The etiology of cleft lip and palate is related to nasal development. Cleft lip, with or without cleft palate, affects approximately 1 in 1000 newborns, with variations depending on ethnicity. Cleft lip and cleft palate are the most common malformations in the head/neck region. From the most common classification we can identify Primary Clefts which involve the tissue derived from the primitive embryonic palate (the hard palate anterior to the incisive foramen, alveolus and maxillary lip) and Secondary Clefts which involve the tissues derived from the secondary palate (the uvula, the soft palate and the hard palate posterior to the incisive foramen). Complete clefts are those that extend to the nasal floor; Incomplete clefts range from muscular diastasis, with intact epidermis or mucosa, to the presence of only a thin band of tissue connecting the medial and lateral structures. Although the precise mechanisms underlying cleft lip and palate are not yet fully understood, the basic problem of these defects centers on interference in tissue fusion in the initial stages of development. These problems are believed to have multiple etiologies, both genetic and environmental in nature. The primary palate forms during the 4th to 7th weeks, and the secondary palate forms later, during the 4th to 12th weeks, with the palatal elements merging in an anterior-posterior direction ending in the uvula. A failure in the fusion of the medial nasal process with the maxillary process is thought to be the basis for the formation of a cleft lip. A failure, however, in the meeting and fusion of the lateral palatine processes is thought to be the basis of the formation of the cleft palate.
Problems involving cleft lip or palate vary depending on the severity of the defect and include: feeding, speech development, velopharyngeal insufficiency, midfacial development, otitis media secondary to eustachian tube dysfunction, and cosmetics. In general, the goals of therapy for cleft lip defect are acceptable cosmesis and, if necessary, facilitation of closure of the alveolar arch. The goals of therapy for cleft palate instead involve closing the defect without interfering with the growth of the maxillary arch, facilitating closure of the velopharynx, and speech development.
For some years now, maxillofacial surgeons have included an osteopathic consultation in the post-surgical routine to recover the functionality and elasticity of the new structure.