<unk> <unk>  If the<unk>  does not affect the<unk>  structure of the mouth, it is referred to as<unk> <unk> .<unk> <unk>  is formed in the top of the<unk>  as either a small gap or an indentation in the<unk>  (partial or incomplete<unk> , or it continues into the nose (complete<unk> .<unk> <unk>  can occur as a one-sided (unilateral) or two-sided (bilateral) condition. It is due to the failure of fusion of the maxillary prominence and medial nasal processes (formation of the primary<unk> . File:CleftLip1.Unilateral incomplete File:Cleftlip2.Unilateral complete File:CleftLip3.Bilateral complete A mild form of a<unk> <unk>  is a microform<unk> . A microform<unk>  can appear as small as a little dent in the red part of the<unk>  or look like a scar from the<unk>  up to the nostril. In some cases muscle tissue in the<unk>  underneath the scar is affected and might require reconstructive surgery. It is advised to have newborn infants with a microform<unk>  checked with a craniofacial team as soon as possible to determine the severity of the<unk> . File:13900470_3PREOPERATION0.Six-month-old girl before going into surgery to have her unilateral complete<unk> <unk>  repaired File:10-month-old_girl_showing_scar_from_facial_reconstruction_surgery_for_cleft_lip.The same girl, 1 month after the surgery File:8-year-old_girl_showing_scar_from_infantile_facial_reconstruction_surgery.The same girl, age 8, the scar almost gone<unk><unk> <unk><unk>  is a condition in which the two<unk> s of the skull that form the hard<unk>  (roof of the mouth) are not completely joined. The soft<unk>  is in these cases<unk>  as well. In most cases,<unk> <unk>  is also present.<unk> <unk>  can occur as complete (soft and hard<unk> , possibly including a gap in the jaw) or incomplete (a 'hole' in the roof of the mouth, usually as a<unk>  soft<unk> . When<unk><unk>  occurs, the uvula is usually split. It occurs due to the failure of fusion of the lateral<unk> ne processes, the nasal septum, or the median<unk> ne processes (formation of the secondary<unk> . The hole in the roof of the mouth caused by a<unk>  connects the mouth directly to the inside of the nose. Note: the next images show the roof of the mouth. The top shows the nose, the<unk> s are colored pink. For clarity the images depict a toothless infant. File:Cleftpalate3.Incomplete<unk><unk>  File:Cleftpalate1.Unilateral complete<unk>  and<unk>  File:Cleftpalate2.Bilateral complete<unk>  and<unk>  A result of an open connection between the mouth and inside the nose is called velopharyngeal insufficiency (VPI). Because of the gap, air leaks into the nasal cavity resulting in a hypernasal voice resonance and nasal emissions while talking. Secondary effects of VPI include speech articulation errors (e.g., distortions, substitutions, and omissions) and compensatory misarticulations and mispronunciations (e.g., glottal stops and posterior nasal fricatives). Possible treatment options include speech therapy, prosthetics, augmentation of the posterior pharyngeal wall, lengthening of the<unk> , and surgical procedures. Submucous<unk><unk>  can also occur, which is a<unk>  of the soft<unk>  with a split uvula, a furrow along the midline of the soft<unk> , and a notch in the back margin of the hard<unk> . The diagnosis of submucous<unk><unk>  often occurs late in children as a result of the nature of the<unk> . While the muscles of the soft<unk>  are not joined, the mucosal membranes covering the roof of the mouth appear relatively normal and intact. Teeth Tooth development can be delayed with increasing severity of CLP. Some of the dental problems affect the primary teeth, but most of the problems arise after the permanent teeth erupts. Problems may include fused teeth, missing teeth, and extra teeth erupting behind normal teeth. Missing teeth or extra teeth are both normal occurrences. Typically, the lateral incisors are missing. The enamel (outermost layer of the tooth) is commonly found to be hypomineralized and hypoplastic, making the teeth more likely to decay. As CLP can make oral hygiene more difficult, there is an increased rate of cavities. In addition, abnormal positioning of individual teeth may affect occlusion, which can create an open bite or cross bite. This in turn can then affect the patient's speech. Complications gravity to help the baby swallow the milk more easily.<unk>  may cause problems with feeding, ear disease, speech, socialization, and cognition. Due to lack of suction, an infant with a<unk>  may have trouble feeding. An infant with a<unk><unk>  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<unk><unk> . Gravity feeding can be accomplished by using specialized equipment, such as the Haberman Feeder. Another equipment commonly used for gravity feeding is a customized bottle with a combination of nipples and bottle inserts. 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<unk>  also face many middle ear infections which may eventually lead to 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. Hearing is related to learning to speak. Babies with<unk> l<unk> s 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<unk><unk>  is at risk for receptive language acquisition. Because the<unk> s and<unk>  are both used in pronunciation, individuals with<unk>  usually need the aid of a speech therapist. Tentative evidence has found that those with<unk> s perform less well at language. Psychosocial issues There is research dedicated to the psychosocial development of individuals with<unk><unk> . A<unk><unk> /lip may impact an individual's self-esteem, social skills and behavior. Self-concept may be adversely affected by the presence of a<unk> <unk>  or<unk><unk> , particularly among girls. Negative outcomes can also be associated with the long durations of hospitalization. Psychological issues could extend not just to the individual with CLP but also to their families, particularly their mothers, that experience varying levels of depression and anxiety. Research has shown that during the early preschool years (ages 3–5), children with<unk> <unk>  or<unk><unk>  tend to have a self-concept that is similar to their peers without a<unk> . However, as they grow older and their social interactions increase, children with<unk> s 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 possible speech impediments. 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<unk> <unk>  or<unk><unk> . Children with<unk> s tend to report feelings of anger, sadness, fear, and alienation from their peers, but 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. Strong parent support networks may help to prevent the development of negative self-concept in children with<unk><unk> . 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<unk> <unk>  or<unk><unk>  may affect the behavior of preschoolers. Experts suggest that parents discuss with their children ways to handle negative social situations related to their<unk> <unk>  or<unk><unk> . A child who is entering school should learn the proper (and age-appropriate) terms related to the<unk> . The ability to confidently explain the condition to others may limit feelings of awkwardness and embarrassment and reduce negative social experiences. 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<unk> <unk>  or<unk><unk>  will deal with the typical challenges faced by most of their peers including issues related to self-esteem, dating and social acceptance. Adolescents, however, view appearance as the most important characteristic, above intelligence and humor. 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. Adolescent girls are more likely to develop problems relating to self-concept and appearance. Individuals with<unk> <unk>  or<unk><unk>  often deal with threats to their quality of life for multiple reasons including unsuccessful social relationships, deviance in social appearance, and multiple surgeries.
Cleft lip and cleft palate
Malpuech facial clefting syndrome
Hemifacial microsomia
Anodontia
Acephaly
Hand and foot deformity with flat facies
Nager acrofacial dysostosis
Microcephaly