Cleft lip is a birth defect that occurs when the tissue that makes up the lip does not join completely before birth, resulting in an opening in the upper lip. The opening can be a small slit or a large opening that goes through the lip into the nose. A cleft lip can be on one or both sides of the lip or in the middle of the lip, which occurs very rarely. Cleft palate is a birth defect that occurs when the tissue that makes up the roof of the mouth does not join completely before birth, resulting in an opening in the roof of the mouth. A cleft palate often includes a split in the upper lip but can occur without affecting the lip. Babies with a cleft lip and/or palate may have feeding, speech, hearing, and dental problems. Surgery to repair a cleft lip usually occurs in the first few months of life and is recommended within the first 12 months of life. Surgery to repair a cleft palate is recommended within the first 18 months of life or earlier if possible. Many children will need additional surgical procedures as they grow older. The exact cause of cleft lip and palate is not completely understood, but it is believed to be a combination of genetic and environmental factors affecting the mother during pregnancy.