Embryology · Head and neck: pharyngeal arches
Cleft lip and cleft palate !
- Malformation
An opening in the upper lip, the roof of the mouth or both, because two parts of the face did not join before birth.
Updated 2026-11-01
See it in 3D: Maxillae · Palatine bones · Soft palate · Orbicularis oris · Nasal septum · Auditory tube
What it is
Cleft lip and cleft palate (orofacial clefts) are among the commonest birth defects. Cleft lip happens when the maxillary prominence fails to fuse with the medial nasal prominence (weeks 6–7); cleft palate, when the palatal shelves fail to join (weeks 7–10). They are two causally distinct groups: cleft lip with or without cleft palate, and isolated cleft palate.
Key facts
- CDC (US): about 1 in 1,031 babies is born with cleft lip with or without palate and 1 in 1,563 with isolated cleft palate.
- Rates vary between populations and are higher in Asian and Indigenous American populations.
- In Colombia, orofacial clefts are part of INS birth defect surveillance.
- Team care: lip surgery in the first months and palate surgery before 18 months, plus speech therapy, dentistry and audiology.
Embryological cause
- Cleft lip (± palate): partial or complete failure of the maxillary prominence to fuse with the medial nasal prominence, on one or both sides; weeks 6–7.
- It may extend into the alveolar ridge (between lateral incisor and canine) and back to the incisive foramen.
- Cleft palate: the palatal shelves fail to fuse because they are small, fail to rise, fail to merge, or a tongue that does not drop blocks them (micrognathia).
- Most cases are multifactorial; syndromic forms include Van der Woude (IRF6, lower lip pits).
- Environmental factors: maternal smoking, pre-pregnancy diabetes and some antiseizure drugs (valproate, phenytoin).
How it presents
- Visible cleft of the lip, one or both sides, often with nasal deformity.
- Feeding problems from poor seal and suction, especially with cleft palate.
- Otitis media with effusion and conductive hearing loss, because the palatal muscles cannot open the auditory tube well.
- Nasal speech from velopharyngeal insufficiency, and dental problems.
- Cleft lip with or without palate: more common in boys; isolated cleft palate: more common in girls and more often syndromic (22q11.2, Pierre Robin, Stickler).
Diagnosis
- Second-trimester prenatal ultrasound usually shows cleft lip; isolated cleft palate is hard to see.
- Newborn exam with palpation and inspection of the palate: a submucous cleft can be missed (bifid uvula, notch in the hard palate).
- Search for other anomalies and for a syndrome; genetic testing if there are associated features.
- Hearing assessment because of the risk of otitis media with effusion.
Test yourself
Think of the answer, then tap the question to see it.
Which prominences fail to fuse in lateral cleft lip?
The maxillary prominence and the medial nasal prominence on the same side.
Why do children with cleft palate get more otitis media with effusion?
Because the palatal muscles (tensor and levator veli palatini) cannot open the auditory tube properly.
Which syndrome links cleft lip with lower lip pits?
Van der Woude syndrome, from IRF6 variants, autosomal dominant.
Which cleft type is more common in girls, and why is that thought to be?
Isolated cleft palate; in female fetuses the palatal shelves fuse about a week later.
See it in 3D
The structures of Durgical's 3D anatomy where it is found.
Related
- The face: five prominences
- Palate: primary and secondary palate
- First-arch syndromes: Treacher Collins and Pierre Robin sequence
- 22q11.2 deletion (DiGeorge): the third and fourth pouches
- Valproate, carbamazepine and phenytoin
- Ionizing radiation, tobacco and cocaine
- Maternal diabetes and obesity as teratogens
- Holoprosencephaly
- Prenatal diagnosis: ultrasound, serum screening, cell-free DNA, CVS, amniocentesis
Related conditions
- Cleft lip and palate
- Acute otitis media
- Hearing loss (conductive and sensorineural, including sudden hearing loss)
Educational content on embryonic development; not a guide to prenatal diagnosis or to medicines in pregnancy and no substitute for a health professional's advice. No doses are given.
Sources: Cleft Lip/Cleft Palate | Birth Defects | CDC (Centers for Disease Control and Prevention, 2026); Embryology, Craniofacial Growth, And Development - StatPearls - NCBI Bookshelf (StatPearls Publishing (NCBI Bookshelf), 2023); Langman's Medical Embryology, 13th ed., ch. 17: Head and Neck (Wolters Kluwer, 2015).
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Representative model, for educational purposes only.