About Cleft

About Cleft Lip & Palate

Cleft lip and cleft palate are serious health conditions that impact children and their families worldwide. As a trusted leader in cleft care for children, Operation Smile offers expert insights on the causes, implications, and treatments for cleft lip and palate.

What is Cleft?

A cleft is an opening in the lip, the roof of the mouth, or the soft tissue in the back of the mouth that did not close during early pregnancy. While some openings are easy to see, such as in the lip, others are hidden, such as those in the roof of the mouth.

Antonia Sales (19 years old) holding her before surgery picture surrounded by hospital employees

What are the Different Types of Cleft Conditions?

Moises Valeriana Chamatun Castro Before his Surgery

Cleft Lip

Referring to a split or opening in the upper or lower lip, which can range from a small notch to a complete separation that extends up to the nose. This condition can affect one side (unilateral) or both sides (bilateral) of the upper lip.

Cleft Palate

Involving a gap or opening in the roof of the mouth, known as the palate. It can vary in size and severity, extending from the front of the mouth towards the back. It may affect only the soft tissue at the back of the mouth (soft palate) or involve both the soft and hard palate.

Joseph Misa, 6 years old

Combined Cleft Lip and Palate

Some individuals may have both conditions, either on one side or both sides of the mouth. This combined condition can present unique challenges and often requires comprehensive treatment to address both the lip and palate issues.

How Common are Cleft Conditions?

Cleft conditions are one of the most common facial differences and affect individuals globally. In Canada, they’re frequently treated early in life, but in low- and middle-income countries, a significant number of individuals born with cleft conditions go without treatment into adulthood. It’s estimated that a child is born with a cleft condition every 3 minutes, or in about 1 out of every 500 to 750 births.

How are Cleft Conditions Diagnosed?

Cleft conditions, especially a cleft lip, may be diagnosed by ultrasound during pregnancy. If not during pregnancy, especially a cleft palate, they are diagnosed upon evaluation after birth.

Causes of Cleft Conditions

What Causes Cleft Lip and Cleft Palate?

For most cases, the reason for cleft lip or palate is unknown, and a parent cannot prevent it. The exact causes for cleft palate and cleft lip are not yet fully understood, however studies – including – including research conducted by Operation Smile – suggest a combination of genetic (inherited) variations or changes and environmental factors.

Nutritionist, Georgina Ntem of Ghana, measuring the circumference of the head.
Yeikob Silva Zelaya - Before Surgery
Jheleen Nicole and Andrea Nicole Hulaton

Causes of Cleft Conditions

Genetic Causes of Cleft Conditions

Operation Smile has partnered with the University of Southern California and Children’s Hospital Los Angeles to construct the International Family Study (IFS) to analyze genetic data obtained from saliva samples voluntarily provided by patients, their families, and control groups, as well as information collected from maternal and paternal questionnaires on environmental exposures and lifestyle habits. Ongoing since 2009, the study has amassed the largest repository of genetic information relating to global cleft populations ever collected.

Causes of Cleft Conditions

Environmental Risk Factor

Environmentally, IFS suggests potential risk factors (or reasons for cleft lip and palate) include:

  • Maternal cooking with wood fire indoors – a common practice in the low-and middle-income countries we serve – as well as passive smoke inhalation indoors from tobacco smoking
  • Maternal use of well water
  • Maternal rural residency
  • Maternal exposure to agricultural and industrial chemicals
Leana Onjanirina 3,5 years old, UCL, from Tsiroanomandidy
Patricia Goliati, 6 months old with her mom
Abedu Eni, male, UCL, After

Causes of Cleft Conditions

Maternal Health and Lifestyle

Other studies suggest:

  • What a mother eats or drinks during pregnancy and certain vitamin deficiencies
  • Select medications taken during the first trimester, including specific epilepsy, cancer, arthritis, and psoriasis prescriptions
  • Pre-existing medical conditions of the birthing parent

Operation Smile is dedicated to understanding the root causes of cleft – including genetic, environmental, and lifestyle – to help prevent them in the future.