Developmental Disorders
Cleft Lip and Palate
aka CLP · Orofacial Cleft · Cheiloschisis (lip) · Palatoschisis (palate)
Congenital defect from failure of fusion of facial processes resulting in cleft lip, palate, or both.
§ 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.
§ overviewOverview
Non-syndromic or syndromic oro-facial cleft due to incomplete fusion of maxillary and medial nasal processes (lip) or palatal shelves (palate) during embryogenesis.
§ icdICD Classification
Q35-Q37
§ etiologyEtiology
- 01Multifactorial (genetic + environmental)
- 02Genes: IRF6, MSX1, TGFβ3
- 03Teratogens: alcohol, smoking, anticonvulsants
§ riskRisk Factors
- 01Family history
- 02Maternal smoking/alcohol
- 03Folate deficiency
- 04Anticonvulsant use
§ epidemiologyEpidemiology
CL ± P: 1:700 (Asians) to 1:1000 (Caucasians). Isolated CP: 1:2500. Male > female for CL ± P; female > male for isolated CP.
§ pathogenesisPathogenesis
Failure of fusion between 4–12 weeks IU. Lip closes week 6; palate closes weeks 7–12.
§ clinicalClinical Features
- 01Unilateral or bilateral cleft lip ± alveolus
- 02Cleft of hard/soft palate
- 03Nasal deformity
- 04Feeding difficulties
- 05Speech problems (VPI)
- 06Dental anomalies (missing/supernumerary teeth)
§ investigationsInvestigations
- 01Antenatal USG (lip visible 18 wks)
- 02Genetic testing for syndromic cases
- 03Speech/hearing assessment
§ classificationClassification
- 01Veau classification (I-IV)
- 02Kernahan striped-Y
- 03Tessier classification (craniofacial clefts)
§ treatmentTreatment
- 01Multidisciplinary cleft team
- 02Lip repair: 10 weeks (rule of 10s)
- 03Palate repair: 9–12 months
- 04Alveolar bone graft: 9–11 years (mixed dentition)
- 05Secondary rhinoplasty, orthognathic surgery as needed
§ surgicalSurgical Management
- 01Millard rotation-advancement (lip)
- 02Furlow double-opposing Z-plasty (palate)
- 03Alveolar bone grafting (iliac crest)
§ complicationsComplications
- 01VPI and hypernasality
- 02Eustachian tube dysfunction → OME/hearing loss
- 03Maxillary hypoplasia
- 04Dental anomalies
§ prognosisPrognosis
Excellent aesthetic and functional outcomes with early comprehensive care.
§ examKey Examination Points
- 01Rule of 10 for lip repair
- 02VPI = velopharyngeal insufficiency
- 03Alveolar bone graft timing: mixed dentition
§ revisionQuick Revision Summary
- 01CL+P: male > female
- 02Isolated CP: female > male
- 03IRF6 gene — Van der Woude syndrome
§ vivaBDS Viva Questions
- 01When is cleft lip repair performed?
- 02What is Veau classification?
- 03Describe the embryology of cleft palate.
§ mcqsMCQs — Assessment (3)
Question 1
Ideal timing for cleft lip repair:
Question 2
Most common cleft type:
Question 3
IRF6 mutation is associated with:
§ 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
- Mossey PA. Lancet 2009;374:1773
- Neville BW. Oral & Maxillofacial Pathology, 4e
Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.