Nobody is sure what causes cleft lips and palates which is an opening or split in the upper lip or the roof of the mouth. It could be genetic or from prenatal care or it might occur in the fetal phase. It may require multiple surgeries starting when the baby is around 3 months old. The initial surgery creates a functional palate which reduces the chances that fluid will develop in the middle ears and the teeth and helps facial bones develop properly. Patients might need a bone graft later to fill-in the upper gum line to stabilize the upper jaw and support permanent teeth. Additional surgery can be performed on the look of the lip and nose and to close openings between the nose and mouth.