery 31(5): 316–320. DOI: 10.1016/s1010-5182(03)00074-x.

26.

Smallridge

Hall

Chorbachi

, et al. (2015) Functional outcomes in the Cleft Care UK study – Part 3: Oral health and audiology. Orthodontics & Craniofacial Research 18(2): 25–35. DOI: 10.1111/ocr.12110.

27.

Stothard

Tennant

PWG

Bell

, et al. (2009) Maternal overweight and obesity and the risk of congenital anomalies: A systematic review and meta-analysis. JAMA 301(6): 636–650. DOI: 10.1001/jama.2009.113.

28.

Teach Me Anatomy (2020) Development of the face and palate. Available at: https://teachmeanatomy.info/the-basics/embryology/head-neck/face-palate/ (accessed 10 October 2022)

29.

Vyas

Gupta

Kumar

, et al. (2020) Cleft of lip and palate: A review. Journal of Family Medicine and Primary Care 9(6): 2621–2625. DOI: 10.4103/jfmpc.jfmpc_472_20.

30.

Walker

Anand

Podda

(2022). Cleft Lip. Treasure Island (FL): StatPearls Publishing. StatPearls

31.

Worley

Patel

KG and

Kilpatrick

(2018) Cleft lip and palate. Clinics in Perinatology 45(4): 661–678. DOI: 10.1016/j.clp.2018.07.006.

32.

Zhou

Sinnathamby

, et al. (2020) Folate intake, markers of folate status and oral clefts: An updated set of systematic reviews and meta-analyses. Birth Defects Research 112(19): 1699–1719. DOI: 10.1002/bdr2.1827.