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 Table of Contents  
Year : 2022  |  Volume : 7  |  Issue : 1  |  Page : 110-114

Association of cleft lip and palate with predisposing factors

1 Department of Oral Medicine and Radiology, Krishna Institute of Medical Sciences Deemed University, Karad, Satara, Maharashtra, India
2 Department of Periodontology School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Satara, Maharashtra, India

Date of Submission22-Nov-2021
Date of Decision05-Jan-2022
Date of Acceptance05-Jan-2022
Date of Web Publication27-Jun-2022

Correspondence Address:
Dr. S R Ashwinirani
Department Oral Medicine and Radiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Satara, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/bjhs.bjhs_122_21

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BACKGROUND: The cleft lip (CL) and palate are common orofacial congenital abnormalities observed in Indian population. Various predisposing factors contribute to this condition.
PURPOSE: The purpose is to assess the most common type of CL and palate and to study predisposing factors associated with its development.
MATERIAL AND METHODS: This cross-sectional prospective study was carried in 80 patients with CL and palate. A detailed history was recorded in predesigned pro forma. The occurrence of different types of CL and palate with predisposing factors were assessed.
RESULTS: Out of 80 patients, 18.8% of patients had only CL, 46.2% had unilateral CL with palate (UCLP), and 35% had a bilateral CL with palate (BCLP). CL and palate were observed more in males. The left side of the lip was more affected than the right side. Low socioeconomic status patients had more incidences. Advanced maternal age, more than 35 years, was the most common predisposing factor 62.5%. Consanguineous marriage of parents was the second-most predisposing factor observed in 40% of cases. Breastfeeding habit was observed in 73.3% of CL patients, 25% in UCLP patients, and 17.2% in BCLP patients.
CONCLUSIONS: Males were more commonly affected by CL and palate with the left side predominance. Advanced maternal age above 35 years was the most predisposing factor followed by consanguineous marriage of the parents.

Keywords: Cleft lip, cleft palate, epidemiologic factors

How to cite this article:
Ashwinirani S R, Suragimath G. Association of cleft lip and palate with predisposing factors. BLDE Univ J Health Sci 2022;7:110-4

How to cite this URL:
Ashwinirani S R, Suragimath G. Association of cleft lip and palate with predisposing factors. BLDE Univ J Health Sci [serial online] 2022 [cited 2022 Aug 16];7:110-4. Available from: https://www.bldeujournalhs.in/text.asp?2022/7/1/110/348261

  Introduction Top

The cleft lip (CL) and palate (CLP) are the most common orofacial congenital abnormalities observed, accounting for overall incidence of approximately 1 in 700 live births.[1],[2] CL may be observed Unilaterally UCL or bilaterally on both sides of the lips (BCL). CL may also involve the alveolus or palate of the maxillary bone called unilateral CL with palate (UCLP) or bilateral CL with palate (BCLP). Majority of these individuals may present with other congenital anomalies. The CLP has been observed to be more common among males than females, but few studies on cleft palate cases have showed significantly higher incidence among females compared to males.[3],[4] The UCL on the left side is a common finding in all ethnic groups, and the left side is affected twice more than the right side.[4],[5]

Various factors such as advanced maternal age, maternal smoking, alcohol consumption, physical factors such as trauma, heavy work during pregnancy, exposure to ionizing radiation like working in fields of radiation increase the risk of CLP in infants.[6],[7],[8],[9],[10] Diabetes mellitus Type I has also been attributed to be a risk factor for oral clefts.[11] Certain drugs such as valproic acid, anticonvulsants, retinoic acid derivates, thalidomide, and phenytoin are known to have a teratogenic effect on facial development from exogenic factors.[12],[13]

The patients with CLP usually present with dental anomalies such as malformed maxillary lateral incisor, supernumerary tooth, delayed tooth eruption, enamel hypoplasia and transposition of maxillary lateral and canines or maxillary canines and premolars.[14],[15]

With this background, the present study was designed to assess the rate of occurrence between different orofacial cleft types on the basis of gender and to determine the predisposing factors such as advanced age of parents, smoking during pregnancy, exposure to ionizing radiations, and also to assess the socioeconomic status of parents of patients with CLP.

