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What exactly is a cleft lip and palate? How is this condition diagnosed, what difficulties can a baby born with orofacial clefts expect, and what are the treatment options?

Finding out that your (unborn) baby has a clept lip, a cleft palate, or a cleft lip and palate can be terrifying. Don't panic, though: orofacial clefts are very treatable these days, with one surgical procedure or a series. With treatment, cleft lip and palate can be repaired very well, enabling your baby to function without feeding or speech difficulties. 

What Are Orofacial Clefts?

The first trimester of pregnancy is a period of great changes — a baby develops more rapidly during this time than at any other point of pregnancy. The head starts to form around the fifth or six week. Tissues that started off at the sides begin moving towards the center, forming the mouth, lips, upper jaw, and nose. They normally fuse completely. If this doesn't happen, a gap — or "cleft" — remains, and the baby is born with an orofacial cleft.

Babies can have both a cleft lip and palate, just a cleft lip (more common in boys), or just a cleft palate (more common in girls). 

A cleft lip is a split in the upper lip, which can be mild or severe, running all the way up to the nose. A cleft palate refers to a split in the roof of the mouth. Again, the split may be minor or severe. Babies born with a cleft lip and palate will be affected by both these conditions, which can be unilateral or bilateral. 

Research suggests that risk factors include smoking, drinking, using certain medications, not taking folic acid, and being overweight during the very early weeks of pregnancy. However, that doesn't mean you need to start asking yourself what you did wrong the moment your baby is diagnosed with a cleft lip and palate. Orofacial clefts have a very strong genetic component, which can be passed on by the mother or the father. Boys have a higher risk than girls, and babies of Latin American, Asian and Native American are also more frequently affected. 

Cleft lip and cleft palate are not unusual birth defects — about one in 700 US babies will be born with a cleft lip, cleft palate, or cleft lip and palate, making orofacial clefts the fourth most common birth defect in the United States.

When Are Orofacial Clefts Diagnosed?

The immediately apparent physical characteristics of cleft lip and cleft palate mean that the conditions are very easily spotted at birth, and no special tests are required to verify the diagnosis of orofacial cleft. As technology advances, cleft lip and palate are also noticed on routine ultrasound scans more and more frequently. Cleft lip or cleft lip and palate are easier to see on these scans, and they may be identified as early as the 13th week of pregnancy. 

Stand-alone cleft palates are harder to spot, as they are limited to the oral cavity, but they too are sometimes diagnosed through ultrasound. Where orofacial cleft is spotted on an ultrasound scan, an amniocentesis may be recommended to rule out genetic conditions that also cause orofacial clefts. 

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