Cleft Lip/Palate and Craniofacial Surgery: Causes, Symptoms, Risks, Rule of 10s, and Treatment | Mr. Gwanmesia Skip to main content

Cleft Lip/Palate and Craniofacial Surgery: Causes, Symptoms, Risks, Rule of 10s, and Treatment

Cleft Lip/Palate and Craniofacial Surgery: Causes, Symptoms, Risks, Rule of 10s, and Treatment

“The oral and maxillofacial surgeon’s role is crucial in carefully planning the multiple-stage correctional program for cleft lip and palate patients, helping restore the jaw and facial structures, leading to normal function and appearance!”  

  • Cleft lip/palate is a congenital deformity in the facial areas that are often encountered and occur in facial growth during the embryo stage.
  • Cleft lip, with or without cleft palate, most commonly occurs as isolated birth defects but is also linked to many inherited genetic conditions/ syndromes.
  • Cleft lip/palate can be corrected, and, in most babies, a series of surgeries can be required to restore normal function and achieve a more normal appearance with minimal scarring.
  • The rule of ten includes parameters at 10, such as the weight limit value of 10 lbs, haemoglobin 10 g / dL, and white blood cell count <10,000 mm 3, and the optimal time for surgery, over ten weeks old.

Dr. Ivo Gwanmesia, MBChB, MRCS, FRCS, a British and American board-certified plastic surgeon, noted that “as a craniofacial plastic surgeon, our role is often pivotal, especially in the 20-year term of care for the child born with a cleft lip and palate deformity (CLPD). As a Craniomaxillofacial surgeon, we often provide surgical consultation and educational and emotional support for the family because children with cleft lip with or without palate face various challenges, depending on the extent of the cleft condition.”

What is a Cleft Lip/Palate?

A cleft lip/ palate is a congenital disability when tissues in the baby’s face and mouth don’t fuse properly. However, openings or defects in the upper lip or the roof of the mouth (the palate) occur in babies with cleft lip and palate condition, which is immediately identifiable at birth.

Researchers believe that an interaction of genetic and environmental factors causes most cases of cleft lip and palate. But unfortunately, in many babies, a definite cause isn’t discovered. Both genetic and environmental factors are causative factors for cleft lip/palate condition because, in some cases, babies inherit a gene responsible for developing a cleft. Then an environmental trigger causes the cleft to occur.

If your child is diagnosed with a cleft lip/palate condition, you must arm yourself with plenty of knowledge and information about the treatment options. Therefore, it is inevitable to schedule a one-on-one introductory consultation with a craniofacial plastic surgeon who will repair your baby’s cleft lip and palate and help address various concerns, such as:

  • Difficulty feeding,
  • Ear infections and hearing loss,
  • Dental problems,
  • Speech difficulties,
  • Coping with social, emotional, and behavioural problems due to differences in appearance.

Other Craniofacial Anomalies:

Craniofacial abnormalities are birth defects of the skull and face that affect the look of the child’s head or face and sometimes other body parts. However, the craniofacial surgeon is recommended to proceed with it, as they are dexterous and have a super specialty in correcting deformities of the skull and its associated structures within the head and facial regions.

Dr. Ivo performs cleft lip/ palate surgery with international charities and has mastery in performing all types/ aspects of craniofacial surgeries, including:

Craniosynostosis improves the shape of the skull, and hemifacial microsomia improves the underdeveloped facial status and brings overall facial harmony by correcting facial asymmetry.

Moreover, Dr. Ivo performs Vascular malformation surgery to correct abnormal development of blood vessels, treating several functional or aesthetic problems and addressing life-threatening concerns.

A Hemangioma also results in abnormal blood vessel growth in the skin that may be present at birth (faint red mark). It requires surgical attention when it appears in specific areas on the face, such as the lip when it becomes too large or painful.

Distraction osteogenesis is used in maxillofacial and craniofacial surgery for bone regeneration to repair skeletal deformities and reconstructive surgery. Through the process, irregularities of the jaw bones are corrected and realign the jaws and teeth to improve the way they work and the facial appearance.

Trigonocephaly can occur due to a specific syndrome or be isolated, a congenital abnormality refers to the triangular forehead, or a keel-shaped forehead deformity requires surgical correction for aesthetic and psychosocial reasons.

What Causes Cleft lip and Palate?

During the first six to ten weeks of pregnancy, tissues in the baby’s face (upper jaw and nose) and mouth usually come together to form the mouth and lip features. A cleft condition occurs when lip or palate parts do not fuse completely.

There are other factors that may contribute to the formation of a cleft lip/palate develops, though some may be related to genetic factors, and environmental factors can also trigger the risk of a birth defect, such as:

  • Taking certain medicines during pregnancy, i.e., anti-seizure medicines.
  • Deficiency of prenatal nutrients
  • Exposure to certain chemicals during pregnancy
  • Smoking cigarettes or drinking alcohol during pregnancy.

Symptoms of cleft lip/ Palate:

A baby with a cleft might have the following:

  • Only a cleft palate or cleft lip
  • Both a cleft lip and a cleft palate.

