Cleft lip and Palate: A 30-year Epidemiologic Study in North-East of Iran

Document Type: Original


1 Department of Pediatrics,Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Dental Material Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Department of Orthodontics, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.

5 Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran.


Cleft lip and palate are among the most common congenital anomalies worldwide. This study was conducted in order to explore the incidence and related factors of cleft lip and/or palate (CL/P) among live births in Mashhad, North-Eastern Iran.
Materials and Methods:
In this cross-sectional study, records of 28,519 infants born between March 1982 and March 2011 at three major hospitals in Mashhad were screened for oral clefts. Clinical and demographic factors relating to diagnosed cases, including birth date, gender, birth weight, maternal age, number of pregnancies, type and side of cleft and presence of other congenital anomalies were recorded for analysis.
The overall incidence of CL/P was 1.9 per 1,000 live births. Cleft lip associated with cleft palate (CLP) was the most prevalent type of cleft (50%), followed by isolated cleft lip         (35.2%) and isolated cleft palate (14.8%). A total of 92.6% of oral clefts were bilateral and 5.5% were located on the right side. In addition, clefts were found to be more common in male than female births (male/female ratio=2.3). The rate of associated congenital anomalies in CL/P newborns was 37%. No significant differences were observed in the incidence of oral clefts across three decades of study; except for CLP which was significantly more prevalent between 2002–2011 (P=0.027). There were no significant differences with regard to season of birth, associated anomalies or maternal age of affected newborns in the three time periods of the study. Furthermore, maternal age and number of pregnancies were not significantly different among the three types of cleft (P=0.43 and P=0.91, respectively). Although the mean birth weight of patients affected with isolated cleft palate was considerably lower than that of the other two types of cleft, the difference was not statistically significant (P=0.05). 
This study indicates a frequency of CL/P close to the findings in East Asian countries and higher than some previous reports from Iran, European and American countries. Ethnicity-related genetic factors may have a role in the conflicting results obtained from different populations.


Main Subjects

1. Souza J, Raskin S.  Clinical and epidemiological study of orofacial clefts. J Pediatr (Rio J) 2013; 89 (2):137-44.

2. Lei RLChen HSHuang BYChen YCChen PKLee HY et al. Population-based  study of birth prevalence and factors associated with cleft lip and palate in Taiwan 2002-2009. PLoS One 2013; 8(3): e58690.

3. Eslami N, Majidi MR, Aliakbarian M, Hasanzadeh N. Oral health-related quality of life in children with cleft lip and palate. J Craniofac Surg 2013 Jul; 24(4):e340-3.

4. Wehby GL, Cassell CH. The impact of orofacial clefts on quality of life and healthcare use and costs. Oral diseases 2010;16(1):3-10.

5. Hasanzadeh N, Omidkhoda M, Jahanbin A, Vatankhah M. Coping strategies and psychological distress among mothers of patients with nonsyndromic cleft lip and palate and the family impact of this disorder. J Craniofac Surg 2014, In press.

6. Croen LA, Shaw GM, Wasserman CR, Tolarová MM. Racial and ethnic variations in the prevalence of orofacial clefts in California, 1983-1992. Am J Med Genet 1998;79:42–47.

7. Mossey PA, Little J. Epidemiology of oral clefts: an international perspective. In: Wyszynski DF editors. Cleft lip and palate: from origin to treatment. New York: Oxford University Press; 2002:127–158.

8. Mossey PA, Modell B. Epidemiology  of oral clefts 2012:an international perspective. Front Oral Biol 2012; 16:1-18.

9. Tolarová MM, Cervenka J. Classification and birth prevalence of orofacial clefts. Am J Med Genet 1998;75(2):126-37.

10. Manyama M, Rolian C, Gilyoma J, Magori CC, Mjema K, Mazyala E, et al. An assessment of orofacial clefts in Tanzania. BMC Oral Health 2011; 11:11-5.

11. 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.

12. Tanaka SA, Mahabir RC, Jupiter DC, Menezes JM. Updating the epidemiology of cleft lip with or without cleft palate. Plast Reconstr Surg 2012; 129(3):511e-8e.

