HISTORY. A family history of CL or CP may or may not exist. Identical twins are more likely to share the disorder than are fraternal twins. Inquire about teratogen exposure during the first trimester of pregnancy.

PHYSICAL EXAMINATION. The CL may vary from a small notch to a widespread open cleft and may be unilateral or bilateral. The CP also varies in the extent of the malformation: it can involve only the uvula, extend into the soft and hard palate, or be unilateral, bilateral, or midline.

PSYCHOSOCIAL. Parents' and families' adjustments to an infant with CL or CP may be difficult. The deformity is usually readily observable at birth and often totally unexpected. Support for the family is essential and includes explanations of the surgical procedures and long-term prognosis.

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