Cleft lip 

(cheiloschisis) and cleft palate (palatoschisis), which can also occur together as cleft lip and
palate, are variations of a type of clefting congenital deformity caused by abnormal facial development
during gestation. A cleft is a fissure or opening—a gap. It is the non-fusion of the body's natural
structures that form before birth. Approximately 1 in 700 children born have a cleft lip and/or a cleft palate.
An older term is harelip, based on the similarity to the cleft in the lip of ahare.

Clefts can also affect other parts of the face, such as the eyes, ears, nose, cheeks, and forehead. In
1976, Paul Tessierdescribed fifteen lines of cleft. Most of these craniofacial clefts are even more rare and
are frequently described as Tessier clefts using the numerical locator devised by Tessier.[1]

A cleft lip or palate can be successfully treated with surgery, especially so if conducted soon after birth or
in early childhood.

Cleft lip and palate

If the cleft does not affect the palate structure of the mouth it is referred to as cleft lip. Cleft lip is formed in
the top of the lip as either a small gap or an indentation in the lip (partial or incomplete cleft) or it
continues into the nose (complete cleft). Lip cleft can occur as a one sided (unilateral) or two sided
(bilateral). It is due to the failure of fusion of the maxillary and medial nasal processes (formation of the
primary palate).

Unilateral incomplete Unilateral complete Bilateral complete

A mild form of a cleft lip is a microform cleft.[citation needed] A microform cleft can appear as small as a little
dent in the red part of the lip or look like a scar from the lip up to the nostril.[citation needed] In some
cases muscle tissue in the lip underneath the scar is affected and might require reconstructive surgery.
[citation needed]
 It is advised to have newborn infants with a microform cleft checked with a craniofacial team as
soon as possible to determine the severity of the cleft.[citation needed]
3 month old boy before going into surgery to have The same boy, 1 month after Again the same boy, 18 months old. Note

his unilateral incomplete cleft lip repaired. the surgery. how the scar gets less visible with age.

6 month old girl before going into surgery to have The same girl, 1 month after Again the same girl, age 5 years old. Note how

her unilateral complete cleft lip repaired. the surgery. the scar gets less visible with age.

[edit]Cleft 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. Cleft palate occurs in about one in 700 live births worldwide.[2]

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. It occurs due to the failure of fusion of the lateral palatine processes, the nasal
septum, and/or the median palatine processes (formation of the secondary palate).

The hole in the roof of the mouth caused by a cleft connects the mouth directly to the nasal cavity.

Note: the next images show the roof of the mouth. The top shows the nose, the lips are colored pink. For
clarity the images depict a toothless infant.

Incomplete cleft palate Unilateral complete lip and palate Bilateral complete lip and palate
A direct result of an open connection between the oral cavity and nasal cavity is velopharyngeal
inadequacy (VPI). Because of the gap, air leaks into the nasal cavity resulting in a
hypernasal voice resonance and nasal emissions.[3] Secondary effects of VPI include
speech articulation errors (e.g., distortions, substitutions, and omissions) and compensatory
misarticulations (e.g., glottal stops and posterior nasal fricatives).[4] Possible treatment options
include speech therapy, prosthetics, augmentation of the posterior pharyngeal wall, lengthening of the
palate, and surgical procedures.[3]

Submucous cleft palate (SMCP) can also occur, which is an occult cleft of the soft palate with a classic
clinical triad of bifid uvula, a furrow along the midline of the soft palate, and a notch in the posterior margin
of the hard palate.[5]

[edit]Sub-clinical manifestations
The spectrum of severity in visible CL/P is broad, ranging from notches of the vermilion and/or grooves in
the philtrum to complete unilateral and bilateral clefts of the lip and palate.[6] At the mild end of the
spectrum, studies have described minimal or microform expressions of the CL/P phenotype, typically
involving subtle defects of the lip, alveolar arch, and/or inferior nasal region to varying degrees.
[7]
 Histological evidence indicates that these defects extend to the muscle fibers of the superior orbicularis
oris (OO) muscle.[8] Martin et al.[9] found histological evidence of defects in the OO muscle in two 18-week
fetuses with no obvious visible clefting, suggesting that the CL/P phenotype might also include occult
subepithelial clefts, i.e., OO defects in the absence of any overt signs of CL/P. Subsequently, Martin et al.
[10]
 used ultrasonography to visualize subepithelial OO defects in a small sample of non-cleft relatives of
individuals with CL/P and healthy controls. Critically, they observed a significant increase in the frequency
of OO defects in the non-cleft relatives.

