**5. CT image of cleft palate, courtesy JSS Medical College, Mysore**

#### **5.1 Soft tissue anomalies**

#### *5.1.1 Cleft lip and palate*

Birth deformities such as cleft lip and palate can cause a person to have a number of orofacial malformations. One of the most prevalent birth defects, orofacial clefts can occur alone or in combination with other congenital malformations. Both syndromic and non-syndromic clefts with accompanying abnormalities make up a sizable portion of these clefts [15, 16].

Openings or cracks in the upper lip, the palate or both are known as cleft lip and cleft palate, respectively. When a developing baby's facial tissues do not fully seal, it can lead to cleft lip and cleft palate. The most prevalent birth malformations are cleft lip and cleft palate. Although they most frequently manifest as solitary birth abnormalities, they are also linked to a variety of inherited genetic diseases or syndromes (**Figure 7**).

Diagnostic features:

Typically, a split (cleft) in the lip or palate is obvious from birth. Cleft lip and palate can manifest as follows:

a facial split that affects one or both sides of the lip and palate (roof of the mouth).

a break in the lip that is only visible as a tiny notch or that extends through the upper gum and palate and into the base of the nose. A crack in the roof of the mouth that has no impact on how the face looks. Less frequently, a cleft only affects the soft palate muscles in the rear of the mouth, where the lining of the mouth covers them (submucous cleft palate). This kind of cleft is common [16].

#### **Figure 7.**

*Baby with cleft lip and palate deformity, showing corrected cleft palate and lip (photos courtesy JSS Dental College, cleft centre).*

#### **Signs and symptoms of submucous cleft palate may include the following**:


Most cases of cleft lip and cleft palate are noticed right away at birth and do not require special tests for diagnosis. Increasingly, cleft lip and cleft palate are seen on ultrasound before the baby is born (**Figures 8** and **9**).

Ultrasound before birth

During a prenatal ultrasound, sound waves are used to produce images of the growing foetus. A doctor may notice a variation in the face structures after reviewing the images.

Beginning about the 13th week of pregnancy, ultrasonography can identify cleft lip. Accurately diagnosing a cleft lip may get simpler as the foetus continues to

#### **Figure 8.**

*OPG showing the bony defect in the upper anterior with irregularly arrenged to tooth. Courtesy JSS Dental College, Mysore.*

#### **Figure 9.** *CT image of cleft palate, courtesy JSS Medical College, Mysore.*

develop. When a cleft palate develops on its own, ultrasonography imaging is more challenging (**Figure 10**).

Your doctor might suggest a treatment to remove a sample of amniotic fluid from your uterus if a prenatal ultrasound reveals a cleft (amniocentesis). The fluid test could reveal a genetic condition that could lead to other birth abnormalities in the foetus. But the most common reason for cleft lip and cleft palate is shown **Table 1**.