Other associated deformities of cleft lip and palate include:

  • Crooked or missing teeth
  • Misalignment of teeth and jaw
  • Malformations of the upper jaw
  • Speech issues
  • A fistula between the mouth and the nasal cavity
  • Alveolar clefts are defects in the bone that supports the teeth.

Less commonly, a cleft occurs only at the back of the mouth and is covered by the mouth lining, medically referred to as a submucous cleft palate. It often goes unnoticed at birth and may not be diagnosed until later when signs are pronounced.

Signs of submucous cleft palate may include:

  • Difficulty with feedings
  • Difficulty swallowing
  • Nasal speaking voice
  • Chronic ear infections.

Risk Factors:

  1. A family history of cleft lip/palate poses a higher risk for their parents to have a baby with cleft conditions.
  2. Taking certain medications, alcohol addiction, and smoking cigarettes during pregnancy may increase the risk of having babies with cleft lip/palate conditions.
  3. Women diagnosed with diabetes before pregnancy are prone to having a baby with a cleft lip/palate condition.
  4. Obesity is also a risk factor, as babies born to obese women are more likely to develop cleft lip/palate.

Note: Male babies are more prone to develop cleft lip with or without a palate, whereas cleft palate without a cleft lip is more common in female children.

Rule of 10s:

Cleft lip with or without palate is a birth defect that commonly occurs as an isolated birth defect (ICLP) but is also associated with many inherited genetic conditions or syndromes. In order to determine the right time for cleft lip/palate surgery, an assessment is done for the cleft lip/palate patient, as every child or patient is different and requires a customized surgical plan. In addition, patients with cleft lip/palate will have various problems related to aesthetics, nutrition, speech, and psychosocial functions. An introductory one-on-one consultation with the child’s parent/ patient is required to discuss the details of the surgical procedure and the optimal timing for surgery to achieve the best aesthetic outcomes.

Most repairs are done at about 12 weeks of age. This period allows the appearance of any congenital deformities to be noted and treated. However, it is frequently referred to as the rule of 10s.

Rule of 10s weighing:

  • 10 weeks old,
  • Weight of 10 pounds
  • 10 grams of haemoglobin.

Note: Repair before age one is generally thought to produce the least noticeable scar.



Cleft Lip and Palate Treatments:

  1. Bone grafting: Bone grafting is most frequently performed on children under the age of 10. Adults who missed the surgery in childhood can also benefit from bone grafting procedures. The bone grafting procedure involves taking a small amount of bone from one place, usually the hip, head, ribs, or leg, and placing it in the cleft area near the teeth. Bone grafting is performed to support the lip and nose and improve symmetry, creating a more aesthetic appearance and adding stability to the ridge. And also improve the stability of the front part of the roof of the mouth.
  2. Surgical Closure of Oronasal Fistulae: An oronasal fistulae is a hole between the mouth and nose cavity, which can be problematic if left intentionally after the initial repair of the cleft palate. It may also be developed due to poor healing in this area. Sometimes, when fistulae become very large, they create speech problems. Fistula can be closed surgically using local tissue harvested from the roof of the mouth, the tongue, or the inside cheek.
  3. Osseointegrated Implants: Sometimes, people with cleft lip/palate have one or more missing teeth, and the teeth close to the cleft are more prone to having weak supporting bones. In such cases, osseointegrated implants are the most effective approach for replacing missing teeth.


The oral and maxillofacial surgeon’s role is pivotal, especially for performing the cleft lip/ palate deformities (CLPD), because a baby born with cleft deformities is special and challenged. In addition, cleft lip/palate issues can also be linked to other problems concerning aesthetics, nutrition, speech, and psychosocial functions.

At your introductory consultation, Dr. Ivo Gwanmesia will discuss the details of the procedure employed, including where the surgery will be performed, the type of anaesthesia to be used, possible risks and side effects, recovery, costs, and, most of all, the natural results you can expect.


If you want to know more about cleft lip/palate or require a surgical solution in Harley Street, London, feel free to contact Dr. Ivo Gwanmesia at Tel: 020 7474 1300. Mr. Gwanmesia is an American and British board-certified plastic surgeon with the credit of fellowship in craniomaxillofacial surgery at the world-renowned Cleveland Clinic Foundation, Cleveland, Ohio, United States.

Or, you can schedule an online appointment by filling out the consultation form.







Dr Ivo Gwanmesia

Dr Ivo Gwanmesia is one of Harley Street’s most experienced and renowned craniofacial plastic surgeons. With over a decade of professional experience, he has transformed the lives of countless patients from all over the UK & abroad.

Due to his vast and hands-on training in the UK and the US, Dr Ivo now specialises in more than a dozen different aesthetic, craniofacial and transgender procedures. Some of them include face, neck, and brow lifts, upper and lower blepharoplasty, breast reduction & breast uplift as well as facial feminisation surgery, to name a few.

Dr Gwanmesia has also conducted pioneering research, which led to the development of a new technique for the reconstruction of the middle vault of the nose, known as the ‘Fulcrum Spreader Graft’. He was also part of a study comparing the efficacy of the Sheen Spreader Graft and the Fulcrum Spreader Graft. The study has since been published on PubMed and the Journal of the American Society of Plastic Surgeons.