  Methodology Top

This prospective study included 80 patients with different types of CLP. The institutional ethical clearance was obtained from Krishna Institute of Medical Sciences (Deemed to be University), Karad, and Maharashtra, India (REF. No KIMSDU/IEC/06/2018 Protocol number 0131/2018-2019).

The detailed family history of patient with clefts such as parents' age, socioeconomic status, maternal predisposing factors such as smoking, alcohol consumption, exposure to ionizing radiations, feeding habits of CLP patients was recorded in a predesigned clinical pro forma. The frequency and percentage of different types of cleft lip and palate were recorded in Microsoft Excel sheet and tabulated.

  Results Top

Out of 80 patients examined, only 15 patients had CL accounting for 18.8% of cases, and 65 patients had CL with palate (CLP) accounting for 81.2%. Out of 65 patients with CLP, 36 patients had UCLP accounting for 46.2%, and 29 patients had BCLP accounting for 35%. Males were more commonly affected (55%) with CLP than females (45%). In CL, patient's left side was more affected than the right side with male predominance. In UCLP, males were more affected than females. In the bilateral CLP patients, females were more affected than males [Figure 1], [Figure 2], [Figure 3] and [Table 1].
Figure 1: Photograph showing unilateral cleft lip with palate on the left side

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Figure 2: Extraoral photograph showing treated bilateral cleft lips

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Figure 3: Intraoral photograph showing bilateral cleft palate

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Table 1: Distribution of different types of orofacial clefts

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In our study, comparing the age of parents with the occurrence of CLP patients showed 62.5% of mothers and 56% of fathers were older than 35 years [Table 2].
Table 2: Age-wise distribution of parents of cleft lip and palate patients

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The analysis of the socioeconomic status in our study revealed that 71.3% of the families (n = 57) were from low-socioeconomic strata and 28.7% (n = 23) were from medium-socioeconomic strata [Table 3].
Table 3: Socioeconomic level of parents

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Feeding habits of children with CL in our study showed that 73.3% were breastfed, 25% were UCLP, and 17.2% BCLP were breastfed [Table 4].
Table 4: Feeding habits depending on cleft type

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The association of predisposing factors with CL and CLP in our study showed major association with maternal age above 35 years accounting for 62.5% followed by history of consanguineous marriage (40%), physical factors such as trauma, medical abortion before pregnancy, exposure to ionizing radiations, and only 2% of patients were having habits of smoking, alcohol, and gestational diabetes [Table 5].
Table 5: Maternal predisposing factors related to orofacial cleft patients

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  Discussion Top

The abnormalities of structure, function, or metabolism that are present at birth are named congenital anomalies. CLP is one such type of congenital malformation leading to the defect in lip, alveolus, hard palate, and soft palate causing facial deformity leading to difficulty in eating, drinking, and speaking.

CLP is a worldwide congenital disorder, with the difference in incidence between different populations. In Asian studies, the incidence of oral cleft has been reported to be one in every 1000 live births. The different countries of Asia have reported different incidence, for example, 1.91 in Pakistan,[16] 1.39 in Jordan,[17] 1.76 in North China,[18] 1.81 in Korea,[19] 1.34 in Japan,[20] and 1.5 in Oman.[21] The differences in the incidence may be due to racial/ethnic factors in different parts of the world.[22]

Although CL and CLP patients do not have mortality rates but speaking, hearing, and feeding are the few problems encountered by CL and CLP patients.