[edit]Prevalence among ethnic groups

Main article:  Clefting prevalence in different cultures

Prevalence rates reported for live births for Cleft lip with or without Cleft Palate (CL +/- P) and Cleft Palate
alone (CPO) varies within different ethnic groups.

The highest prevalence rates for (CL +/- P) are reported for Native Americans and Asians. Africans have

the lowest prevalence rates.[11]

 Native Americans: 3.74/1000

 Japanese: 0.82/1000 to 3.36/1000
 Chinese: 1.45/1000 to 4.04/1000
 Caucasians: 1.43/1000 to 1.86/1000
 Latin Americans: 1.04/1000
 Africans: 0.18/1000 to 1.67/1000

Rate of occurrence of CPO is similar for Caucasians, Africans, North American natives, Japanese and
Chinese. The trait is dominant.

Prevalence of "cleft uvula" has varied from .02% to 18.8% with the highest numbers found
among Chippewa and Navajo and the lowest generally in Africans.[citation needed]

[edit]Causes of cleft
The development of the face is coordinated by complex morphogenetic events and rapid proliferative
expansion, and is thus highly susceptible to environmental and genetic factors, rationalising the high
incidence of facial malformations. During the first six to eight weeks of pregnancy, the shape of the
embryo's head is formed. Five primitive tissue lobes grow:

a) one from the top of the head down towards the future upper lip; (Frontonasal Prominence)
b-c) two from the cheeks, which meet the first lobe to form the upper lip; (Maxillar Prominence)
d-e) and just below, two additional lobes grow from each side, which form the chin and lower lip;
(Mandibular Prominence)

If these tissues fail to meet, a gap appears where the tissues should have joined (fused).
This may happen in any single joining site, or simultaneously in several or all of them.
The resulting birth defect reflects the locations and severity of individual fusion failures
(e.g., from a small lip or palate fissure up to a completely malformed face).

The upper lip is formed earlier than the palate, from the first three lobes named a to c
above. Formation of the palate is the last step in joining the five embryonic facial lobes,
and involves the back portions of the lobes b and c. These back portions are called
palatal shelves, which grow towards each other until they fuse in the middle.[12]This
process is very vulnerable to multiple toxic substances, environmental pollutants, and
nutritional imbalance. The biologic mechanisms of mutual recognition of the two cabinets,
and the way they are glued together, are quite complex and obscure despite intensive
scientific research.[13]

[edit]Genetic factors
Genetic factors contributing to cleft lip and cleft palate formation have been identified for
some syndromic cases, but knowledge about genetic factors that contribute to the more
common isolated cases of cleft lip/palate is still patchy.
Many clefts run in families, even though in some cases there does not seem to be an
identifiable syndrome present,[citation needed] possibly because of the current incomplete
genetic understanding of midfacial development.

Syndromic cases:

 The Van der Woude Syndrome is caused by a specific variation in the gene IRF6 that

increases the occurrence of these deformities threefold.[14][15]
 Another syndrome, Siderius X-linked mental retardation, is caused by mutations in
the PHF8 gene (OMIM 300263); in addition to cleft lip and/or palate, symptoms
include facial dysmorphism and mild mental retardation.[16]

In some cases, cleft palate is caused by syndromes which also cause other problems.

 Stickler's Syndrome can cause cleft lip and palate, joint pain, and myopia.[citation needed]
 Loeys-Dietz syndrome can cause cleft palate or bifid uvula, hypertelorism, and aortic
aneurysm.[citation needed]
 Hardikar syndrome can cause cleft lip and palate, Hydronephrosis, Intestinal
obstruction and other symptoms.[17]
 Cleft lip/palate may be present in many different chromosome disorders
including Patau Syndrome (trisomy 13).