13. IPDTOC Working Group. Prevalence at birth of cleft lip with or without cleft palate: Data from the International Perinatal Database of Typical Oral Clefts (IPDTOC). Cleft Palate Craniofac J. 2011; 48(1):66-81.

14. Khazaei SShirani AMKhazaei MNajafi F. Incidence of cleft lip and palate in Iran. A meta-analysis. Saudi Med J 2011; 32(4):390-3.

15.Golalipour MJMirfazeli ABehnampour N. Birth prevalence of oral clefting in northern Iran. Cleft Palate Craniofac J 2007; 44(4):378-80.

16. Yassaei SMehrgerdy ZZareshahi G. Prevalence of cleft lip and palate in births from 2003 - 2006 in Iran. Community Dent Health 2010; 27(2):118-21.

17.Zandi MHeidari A. An epidemiologic study of orofacial clefts in hamedan city, iran: a 15-year study. Cleft Palate Craniofac J 2011; 48(4):483-9.

18. Farhud DD, Walizadeh GR, Kamali MS. Congenital malformations and genetic diseases in Iranian infants. Hum Genet 1986;74(4):382-5.

19. Rajabian MHSherkat M. An epidemiologic study of oral clefts in Iran: analysis of 1,669 cases. Cleft Palate Craniofac J 2000; 37(2):191-6.

20. Rajabian MHAghaei S. Cleft lip and palate in southwestern Iran: an epidemiologic study of live births. Ann Saudi Med 2005; 25(5):385-8.

21. Jalili DFathi MJalili C. Frequency of cleft lip and palate among live births in Akbar Abadi Hospital. Acta Med Iran 2012;50(10):704-6.

22. Jamilian A, Nayeri F, Babayan A. Incidence of cleft lip and palate in Tehran. J Indian Soc Pedod Prev Dent 2007;25:174-6.

23. Taher AA. Cleft lip and palate in Tehran. Cleft Palate Craniofac J 1992; 29(1):15-6.

24. Jahanbin AKianifar HYaghoubi-Al ZMalekian AKeikhaee BHasanzadeh N, et al. Had prevalence of cleft lip and palate differed during the Iran-Iraq war? J Craniofac Surg. 2013 May; 24(3):826-9.

25. Murray JCDaack-Hirsch SBuetow KH, Munger REspina LPaglinawan N, et al. Clinical and epidemiologic studies of cleft lip and palate in the Philippines. Cleft Palate Craniofac J 1997; 34 (1):7-10.

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.  

27. Elahi MM, Jacson IT, Elahi O, Khan AH, Mubarak F, Tariq GB, et al. Epidemiology of cleft

lip and palate in Pakistan. Plast Reconstr Surg 2004;113:1548-55.

 28. Al Omari F, Al-Omari IK. Cleft lip and palate in Jordan: birth prevalence rate. Cleft Palate Craniofac J 2004;41(6):609-12.

 29. FitzPatrick DRRaine PABoorman JG. Facial clefts in the west of Scotland in the period 1980-1984: epidemiology and genetic diagnoses. J Med Genet 1994; 31(2):126-9.

 30. Iregbulem LM. The incidence of cleft lip and palate in Nigeria. Cleft Palate J 1982;19(3):201-5.

 31. Yazdee AK, Saedi B, Sazegar AA, Mehdipour P. Epidemiological aspects of cleft lip and palate in Iran. 2011; 49(1):54-8.

 32. Jahanbin A, Eslami N. Seasonal and yearly trends in cleft lip and palate in northeast Iran, 1989-2011. J Craniofac Surg 2012; 23(5):e456-9.

 33. Calzolari E, Pierini A, Astolfi G, Bianchi F, Neville AJ, Rivieri F. Associated anomalies in multi-malformed infants with cleft lip and palate: An epidemiologic study of nearly 6 million births in 23 EUROCAT registries. Am J Med Genet A 2007; 143: 528-37.