Unilateral complete cleft lip and palate in an infant
1-year-old male
§Case presentation
Infant reviewed at 3 months in the cleft multidisciplinary clinic; age recorded in completed years.
§Chief complaint
Cleft of the lip and palate noted at birth; feeding difficulty
§Medical & dental history
- 01Term normal delivery; no syndromic features on paediatric assessment
- 02No maternal folate deficiency documented
- 03Neonatal feeding plate provided; deciduous dentition not yet erupted
§Clinical examination
- 01Complete left-sided cleft of lip, alveolus and primary and secondary palate
- 02Displaced and rotated nasal alar base with a deviated columella
- 03Feeding assisted with a squeeze bottle and soft teat; weight gain now on the 40th centile
- 04Hearing screening shows bilateral middle ear effusion
§ figuresFigures (3)
Fig. 1cleft lip and palate left seen from bottom
“Cleft lip max palate left bot” · Schwing · CC BY-SA 3.0 · Wikimedia Commons
Fig. 2cleft lip and palate both sides seen from bottom
“Cleft lip max palate left right bot” · Schwing · CC BY-SA 3.0 · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Cleft Lip and Palate figures pending faculty review.
§Differential diagnosis
§Final diagnosis
Non-syndromic complete unilateral (left) cleft lip, alveolus and palate
Clinical examination plus paediatric and genetic assessment excluding syndromic features establishes a non-syndromic complete unilateral cleft, managed along a staged multidisciplinary pathway.
§Investigations
- 01Paediatric assessment for associated anomalies; echocardiogram normal
- 02Genetic review — no syndromic diagnosis
- 03Hearing assessment and audiology follow-up
- 04Growth and feeding monitoring
§Radiology
- 01Later occlusal and CBCT imaging at age 8-10 to plan alveolar bone grafting
§Treatment plan
- 01Feeding support and presurgical nasoalveolar moulding
- 02Lip and nose repair at 3-6 months (Millard rotation-advancement)
- 03Palate repair at 9-12 months for speech development
- 04Speech therapy, grommets as needed, orthodontics
- 05Alveolar bone graft at mixed dentition, before canine eruption
- 06Orthognathic surgery and definitive rhinoplasty at skeletal maturity if required
§Surgical procedure
- 01Millard rotation-advancement cheiloplasty with primary nasal correction at 4 months
- 02Two-flap palatoplasty with intravelar veloplasty at 10 months
§Follow-up & outcome
- 01Speech assessment at 18 months, 3 and 5 years
- 02Annual multidisciplinary clinic review
- 03Alveolar bone graft planned at age 9
Outcome: Good lip and nasal form, competent velopharyngeal function with normal speech development at 3 years.
§Discussion
- 01Cleft care is lifelong and multidisciplinary: surgeon, orthodontist, speech therapist, audiologist, psychologist, geneticist and specialist nurse.
- 02Timing balances speech development against mid-face growth restriction from early palatal surgery.
- 03Secondary alveolar bone grafting with cancellous iliac crest bone before canine eruption gives the best periodontal and eruption outcomes.
§Clinical pearls / learning points
- 01Rule of tens is a traditional guide to fitness for lip repair: 10 weeks, 10 lb, haemoglobin 10 g/dL.
- 02Always examine the lower lip for pits — Van der Woude is the commonest syndromic cleft.
§Viva questions
When is alveolar bone grafting performed?
In the mixed dentition, when the canine root is one-half to two-thirds formed, usually at 8-11 years.
Which embryological failure produces a cleft palate?
Failure of fusion of the palatal shelves with each other and with the primary palate between weeks 8 and 12.
§MCQs
Q1Cleft palate repair is usually performed at:
Q2The commonest syndrome associated with cleft lip and palate is:
§ evidenceReferences & Evidence
Current Classification
WHO Classification of Tumours Online — Head and Neck
IARC / WHO · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Evidence summary
Highest level of evidence linked to this page: WHO / Official Classification.
- L1 · Classification — 1
- L4 · Research — 1
- L6 · Textbook — 3
1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.
Content last reviewed
September 2026
Evidence last reviewed
September 2026
Next scheduled review
September 2027
Review status
EVIDENCE REVIEWED
Search latest PubMed evidence
Last literature search: 7 September 2026
Current Classification
IARC / WHO. IARC · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Key Research
Mossey PA, Little J, Munger RG et al.. Lancet (London, England) · 2009 · 374(9703):1773-85
Seminar reviewing aetiology, epidemiology and multidisciplinary management of orofacial clefting.
Histopathology References
Barnes L. CRC Press · 2008
Detailed histopathological reference for head and neck diagnostic criteria.
Textbook References
Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024
Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.
Rajendran R, Sivapathasundharam B. Elsevier · 2020
Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.
Additional sources cited on this page
- Shaw W et al. The Eurocleft study: standards of care. Cleft Palate Craniofac J.
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