Orofacial Clefts May Be a Window Into Identifying Common Psychopathology Development

The research supporting a connection between physical and psychiatric illness continues to grow and advance. For example, there is continued work to identify whether this is due to connected brain pathology or to psychosocial stressors that inherently come with having another illness. Congenital illnesses may represent a window into our better understanding this connection, as the defect during embryogenesis that leads to the illness is sometimes known. Oral facial clefts (OCF) represent a congenital malformation that is well suited to study this question, as it is a common congenital condition and there are studies showing the increased prevalence of psychiatric comorbidities for those with OFC.¹ Of all patients with OFC, 70% are nonsyndromic, meaning they do not have an associated genetic syndrome leading to the development of the OFC.² There are three different types of OFC-cleft lip, cleft lip and palate, and cleft palate only-but it has been shown that all three seem to be associated with an increased risk for psychiatric illness. The timing of when OFC is believed to develop reflects a period when cells are differentiating from the neural tube, and thus a critical period in brain development.³ Some risk factors for developing OFC, such as alcohol use, antiepileptics, and smoking, may also affect brain development and are also associated with risk for the development of psychiatric disorders. What previous studies of OFC and psychiatric comorbidities have not been able to do is to control for other potential causes of OFC, especially familial risks.