In our study, out of 80 patients, the ratio of CL and CLP was 1:4 accounting for 18.7% of only CL patients and 81.2% of CLP. Fogh-Andersen in the Caucasian population reported a CL: CLP: cerebroplacental ratio of 1:2:1.[23]

In our study, males were more commonly affected (55%) with CLP than females (45%). The studies performed in Pakistan, Croatia and Argentina, also showed male predominance, respectively.[16],[24],[25] The results of our study were also in accordance with Lei et al.'s study.[26]

In the present study, CL on the left side was more affected than the right side with male predominance. The previous studies conducted in different populations have also shown similar results.[10],[26] According to Johnston and Brown who suggested that the blood vessels supplying the right side of the fetal head leave the aortic arch closer to the heart and may be perfused better by blood than those on the left side might be the cause for left-side predominance of CLP.[25]

In the present study, UCLP was observed more in males compared to females. The bilateral CLP was observed more in females compared to males. Studies conducted by Kim et al. in North Korea showed the prevalence of CL and cleft palate to be more in males than females, and the incidence of cleft palate was higher in women when compared with men.[27]

The literature shows that the occurrence of CL is more predominant in males in comparison with females with 2:1 ratio, and cleft palate is seen more in females with male-to-female ratio of 1:2. The physiologic reason might be due to the fact that palatine shelves close 1 week later in females than the males.[28]

The study conducted by Rajabian and Sherkat in Iran showed the incidence of different types of clefts was higher in males than females, as observed in the present study.[29]

Breastfeeding habits in our study showed that 73.3% of the babies had been breastfed in CL group. Whereas only 25% of patients with UCLP and 17.2% of patients with BCLP were fed with breastfeeding habits. The study conducted by Silva et al. also showed 64% of CL patients were breastfed and 22% of cleft palate and 2% of patients with unilateral and BCLP.

In the present study, the maternal predisposing factors associated with oral cleft showed major association with mothers aged above 35 years during gestation accounting for 62.5%. The association of cleft with advanced maternal age was also previously reported in other studies,[30],[31] and contradictory results about advanced maternal age were mentioned in few studies.[27],[28]

The second-most predisposing factor was a history of consanguineous marriage which accounted for 40% of cases in the parents. The results of our study were similar to the study conducted by Rajabian and Sherkat who reported about 45.8% of the cases with history of consanguineous marriage.[29] In the study conducted by Khazaei et al. in Iran reported that 51.4% of CLP patients' parents were consanguineously married.[31] The results of our study were also consistent with Cheshmi et al. study.[32] Consanguineous marriage as a risk for the development of CLP was not significant as per the studies conducted by Corona-Rivera et al.[33] and Mbuyi-Musanzayi et al.[34]

In our study, comparing the maternal predisposing factors with cleft patients, the third-most predisposing factors were physical trauma during pregnancy, medical abortion before pregnancy accounted for 18.7%. The results were also consistent with the results of several studies done previously.[32],[35] However, studies conducted by Mbuyi-Musanzayi et al.[34] and Acuña-González et al.[36] showed that the maternal history of miscarriage increased the risk of giving birth to a child with CLP in the subsequent pregnancies with no statistically significant results.

The maternal exposure to ionizing radiations and drugs was less in our patients which accounted for only 13.7%. The previous studies using medications such as anti-stress medications, miscarriage prevention drugs, antibiotics, and analgesics such as nonsteroidal anti-inflammatory drugs also showed increased incidence of CLP.[35],[37]

The least common maternal predisposing factor in our study was smoking, alcohol consumption, and gestational diabetes which accounted for only 2.5%. The studies conducted by Cheshmi et al. showed that pregnancy complications such as gestational diabetes, pregnancy hypertension, maternal cold or flu, preeclampsia, anemia, and intrauterine hypoxia can potentially increase the risk of oral CLP in children.[32]

