Cleft Lip

Cleft lip is a birth defect in which the tissues that form the upper lip don’t join together completely during fetal development. The result is an opening or split in the lip.

The severity of cleft lip can vary widely, from a small notch in the lip to a large opening that extends up into the nose. In some cases, the cleft may also cause a split or separation in the upper gums and jaw bone.

Cleft lip may occur alone or together with cleft palate, an opening in the roof of the mouth (the palate) caused when the tissues don’t grow together properly. Cleft lip may also be associated with other genetic conditions and abnormalities.

While it can be stressful to parents, cleft lip is one of the most common and treatable birth defects. Surgery to repair the cleft lip will take place after your baby is born.

How does cleft lip affect my baby?

Depending on the severity of the defect, children with cleft lip may have problems with:

• Feeding
• Speech development
• Hearing
• Dental abnormalities
• Breathing
• Self-esteem

Early referral to a center that specializes in birth defects of the face and head, such as Texas Children’s Craniofacial Clinic, ensures timely, expert treatment for the best possible outcomes. 

Types of Cleft Lip

There are several types of cleft lip, depending on the location and severity of the defect.

A cleft that involves one side of the upper lip is a unilateral cleft. A cleft that involves both sides of the lip is a bilateral cleft. Rarely does the cleft occur in the middle of the lip.

The mildest form of cleft lip, which looks like a small notch, is known as a microform cleft lip.

When the cleft in the lip doesn’t extend into the nose it is called an incomplete cleft. A cleft lip that extends up into the nostril is known as a complete cleft and is the most severe.

Cause and Risk Factors

Cleft lip and/or palate occurs in an estimated 1 in 1,000 births. 

While the cause of these birth defects is generally unknown, genetic and environmental risk factors may include:

• Certain medications used during pregnancy, such as those used to treat seizures
• A family history of cleft lip and/or palate
• Smoking and drinking alcohol during pregnancy
• Being of Asian descent  
• Diabetes that isn’t managed properly

Diagnosis

In some cases, advanced fetal ultrasound can detect cleft lip during pregnancy. The diagnosis is then confirmed at birth during a physical exam of your newborn.

Typically cleft lip is diagnosed at birth.

Prenatal Evaluation and Testing

If cleft lip is diagnosed during your pregnancy, you may be referred to a fetal center for a comprehensive prenatal evaluation to determine if your baby’s birth defect is “isolated” or if there are other abnormalities present.

Additional testing may include:

• Anatomy ultrasound to gain more information about the defect, assess fetal growth and development, and identify any other conditions
• Fetal echocardiogram to evaluate your baby’s heart and look for any heart defects
• Fetal MRI to evaluate the fetal brain
• Amniocentesis and chromosomal analysis, to screen for genetic abnormalities often associated with cleft palate

At Texas Children’s Fetal Center, we arrange a visit for you to meet with a team of specialists experienced in diagnosing and treating fetal birth defects, including maternal-fetal medicine physicians, neonatologists, pediatric surgeons, genetic counselors and fetal imaging experts. Following a full day of evaluations, our specialists will then meet with you about your results, answer any questions you have, and provide recommendations based on your baby’s cleft lip and any related conditions, to help you make the most informed decisions regarding care and treatment. 

A cleft lip diagnosis during pregnancy enables your family and your health care team to plan ahead for any special needs your baby may have at birth and to arrange for the earliest possible treatment at a craniofacial clinic.

Pregnancy and Delivery

Depending on the severity of the defect and any other abnormalities present, you and your baby may be closely monitored throughout your pregnancy, with regular ultrasounds to assess fetal growth and development.

Delivery at a hospital experienced in the care and treatment of newborns with facial anomalies and other birth defects is recommended. Our specialists work closely with Texas Children’s Cleft Lip and Palate Clinic to coordinate your baby’s care across a multidisciplinary team, including maternal-fetal medicine specialists, neonatologists and the craniofacial team, ensuring the best possible care beginning at birth and continuing throughout childhood and adolescence.

Treatment

While treatment depends on the individual child, surgery to repair cleft lip is typically performed during the first three to six months of life. Additional surgeries, as well as treatment and therapy for hearing, speech and dental issues, may also be needed.

In severe cases of cleft lip, treatment known as Nasoalveolar Molding (NAM) may begin as early as one week of age to reshape the gums, lip and nostril using a plastic plate. Performed by a craniofacial orthodontist, this pre-surgery molding can make surgical repair easier and decrease the number of procedures required.

Because treatment for cleft lip is based on the child’s growth and development, all patients at Texas Children’s Cleft Lip and Palate Clinic are assessed annually until they are fully grown.

Long-Term Outcomes

Living with cleft lip can be challenging for children and their families. With early intervention and closely monitored care by a craniofacial team, in most cases required treatment is completed by age 18, if not sooner, and children do very well.  

Why Texas Children’s Fetal Center?

• A single location for expert maternal, fetal and pediatric care. At Texas Children’s Hospital, mother and baby can get the specialized care required for the diagnosis and treatment of fetal birth defects all in one location, for highly coordinated care and treatment planning.
• A skilled, experienced team with proven outcomes. We have a dedicated team of maternal-fetal medicine specialists, pediatric surgeons, neonatologists, fetal imaging specialists, genetic counselors and others who work in concert to care for you and your baby every step of the way. With their unique expertise and unified approach, they offer the best possible care for babies with fetal abnormalities.
• We care for your child’s needs at every stage of life. Our comprehensive approach starts with your first prenatal visit and continues through your child’s delivery, postnatal care, childhood and adolescence, thanks to one of the nation’s leading teams of fetal and pediatric specialists for the treatment of birth defects.

Cleft Lip in the News

• Teamwork Helps Kids with Cleft Lip and Palate Develop Normally

Videos

• Texas Children’s Cleft Lip and Palate program
• Multidisciplinary Care of the Cleft Patient
• Treating Craniofacial Conditions at Texas Children’s Hospital

Additional Resources

• Six things to consider when choosing a fetal center