Non-syndromic cases: Many genes associated with syndromic cases of cleft lip/palate

(see above) have been identified to contribute to the incidence of isolated cases of cleft
lip/palate. This includes in particular sequence variants in the
genes IRF6, PVRL1 and MSX1.[18] The understanding of the genetic complexities
involved in themorphogenesis of the midface, including molecular and cellular processes,
has been greatly aided by research on animal models, including of the
genes BMP4, SHH,SHOX2, FGF10 and MSX1.[18]

Types include:

Type OMIM Gene Locus

OFC1 119530  ? 6p24

OFC2 602966  ? 2p13

OFC3 600757  ? 19q13

OFC4 608371  ? 4q

OFC5 608874 MSX1 4p16.1

OFC6 608864  ? 1q

OFC7 600644) PVRL1 11q

OFC8 129400 TP63 3q27

OFC9 610361  ? 13q33.1-q34

SUMO
OFC10 601912 2q32.2-q33
1

OFC11 600625 BMP4 14q22

OFC12 612858  ? 8q24.3

[edit]Environmental influences
Environmental influences may also cause, or interact with genetics to produce,
orofacial clefting. An example for how environmental factors might be linked to genetics
comes from research on mutations in the gene PHF8 that cause cleft lip/palate (see
above). It was found that PHF8 encodes for a histone lysine demethylase,[19] and is
involved in epigenetic regulation. The catalytic activity of PHF8 depends on
molecular oxygen,[19] a fact considered important with respect to reports on increased
incidence of cleft lip/palate in mice that have been exposed to hypoxia early
during pregnancy.[20] In humans, fetal cleft lip and other congenital abnormalities have
also been linked to maternal hypoxia, as caused by e.g. maternal smoking,
[21]
 maternal alcohol abuse or some forms of maternal hypertension treatment.[22] Other
environmental factors that have been studied include: seasonal causes (such as
pesticide exposure); maternal diet and vitamin intake; retinoids - which are members of
the vitamin A family; anticonvulsant drugs; alcohol; cigarette use; nitrate compounds;
organic solvents; parental exposure to lead; and illegal drugs (cocaine, crack cocaine,
heroin, etc.).

Current research continues to investigate the extent to which Folic acid can reduce the
incidence of clefting.

[edit]Diagnosis

Traditionally, the diagnosis is made at the time of birth by physical examination. Recent
advances in prenatal diagnosis have allowed obstetricians to diagnose facial cleftsin
utero.[23]

[edit]Treatment

This section does not cite any references or sources.

Please help improve this article by adding citations to reliable sources. Unsourced material
may be challenged and removed. (February 2009)

Cleft lip and palate is very treatable; however, the kind of treatment depends on the type
and severity of the cleft.

Most children with a form of clefting are monitored by a cleft palate team or craniofacial
team through young adulthood. Care can be lifelong. Treatment procedures can vary
between craniofacial teams. For example, some teams wait on jaw correction until the
child is aged 10 to 12 (argument: growth is less influential as deciduous teethare
replaced by permanent teeth, thus saving the child from repeated corrective surgeries),
while other teams correct the jaw earlier (argument: less speech therapy is needed than
at a later age when speech therapy becomes harder). Within teams, treatment can differ
between individual cases depending on the type and severity of the cleft.

[edit]Cleft lip treatment

Within the first 2–3 months after birth, surgery is performed to close the cleft lip. While
surgery to repair a cleft lip can be performed soon after birth, often the preferred age is at
approximately 10 weeks of age, following the "rule of 10s" coined by surgeons
Wilhelmmesen and Musgrave in 1969 (the child is at least 10 weeks of age; weighs at
least 10 pounds, and has at least 10g hemoglobin). If the cleft is bilateral and extensive,
two surgeries may be required to close the cleft, one side first, and the second side a few
weeks later. The most common procedure to repair a cleft lip is the Millard
procedure pioneered by Ralph Millard. Millard performed the first procedure at aMobile
Army Surgical Hospital (MASH) unit in Korea.[24]
 Often an incomplete cleft lip requires the same surgery as complete cleft. This is done for
two reasons. Firstly the group of muscles required to purse the 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 stitches 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.

The blue lines indicate Movement of the flaps; flap A is Pre-operation Post-operation, the lip is

incisions. moved between B and C. C is swollen from surgery and

rotated slightly while B is will get a more natural look

pushed down. within a couple of weeks.

See photos in the section

above.

[edit]Pre-surgical devices for cleft lip treatment

In some cases of a severe bi-lateral complete cleft, the premaxillary segment will be
protruded far outside the mouth.