  Conclusions Top

CL and cleft palate are congenital abnormalities occurring worldwide with varying incidence. Based on the results of our study, they are more common in males than females. The most common maternal predisposing factor was advanced maternal age above 35 years followed by history of consanguineous marriage and the least association was found with gestational diabetes, smoking, and alcohol consumption.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Farronato G, Cannalire P, Martinelli G, Tubertini I, Giannini L, Galbiati G, et al. Cleft lip and/or palate: Review. Minerva Stomatol 2014;63:111-26.  Back to cited text no. 1
Pigott RW. Organisation of cleft lip and palate services – Results of a questionnaire. Br J Plast Surg 1992;45:385-7.  Back to cited text no. 2
Wyszynski DF, Beaty TH, Maestri N. Genetics of non-syndromic cleft lip with or without cleft palate revisted. Cleft Palate Craniofac J 1996;33:406-17.  Back to cited text no. 3
Tolarová M. Orofacial clefts in Czechoslovakia. Incidence, genetics and prevention of cleft lip and palate over a 19-year period. Scand J Plast Reconstr Surg Hand Surg 1987;21:19-25.  Back to cited text no. 4
Kilpeläinen PV, Laine-Alava MT. Palatal asymmetry in cleft palate subjects. Cleft Palate Craniofac J 1996;33:483-8.  Back to cited text no. 5
Womersley J, Stone DH. Epidemiology of facial clefts. Arch Dis Child 1987;62:717-20.  Back to cited text no. 6
Shaw GM, Croen LA, Curry CJ. Isolated oral cleft malformations: Associations with maternal and infant characteristics in a California population. Teratology 1991;43:225-8.  Back to cited text no. 7
Wyszynski DF, Duffy DL, Beaty TH. Maternal cigarette smoking and oral clefts: A meta-analysis. Cleft Palate Craniofac J 1997;34:206-10.  Back to cited text no. 8
Chung KC, Kowalski CP, Kim HM, Buchman SR. Maternal cigarette smoking during pregnancy and the risk of having a child with cleft lip/palate. Plast Reconstr Surg 2000;105:485-91.  Back to cited text no. 9
Grewal J, Carmichael SL, Ma C, Lammer EJ, Shaw GM. Maternal periconceptional smoking and alcohol consumption and risk for select congenital anomalies. Birth Defects Res A Clin Mol Teratol 2008;82:519-26.  Back to cited text no. 10
Carinci F, Rullo R, Farina A, Morano D, Festa VM, Mazzarella N, et al. Non-syndromic orofacial clefts in Southern Italy: Pattern analysis according to gender, history of maternal smoking, folic acid intake and familial diabetes. J Craniomaxillofac Surg 2005;33:91-4.  Back to cited text no. 11
Young DL, Schneider RA, Hu D, Helms JA. Genetic and teratogenic approaches to craniofacial development. Crit Rev Oral Biol Med 2000;11:304-17.  Back to cited text no. 12
Fraser FC. The genetics of cleft lip and cleft palate. Am J Hum Genet 1970;22:336-52.  Back to cited text no. 13
Lourenço Ribeiro L, Teixeira Das Neves L, Costa B, Ribeiro Gomide M. Dental anomalies of the permanent lateral incisors and prevalence of hypodontia outside the cleft area in complete unilateral cleft lip and palate. Cleft Palate Craniofac J 2003;40:172-5.  Back to cited text no. 14
Lucas VS, Gupta R, Ololade O, Gelbier M, Roberts GJ. Dental health indices and caries associated microflora in children with unilateral cleft lip and palate. Cleft Palate Craniofac J 2000;37:447-52.  Back to cited text no. 15
Elahi MM, Jackson IT, Elahi O, Khan AH, Mubarak F, Tariq GB, et al. Epidemiology of cleft lip and cleft palate in Pakistan. Plast Reconstr Surg 2004;113:1548-55.  Back to cited text no. 16
Al Omari F, Al-Omari IK. Cleft lip and palate in Jordan: Birth prevalence rate. Cleft Palate Craniofac J 2004;41:609-12.  Back to cited text no. 17
Wang W, Guan P, Xu W, Zhou B. Risk factors for oral clefts: A population-based case-control study in Shenyang, China. Paediatr Perinat Epidemiol 2009;23:310-20.  Back to cited text no. 18
