Editing Cleft lip and cleft palate (section)

==Diagnosis==
Traditionally, the diagnosis is made at the time of birth by physical examination. Recent advances in [[prenatal diagnosis]] have allowed [[obstetrician]]s to diagnose facial clefts [[Uterus|in utero]] with [[Obstetric ultrasonography|ultrasonography]].<ref>{{cite journal | vauthors = Costello BJ, Edwards SP, Clemens M | title = Fetal diagnosis and treatment of craniomaxillofacial anomalies | journal = Journal of Oral and Maxillofacial Surgery | volume = 66 | issue = 10 | pages = 1985–1995 | date = October 2008 | pmid = 18848093 | doi = 10.1016/j.joms.2008.01.042 }}</ref>

Clefts can also affect other parts of the face, such as the eyes, ears, nose, cheeks, and forehead. In 1976, [[Paul Tessier]] described fifteen lines of cleft.  Most of these [[craniofacial cleft]]s are even rarer and are frequently described as Tessier clefts using the numerical locator devised by Tessier.<ref>{{cite journal | vauthors = Tessier P | title = Anatomical classification facial, cranio-facial and latero-facial clefts | journal = Journal of Maxillofacial Surgery | volume = 4 | issue = 2 | pages = 69–92 | date = June 1976 | pmid = 820824 | doi = 10.1016/S0301-0503(76)80013-6 }}</ref>

===Classification===
{{main|Classification of cleft lip and cleft palate}}

Cleft lip and cleft palate is an "umbrella term" for a collection of orofacial clefts. It includes clefting of the upper lip, the [[Dental arch|maxillary alveolus]] (dental arch), and the [[Hard palate|hard]] or [[soft palate]], in various combinations. Proposed anatomic combinations include:<ref name=Allori2017>{{cite journal | vauthors = Allori AC, Mulliken JB, Meara JG, Shusterman S, Marcus JR | title = Classification of Cleft Lip/Palate: Then and Now | journal = The Cleft Palate-Craniofacial Journal | volume = 54 | issue = 2 | pages = 175–188 | date = March 2017 | pmid = 26339868 | doi = 10.1597/14-080 | s2cid = 207236616 }}</ref>
* cleft lip
* cleft lip and alveolus
* cleft lip, alveolus, and palate
* cleft lip and palate (with an intact alveolus)
* cleft palate

=== Prenatal diagnosis ===
Cleft lip with or without palate is classified as the most common congenital birth defect. It has been noted that the prevalence of orofacial clefts varies by race. The highest number of cases have been recorded among Asians and Native Americans, followed by Europeans, Hispanics and African-Americans. The critical period for cleft development ranges from the 4th to the 12th week of intrauterine life. Clefts of the primary palate develop between the 4th and 7th weeks of intrauterine life, while clefts of the secondary palate develop between the 8th and 12th embryonic weeks.

Accurate evaluation of craniofacial malformations is usually possible with the ultrasound scan performed during pregnancy. This is however not a routine procedure according to the American Institute of Ultrasound in Medicine. The accuracy of ultrasonography for prenatal diagnosis of cleft lip +/- palate is dependent on the experience of the sonologist, maternal body type, foetal position, the amount of amniotic fluid and the type of cleft.

Prenatal diagnosis enables appropriate and timely education and discussion with parents by the cleft team. This helps improve the quality of treatment received by the child and improves quality of life.

An accurate prenatal diagnosis of the CLP anomaly is critical for establishing long-term treatment planning, prediction of treatment outcome, and discussion and education of the parent. Although there is no intrauterine treatment for CLP, both mother and child benefit from early diagnosis and education. A multidisciplinary team approach is now accepted as the standard of care in dealing with CLP patients.

The time period immediately after the diagnosis and the first year after the birth is most challenging for parents. A systematically planned treatment plan and support system will help assist parents. The ultimate aim is to help educate parents and create awareness so as to improve care provided for the child.<ref>{{cite journal | vauthors = Sreejith VP, Arun V, Devarajan AP, Gopinath A, Sunil M | title = Psychological Effect of Prenatal Diagnosis of Cleft Lip and Palate: A Systematic Review | journal = Contemporary Clinical Dentistry | volume = 9 | issue = 2 | pages = 304–308 | date = 2018 | pmid = 29875578 | pmc = 5968700 | doi = 10.4103/ccd.ccd_673_17 | doi-access = free }}</ref>