Cleft lip and cleft palate ICD-10 code: Q35-Q37 ICD-9 code: 749 For other uses, see Cleft (disambiguation). Cleft is a congenital deformity caused by a failure in facial development during pregnancy. It can be treated with surgery shortly after birth with highly successful results. Cleft occurs in somewhere between one in 600 and one in 800 births. Cleft occurs in several severities and is divided in two major categories: cleft lip and cleft palate. Contents 1 Cleft lip 2 Palate 3 Causes 4 Treatment 5 Complications 6 Controversy 7 Famous people with a cleft 8 See also 9 External links Cleft lip If only skin tissue is affected one speaks of cleft lip. Cleft lip is formed in the upper lip as either a small gap or dent in the lip (partial or incomplete cleft) or continues into the nose (complete cleft). Lip cleft can occur as one sided (unilateral) or two sided (bilateral). It is colloquially called hare-lip (because a hare's lip is similarly cleft), or even hair lip (misspelling of the previous). Unilateral incomplete Unilateral complete Bilateral complete Palate Cleft palate is a condition in which the two plates of the skull that form the hard palate (roof of the mouth) are not completely joined. The soft palate is in these cases cleft as well. In most cases, cleft lip is also present. Palate cleft can occur as complete (soft and hard palate, possibly including a gap in the jaw) or incomplete (a 'hole' in the roof of the mouth, usually as a cleft soft palate). When cleft palate occurs, the uvula is usually split. Unilateral complete lip and palate Bilateral complete lip and palate Incomplete cleft palate   Causes During the first six to eight weeks of pregnancy, the shape of the embryo's head is formed. Five tissues grow (one from the back of the neck over the top of the head down towards the upper lip, two from the cheeks and meet the first layer to form the upper lip and two from each side form the chin and lower lip). If these tissues fail to 'touch' a gap appears where the tissues should have joined. The cause of cleft lip and cleft palate formation is genetic in nature. A specific gene that three-fold increases occurrence of these deformities have been identified in 2004 as reported by the BBC [1]. If a person (male or female) is born with a cleft, the chances of that person having a child with a cleft, given no other obvious factor, rises to 7 in 100 (instead of 1 in 700). Folic acid reduces the odds slightly. Clefting seems to be at least in part related to ethnicity, occurring most often among Asians, Latinos and Native Americans (1 in 500), next most often among persons of European ethnicity (1 in 700) and least often among persons of African ethnicity (1 in 1,000). In some cases, cleft palate is caused by syndromes which also cause other problems. Many clefts run in families, even though there does not seem to be any identifiable syndrome present. Treatment Within the first 6 months after birth, surgery is performed to close the gap in the lip. Most large hospitals have a Cleft or Craniofacial team of specialists to treat children and aid parents. Often an incomplete cleft requires the same surgery as complete cleft. This is done for two reasons. Firstly the group of muscles required to purse your lips run through the upper lip. In order to restore the complete group a full incision must be made. Secondly, to create a less obvious scar the surgeon tries to line up the scar with the natural lines in the upper lip (such as the edges of the philtrum) and tuck away stiches as far up the nose as possible. Incomplete cleft gives the surgeon more tissue to work with, creating a more supple and natural looking upper lip. Cleft palate also can be corrected by surgery, usually performed between 9 and 18 months. Combinations of surgery methods and repeated surgeries are often necessary as the child grows. Complications Cleft may cause problems with feeding (see also Haberman Feeder), ear disease, and speech. Some of the primary and permanent teeth may also be missing. When the lip is cleft, the person may face social stigma. Controversy In some countries cleft lip or palate deformity are either tolerated or officially sanctioned reasons to perform abortion beyond the legal fetal age limit, even though the fetus is not in jeopardy of life or limb. Some human rights activists contend this practice of "cosmetic murder" amounts to Nazi eugenics. A London clergywoman, who suffered from a congenital jaw deformity herself (not a cleft lip or palate as is sometimes reported), has started legal action to stop the practice in England as reported by CNN [2] and the BBC [3] Sometimes the term "harelip" is used to describe a cleft lip. The term is antiquated and considered derrogatory, although it is still widely used in parts of the southern United States and in Europe. Famous people with a cleft Tom Brokaw Jürgen Habermas Doc Holliday Jesse Jackson Stacy Keach Thomas Malthus Cheech Marin Blaise Winter Cliff Palate from the Howard Stern Show Research reported that pharao Tutankhamun had cleft palate [4]. President Abraham Lincoln's son Thomas Lincoln had cleft palate [5]. It is a popular belief Joaquin Phoenix has a cleft lip. However, the mark on his lip is actually an unrelated scar. See also Haberman Feeder Van der Woude syndrome The Smile Train External links Cleft lip and palate information from Seattle Children's Craniofacial Center cleftAdvocate - Non-profit support organization for all craniofacial conditions; on-line and in-person family support, insurance and advocacy assistance, and more. CleftClub.com - Cleft lip and palate support groups and information center. Born to be Cleft - The account of a person born with both cleft lip and cleft palate during the early 1970s. Cleft Lip and Palate Association http://www.plasticsurgery.org/public_education/procedures/CleftLipPalate.cfm http://www.cleftline.org http://www.smilechina.com http://www.smiletrain.org Cleft Lip and Cleft Palate (March of Dimes) Non-profit cleft surgery organization Operation Smile World Craniofacial Foundationde:Lippen-, Kiefer-, Gaumenspalte Search Term: "Cleft" Categories: Congenital disorders