Kianifar H, Hasanzadeh N, Jahanbin A, Ezzati A, Kianifar H. Cleft lip and palate: A 30-year epidemiologic study in North-East of Iran. Iran J Otorhinolaryngol 2015;27:35-41.  Back to cited text no. 19
Cooper ME, Ratay JS, Marazita ML. Asian oral-facial cleft birth prevalence. Cleft Palate Craniofac J 2006;43:580-9.  Back to cited text no. 20
Rajab A, Thomas C. Oral clefts in the Sultanate of Oman. Eur J Plast Surg 2001;24:230-3.  Back to cited text no. 21
Mirfazeli A, Kaviany N, Hosseinpour KR, Golalipour MJ. Incidence of cleft lip and palate in Gorgan – Northern Iran: An epidemiological study. Oman Med J 2012;27:461-4.  Back to cited text no. 22
Fogh-Andersen P. Inheritance of Harelip and Cleft Palate. Copenhagen: A. Busck; 1942.  Back to cited text no. 23
Magdalenić-Mestrović M, Bagatin M. An epidemiological study of orofacial clefts in Croatia 1988-1998. J Craniomaxillofac Surg 2005;33:85-90.  Back to cited text no. 24
Rittler M, López-Camelo J, Castilla EE. Sex ratio and associated risk factors for 50 congenital anomaly types: Clues for causal heterogeneity. Birth Defects Res A Clin Mol Teratol 2004;70:13-9.  Back to cited text no. 25
Lei RL, Chen HS, Huang BY, Chen YC, Chen PK, Lee HY, et al. Population-based study of birth prevalence and factors associated with cleft lip and/or palate in Taiwan 2002-2009. PLoS One 2013;8:e58690.  Back to cited text no. 26
Kim S, Kim WJ, Oh C, Kim JC. Cleft lip and palate incidence among the live births in the Republic of Korea. J Korean Med Sci 2002;17:49-52.  Back to cited text no. 27
Peterson LJ, Ellis E, Hupp JR, Tucker MR. Contemporary Oral and Maxillofacial Surgery. 5th ed. St. Louis: Mosby; 2008.  Back to cited text no. 28
Rajabian MH, Sherkat M. An epidemiologic study of oral clefts in Iran: Analysis of 1,669 cases. Cleft Palate Craniofac J 2000;37:191-6.  Back to cited text no. 29
Shi M, Christensen K, Weinberg CR, Romitti P, Bathum L, Lozada A, et al. Orofacial cleft risk is increased with maternal smoking and specific detoxification gene variants. Am J Hum Genet 2007;80:76-90.  Back to cited text no. 30
Khazaei M, Ghanbari S, Rezaei M, Alipour A, Khazaei S. Evaluation of cleft lip and palate frequency and related risk factors in infants born in Kermanshah Hospitals (2001-2008). J Isfahan Dent Sch 2010;6:298-304.  Back to cited text no. 31
Cheshmi B, Jafari Z, Naseri MA , Davari HA..Assessment of the correlation between various risk factors and orofacial cleft disorder spectrum: a retrospective case-control study. Maxillofacial Plastic and Reconstructive Surgery 2020;42:2-6.  Back to cited text no. 32
Corona-Rivera JR, Bobadilla-Morales L, Corona-Rivera A, Peña-Padilla C, Olvera-Molina S, Orozco-Martín MA, et al. Prevalence of orofacial clefts and risks for nonsyndromic cleft lip with or without cleft palate in newborns at a university hospital from West Mexico. Congenit Anom 2018;58:117-23.  Back to cited text no. 33
Mbuyi-Musanzayi S, Kayembe TJ, Kashal MK, Lukusa PT, Kalenga PM, Tshilombo FK, et al. Non-syndromic cleft lip and/or cleft palate: Epidemiology and risk factors in Lubumbashi (DR Congo), a case-control study. J Craniomaxillofac Surg 2018;46:1051-8.  Back to cited text no. 34
Xu DP, Qu WD, Sun C, Cao RY, Liu DW, Du PG. A study on environmental factors for nonsyndromic cleft lip and/or palate. J Craniofac Surg 2018;29:364-7.  Back to cited text no. 35
Acuña-González G, Medina-Solís CE, Maupomé G, Escoffie-Ramírez M, Hernández-Romano J, Márquez-Corona Mde L, et al. Family history and socioeconomic risk factors for non-syndromic cleft lip and palate: A matched case-control study in a less developed country. Biomedica 2011;31:381-91.  Back to cited text no. 36
Puhó EH, Szunyogh M, Métneki J, Czeizel AE. Drug treatment during pregnancy and isolated orofacial clefts in Hungary. Cleft Palate Craniofac J 2007;44:194-202.  Back to cited text no. 37


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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