Nasoalveolar molding followed by surgery can improve long-term nasal symmetry among

patients with complete unilateral cleft lip-cleft palate patients compared to surgery alone,
according to a retrospective cohort study.[25] Significant improvements in nasal symmetry
were observed in the measurements of the projected length of the nasal ala, position of
the superoinferior alar groove, position of the mediolateral nasal dome, and nasal bridge
deviation. "The nasal ala projection length demonstrated an average ratio of 93.0 percent
in the surgery-alone group and 96.5 percent in the nasoalveolar molding group" this study
concluded.

[edit]Cleft palate treatment

This section does not cite any references or sources.
Please help improve this article by adding citations to reliable sources. Unsourced material
may be challenged and removed. (February 2009)
 A repaired cleft palate on a 64-year-old female.

Often a cleft palate is temporarily closed, the cleft isn't closed, but it is covered by
a palatal obturator (a prosthetic device made to fit the roof of the mouth covering the
gap).

Cleft palate can also be corrected by surgery, usually performed between 6 and 12
months. Approximately 20-25% only require one palatal surgery to achieve a competent
velopharyngeal valve capable of producing normal, non-hypernasal speech. However,
combinations of surgical methods and repeated surgeries are often necessary as the
child grows. One of the new innovations of cleft lip and cleft palate repair is the Latham
appliance. The Latham is surgically inserted by use of pins during the child's 4th or 5th
month. After it is in place, the doctor, or parents, turn a screw daily to bring the cleft
together to assist with future lip and/or palate repair.

If the cleft extends into the maxillary alveolar ridge, the gap is usually corrected by filling
the gap with bone tissue. The bone tissue can be acquired from the patients own chin, rib
or hip.

[edit]Speech and hearing treatments

A tympanostomy tube is often inserted into the eardrum to aerate the middle ear. This is
often beneficial for the hearing ability of the child.

Children with cleft palate typically have a variety of speech problems. Some speech
problems result directly from anatomical differences such as velopharyngeal inadequacy.
Velopharyngeal inadequacy refers to the inability of the soft palate to close the opening
from the throat to the nasal cavity, which is necessary for many speech sounds, such
as /p/, /b/, /t/, /d/, /s/, /z/, etc.[26] This type of errors typically resolve after palate repair.[27]

However, sometimes children with cleft palate also have speech errors which develop as
the result of an attempt to compensate for the inability to produce the target phoneme.
These are known as compensatory articulations. Compensatory articulations are usually
sounds that are non-existent in normal English phonology, often do not resolve
 automatically after palatal repair, and make a child’s speech even more difficult to
understand.[27][28][29]

Speech-language pathology can be very beneficial to help resolve speech problems

associated with cleft palate. In addition, research has indicated that children who receive
early language intervention are less likely to develop compensatory error patterns later.[30]

[edit]Sample treatment schedule

This section does not cite any references or sources.
Please help improve this article by adding citations to reliable sources. Unsourced material
may be challenged and removed. (February 2009)

Note that each individual patient's schedule is treated on a case-by-case basis and can
vary per hospital. The table below shows a common sample treatment schedule. The
colored squares indicate the average timeframe in which the indicated procedure occurs.
In some cases this is usually one procedure (for example lip repair) in other cases this is
an ongoing therapy (for example speech therapy).

0 3 6 9 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
age m m m m y  y  y  y  y  y  y  y  y  y y y y y y y y y

Palatal obturator                                            
Repair cleft lip                                            
Repair soft palate                                            
Repair hard palate                                            
Tympanostomy tube                                            
Speech
                                           
therapy/Pharyngoplasty
Bone grafting jaw                                            
Orthodontics                                            
Further cosmetic
corrections (Including                                            
jawbone surgery)
[edit]Craniofacial team
Main article:  Craniofacial team

A craniofacial team is routinely used to treat this condition. The majority of hospitals still
use craniofacial teams; yet others are making a shift towards dedicated cleft lip and
palate programs. While craniofacial teams are widely knowledgeable about all aspects of
craniofacial conditions, dedicated cleft lip and palate teams are able to dedicate many of
their efforts to being on the cutting edge of new advances in cleft lip and palate care.
Many of the top pediatric hospitals are developing their own CLP clinics in order to
provide patients with comprehensive multi-disciplinary care from birth through
adolescence. Allowing an entire team to care for a child throughout their cleft lip and
palate treatment (which is ongoing) allows for the best outcomes in every aspect of a
child's care. While the individual approach can yield significant results, current trends
indicate that team based care leads to better outcomes for CLP patients. .[31]

The members of the craniofacial team at a minimum include a plastic or facial plastic
surgeon, or an Oral and maxillofacial surgeon trained in craniofacial surgery,
otolaryngologist, geneticist, orthodontist, and social worker.

