Cleft Types

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Do you know among all the craniofacial or orofacial cleft deformities, what is the most common found in newborns? Cleft deformities, either it is of the lip, palate, or both.
Being one of the frequently caused congenital abnormalities, it usually occurs in roughly every 1 in 700 births. That is one of the reasons you must know what are these deformities, how they affect the child’s facial appearance, and what are their most common types.

Cleft Lip and Cleft Palate

Overall, these congenital malformations directly affect the facial and mouth tissues. Usually, it happens in the early phases of the pregnancy, when the baby is still in the womb. Another similarity is that both are physical separations that are evident to the eyes. Where cleft lip is defined as a separation of the upper lips leaving an opening that might include the gum line or the palate, a cleft palate is focused on a split or opening observed in the tissues of the mouth’s roof that usually includes either the hard palate or the soft palate or both.

Types of Cleft palate and Cleft lip

Have you ever heard about unilateral or bilateral deformities? If Yes, then there are chances of understanding the types of cleft lip and palate more efficiently.
As far as the categories are concerned, they are typically divided based on two criteria. Depending on the degree of cleft, the two types are:

  • Incomplete cleft lip and Incomplete cleft palate
  • Complete cleft lip and Complete cleft palate

Depending on the side affected, the two categories are:

  • Unilateral cleft lip and Unilateral cleft palate
  • Bilateral cleft lip and Bilateral cleft palate

On one hand, the Cleft lip can be accompanied by a cleft palate. On the other hand, a cleft palate can be accompanied by a cleft lip. The reason? Because the lip and the palate are developed discreetly, there is a possibility of having a cleft palate without a cleft lip, a cleft lip without a cleft palate, or both a cleft lip and cleft palate together.
Now, it is time to get in some of the details regarding different categories to help you predict the future complications, possible physical manifestations, and appropriate surgeries.

A complete cleft

  • A complete cleft palate is a condition if your child has a deformity that involves both primary and secondary palates extending from the uvula to the alveolar ridge.
  • A complete cleft lip is a deformity with an opening extended from the lip all along with the nostril.

An incomplete cleft

  • An incomplete cleft palate is known to deform only the secondary palate and uvula leaving the primary palate intact. Plus, the alveolar ridge also stays undamaged. The chances are 50-50 of the opening reaching the incisive foramen.
  • An incomplete cleft lip is opposite to the complete deformity as the name reflects. Visually, the opening extended from the lip will end before it reaches the nostril. It results in leaving room for a properly attached tissue right below the nostril.

Here are the two most common incomplete cleft anomalies

Submucosal cleft

You must be thinking why SUB? The answer is simple! It is a type of cleft that not includes the whole mucosa but the tissues that are present under the mucosa. It cannot be visualized with a human eye that is why the characteristic physical sign is its bifid uvula that creates problems in making sounds, speech, and speaking.

Soft palate cleft

You can better guess its anatomy by the name!

A condition where the only soft palate is involved starting from the tip of the uvula and ending right before the soft and hard palate junction point. Unfortunately, they are hard to visualize. It is similar to a submucosal cleft in terms of visual appearance and severity of speech problems. The characteristic complication found in the “longer soft cleft palate” is the sucking or suckling inability of a child. On the contrary, having a partial or shorter soft palate cleft doesn’t manifest any severe clinical or medical symptoms at birth. The only problem will be the nasal reflux of food especially after eating liquids.

Unilateral incomplete and complete cleft

As per the surveys, the most common type is the Unilateral anomalies that affect a single side of the lip, either accompanied by a cleft palate or not.

Incomplete unilateral cleft lip and palate – One-sided cleft leaving an evident gap on the lip with a cleft palate. You will find the scar or gap ending before the nasal point.

Complete unilateral cleft lip and palate – One-sided cleft featuring a lip gap extending into the nose and even palate.

Forme fruste unilateral cleft lip – Visually gives the impression as a delicate and elusive opening, it appears on a single side of the upper lip. It usually looks like a minor indentation.

Incomplete unilateral cleft lip – One-sided cleft having an upper lip gap without a cleft palate and without distorting the nasal point. The manifestation can be in the shape of a minor gap in the vermillion or a little extended groove deep into the skin. The child will have the widened nostrils but intact.

Complete unilateral cleft lip – One-sided cleft with an upper lip scar extending into the nose and even palate. The nose will have certain anatomic distortions, for instance, the nostril will not only be widened but the floor of the nostril might be missing. The abilities of speaking and feeding are severely disturbed.

Bilateral incomplete and complete cleft

Bilateral defects are known to affect both sides of the palate and/or lip. So, we can say it causes two clefts.
Incomplete bilateral cleft lip and palate – Notches on both sides leaving a gap on the upper lip accompanied by a cleft palate. The gap will end before the nasal point without getting extended inside the nasal area.
Complete bilateral cleft lip and palate – A gap on both sides of the lip extending from the upper lip to the nose featuring cleft palate.
Incomplete bilateral cleft lip – Two-sided cleft having an upper lip gap without a cleft palate and without distorting the nasal point. In a few cases, the involvement of the orbicularis muscles is seen otherwise they stay intact.
Complete bilateral cleft lip – Two-sided cleft with an upper lip scar extending into the nose and even palate. The nose will appear flattened due to nasal disruption. The visual manifestation includes missing philtral columns, philtral dimple, and central orbicularis muscle affecting the speech skills as well as eating and drinking ability.
The following two do not belong to any certain category and are found to be rare anomalies but are important to know. So, do not forget to read our full blog.

Cleft nose

  1. Distinguished visual changes of the nose
  2. Usually manifested due to cleft lip and/or palate
  3. Distorted, uneven nostrils
  4. Deviation or the malposition of the nasal septum
  5. Causes unbearable but curable breathing problems.
  6. The greater the gap width, severe the nasal issues will be.
  7. It can be unilateral or bilateral

Tessier cleft palate or facial no. 7 cleft

  1. A lateral facial cleft involving lips, upper jaw, mouth, cheeks, eyes, ears, and forehead
  2. A characteristic feature of macrostomia
  3. Facial and skull bony abnormalities (maxilla, mandible, temporal, and zygoma)
  4. Auricular malformations
  5. Incomplete cleft