If a child has a cleft lip or cleft palate, the risk of recurrence can be estimated based on the clinical history and findings. The causes of cleft lip/palate appears to be multifactorial and may involve multiple genes, although some families show an X-linked inheritance.
According to Harper (page 211), the risk of a cleft lip and palate in the general population is 0.1%, while the risk of an isolated cleft palate is 0.04%.
The risk of recurrence is higher if:
(1) the extent of the cleft is more severe (bilateral greater than unilateral)
(2) more close family members are affected
(3) if a sib is female (reflecting the overall lower risk of occurrence)
Number of Affected Sibs
Number of Affected Parents
Recurrence Cleft Palate
Recurrence Cleft Lip with/without Cleft Palate
1
0
3.6%
4.3%
2
0
13%
14%
0
1
3%
4%
1
1
11%
12%
2
1
24%
26%
0
2
28%
37%
1
2
39%
45%
2
2
46%
51%
from Cohen et al (Figure 53.6, page 1136), based on Tolarova and Morton (1975)
where:
• If you count each sib as 1 point, 1 parent as 1 point, and 2 parents as 3 points, the total number of points vs recurrence risk looks like a line.
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