A complete listing of craniofacial teams in the United States is available through the Cleft
Palate Foundation

[edit]Complications

This section does not cite any references or sources.

Please help improve this article by adding citations to reliable sources. Unsourced material
may be challenged and removed. (February 2009)

A baby being fed using a customized bottle. The upright sitting position allowsgravity to help the
baby swallow the milk more easily

Cleft may cause problems with feeding, ear disease, speech and socialization.

Due to lack of suction, an infant with a cleft may have trouble feeding. An infant with a
cleft palate will have greater success feeding in a more upright position. Gravity will help
prevent milk from coming through the baby's nose if he/she has cleft palate. Gravity
feeding can be accomplished by using specialized equipment, such as the Haberman
Feeder, or by using a combination of nipples and bottle inserts like the one shown, is
commonly used with other infants. A large hole, crosscut, or slit in the nipple, a protruding
nipple and rhythmically squeezing the bottle insert can result in controllable flow to the
infant without the stigma caused by specialized equipment.
Individuals with cleft also face many middle ear infections which can eventually lead to
total hearing loss. The Eustachian tubes and external ear canals may be angled or
tortuous, leading to food or other contamination of a part of the body that is normally self
cleaning.

Speech is both receptive and expressive. We hear and understand spoken language
(receptive) We learn to manipulate our mouth, tongue, oral cavity, to express ourselves
(expressive).

Hearing is related to learning to speak. Babies with palatal clefts may have compromised
hearing and therefore, if the baby cannot hear, it cannot try to mimic the sounds of
speech. Thus, even before expressive language acquisition, the baby with the cleft palate
is at risk for receptive language acquisition. Because the lips and palate are both used in
pronunciation, individuals with cleft usually need the aid of a speech therapist.

Bonding with the infant, socializing with family and community may be interrupted by the
unexpected appearance, unusual speech and the surgical interventions necessary.
Support for the parents as well as for the child can be pivotal.

[edit]Psychosocial issues
Having a cleft palate/lip does not inevitably lead to a psychosocial problem. Most children
who have their clefts repaired early enough are able to have a happy youth and a healthy
social life. However, it is important to remember that adolescents with cleft palate/lip are
at an elevated risk for developing psychosocial problems especially those relating to self
concept, peer relationships, and appearance. It is important for parents to be aware of
the psychosocial challenges their adolescents may face and to know where to find
professional help if problems arise.

A cleft palate/lip may impact an individual’s self-esteem, social skills, and behavior. There

is a large amount of research dedicated to the psychosocial development of individuals
with cleft palate. Self-concept may be adversely affected by the presence of a cleft lip
and or cleft palate. Research has shown that during the early preschool years (ages 3–
5), children with cleft lip and or cleft palate tend to have a self-concept that is similar to
their peers without a cleft. However, as they grow older and their social interactions with
other children increase, children with clefts tend to report more dissatisfaction with peer
relationships and higher levels of social anxiety. Experts conclude that this is probably
due to the associated stigma of visible deformities and speech abnormalities, if present.
Children who are judged as attractive tend to be perceived as more intelligent, exhibit
more positive social behaviors, and are treated more positively than children with cleft lip
and or cleft palate.[32] Children with clefts tend to report feelings of anger, sadness, fear,
and alienation from their peers. Yet these children were similar to their peers in regard to
"how well they liked themselves."

The relationship between parental attitudes and a child’s self-concept is crucial during the
preschool years. It has been reported that elevated stress levels in mothers correlated
with reduced social skills in their children.[33] Strong parent support networks may help to
prevent the development of negative self-concept in children with cleft palate[citation needed]. In
the later preschool and early elementary years, the development of social skills is no
longer only impacted by parental attitudes but is beginning to be shaped by their peers. A
cleft lip and or cleft palate may affect the behavior of preschoolers. Experts suggest that
parents discuss with their children ways to handle negative social situations related to
their cleft lip and or cleft palate. A child who is entering school should learn the proper
(and age-appropriate) terms related to the cleft. The ability to confidently explain the
condition to others may limit feelings of awkwardness and embarrassment and reduce
negative social experiences.[34]

As children reach adolescence, the period of time between age 13 and 19, the dynamics
of the parent-child relationship change as peer groups are now the focus of attention. An
adolescent with cleft lip and or cleft palate will deal with the typical challenges faced by

most of their peers including issues related to self esteem, dating, and social acceptance.
[35][36][37]
 Adolescents, however, view appearance as the most important characteristic
above intelligence and humor.[38] This being the case, adolescents are susceptible to
additional problems because they cannot hide their facial differences from their peers.
Adolescent boys typically deal with issues relating to withdrawal, attention, thought,
and internalizing problems and may possibly develop anxiousness-depression and
aggressive behaviors.[37] Adolescent girls are more likely to develop problems relating to
self concept and appearance. Individuals with cleft lip and or cleft palate often deal with
threats to their quality of life for multiple reasons including: unsuccessful social
relationships, deviance in social appearance, and multiple surgeries.

[edit]Controversy
In some countries, cleft lip or palate deformities are considered reasons (either generally
tolerated or officially sanctioned) 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 eugenics. British clergywoman Joanna
Jepson, 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 the United
Kingdom[39][40] (although in the United Kingdom, such an abortion would not be permitted
under the 1967 Abortion Act, because a cleft lip and palate is not considered a serious
handicap).

The Japanese anime Ghost Stories caused controversy through an episode featuring

a Kuchisake-onna (a ghost with a Glasgow smile) because her scar resembled a cleft lip.
[41]

[edit]Famous people born with a cleft

Name Comments

[42]
John Henry "Doc" American dentist, gambler and gunfighter of the American Old West,
Holliday who is usually remembered for his friendship withWyatt Earp and
the Gunfight at the O.K. Corral

[43]
Tutankhamen Egyptian pharaoh who may have had a slightly cleft palate according
to diagnostic imaging

[44]
Thorgils Skarthi Thorgils 'the hare-lipped' - a 10th century Viking warrior and founder
of Scarborough, England.

[45]
Tad Lincoln Fourth and youngest son of President Abraham Lincoln

[46][47]
Carmit Bachar American dancer and singer

[48]
Jürgen Habermas German philosopher and sociologist

[49]
Ljubo Milicevic Australian professional footballer
 [50]
Stacy Keach American actor and narrator

[51]
Cheech Marin American actor and comedian

[52]
Chin-Chin American magician and stage illusionist

[53]
Owen Schmitt American football fullback

Trent Franks US Congressman Arizona 2nd Congressional District

[edit]Cleft lip and palate in animals

Cleft lips and palates are occasionally seen in cattle and dogs, and rarely
in sheep, cats, horses, pandas and ferrets. Most commonly, the defect involves the
lip,rhinarium, and premaxilla. Clefts of the hard and soft palate are sometimes seen with
a cleft lip. The cause is usually hereditary. Brachycephalic dogs such
as Boxers andBoston Terriers are most commonly affected.[54] An inherited disorder with
incomplete penetrance has also been suggested in Shih tzus, Swiss
Sheepdogs, Bulldogs, and Pointers.[55] In horses, it is a rare condition usually involving
the caudal soft palate.[56] In Charolais cattle, clefts are seen in combination
with arthrogryposis, which is inherited as an autosomal recessive trait. It is also inherited
as an autosomal recessive trait in Texel sheep. Other contributing factors may include
maternal nutritional deficiencies, exposure in utero to viral infections, trauma, drugs, or
chemicals, or ingestion of toxins by the mother, such as certain lupines by cattle during
the second or third month of gestation.[57] The use of corticosteroids during pregnancy in
dogs and the ingestion of Veratrum californicum by pregnant sheep have also been
associated with cleft formation.[58]

Difficulty with nursing is the most common problem associated with clefts, but aspiration
pneumonia, regurgitation, and malnutrition are often seen with cleft palate and is a
common cause of death. Providing nutrition through a feeding tube is often necessary,
but corrective surgery in dogs can be done by the age of twelve weeks.[54] For cleft palate,
there is a high rate of surgical failure resulting in repeated surgeries.[59] Surgical
techniques for cleft palate in dogs include prosthesis, mucosal flaps, and
 microvascular free flaps.[60] Affected animals should not be bred due to the hereditary
nature of this condition.

Cleft lip in a Boxer Cleft lip in a Boxer with premaxillary Same dog as picture on left, one year

involvement later

[edit]See also