Cleft Lip vs Cleft Palate: 6 Differences Parents Should Understand

Cleft lip and cleft palate are both birth differences that happen when parts of a baby’s face or mouth do not fully join during pregnancy. A cleft lip affects the upper lip and may extend toward the nose, while a cleft palate affects the roof of the mouth. Some babies are born with only one of these conditions, while others have both. Because the terms are often mentioned together, many parents may not realize that they can affect feeding, speech, dental health, hearing, and treatment planning in different ways.

Understanding the difference between cleft lip and cleft palate can help parents feel more prepared for diagnosis, surgery, and long-term care. A cleft lip is often easier to see at birth or during prenatal ultrasound, while a cleft palate may require a closer exam inside the mouth. Treatment usually involves a team approach, including surgeons, pediatricians, feeding specialists, dentists, speech therapists, and hearing specialists. This article explains six differences between cleft lip and cleft palate that parents should understand.

The fundamental characteristics of a cleft lip and a cleft palate

A cleft lip is a physical separation in the upper lip, while a cleft palate is an opening in the roof of the mouth; both are congenital orofacial defects that can occur individually or together. These conditions are birth defects that arise from incomplete fusion of facial structures during early embryonic development. They can range significantly in severity, from a minor notch in the lip to a complete separation of the lip and palate extending into the nasal cavity. To understand their differences, it is essential to first define each condition distinctly.

Defining Orofacial Clefts

A cleft lip and a cleft palate are common congenital (present at birth) facial conditions that occur during early pregnancy. They are classified as orofacial clefts, which are physical gaps or splits that form when the facial tissues do not fuse completely during embryonic development.

                     [Structural Profiles of Orofacial Clefts]
                                         │
         ┌───────────────────────────────┴───────────────────────────────┐
         ▼                                                               ▼
   [Cleft Lip]                                                     [Cleft Palate]
   - Visible split in the upper lip                                - Internal opening in the roof of the mouth
   - Failure to fuse between weeks 4 and 7                         - Failure to fuse between weeks 6 and 9
   - Can be unilateral or bilateral                                - Involves the hard and/or soft palate

These conditions can range from a minor notch in the lip to a complete separation that extends through the roof of the mouth and into the nasal cavity. They can occur as an isolated cleft lip, an isolated cleft palate, or both conditions together.

Anatomical Features of a Cleft Lip

When explaining what is a cleft lip, it is described as a visible split in the upper lip tissue. This gap happens when two key parts of the developing face—the medial nasal process and the maxillary process—fail to join properly during the first trimester, typically between the fourth and seventh weeks of pregnancy.

The structural severity of this condition varies across different presentations:

• Incomplete Cleft Lip: A minor gap or notch that stays within the pink portion of the lip (the vermilion border). This is sometimes called a microform cleft.

• Complete Cleft Lip: A deep split that extends all the way from the lip into the base of the nostril. This type often affects the underlying muscle and the alveolar ridge (the upper gum line where teeth grow).

• Unilateral vs. Bilateral: A unilateral cleft affects only one side of the upper lip (more commonly the left side). A bilateral cleft creates two separate gaps on both sides, which can cause the central piece of the lip (the prolabium) to stick forward.

Anatomical Features of a Cleft Palate

A cleft palate is an internal birth defect characterized by a split or opening in the roof of the mouth. This opening forms an abnormal direct connection between the oral cavity (the mouth) and the nasal cavity (the nose). It occurs when the left and right palatal shelves fail to meet and fuse in the middle during the sixth to ninth weeks of pregnancy.

The palate itself is split into two distinct areas: the hard palate (the bony front section) and the soft palate (the muscular back section that ends at the uvula). A cleft can impact these structures in different ways:

• Isolated Soft Palate Cleft: The gap is confined strictly to the flexible, muscular tissue at the back of the mouth.

• Complete Palate Cleft: The opening runs the entire length of the roof of the mouth, cutting through both the hard bone and the soft tissue.

• Submucous Cleft Palate: A hidden variation where the underlying palate muscles are split, but the pink lining (mucous membrane) covering them is intact. This type is less obvious and is often discovered later in childhood due to speech or feeding difficulties.

Combined Presentation: Cleft Lip and Palate

A baby can be born with both a cleft lip and a cleft palate at the same time. This combined presentation is a common scenario in orofacial cleft cases.

[Embryonic Tissue Disruption] ──► [Unilateral/Bilateral Lip Split] ──► [Alveolar Ridge Breach] ──► [Palatal Shelf Fusion Failure]

This combination occurs because the tissues that form the lip and the mouth grow close together and follow overlapping timelines in the womb. The lip and the very front part of the upper jaw (the primary palate) develop from the same embryonic structures.

If this initial step is disrupted, it can create a physical barrier that prevents the rest of the palatal shelves (the secondary palate) from joining later on. A complete cleft lip often continues through the gum line, making it highly likely that the roof of the mouth will remain split as well.

A combined cleft lip and palate involves both external and internal structures, requiring a coordinated care plan to address challenges with feeding, speech development, fluid buildup in the ears, and dental alignment.

6 Core differences between a cleft lip and a cleft palate

Core Difference 1: Anatomical Location and Structural Deficits

The most fundamental distinction between these two congenital orofacial conditions lies within their precise anatomical boundaries and the specific tissue layers they disrupt.

                           [Anatomical Cavity Mapping]
                                       │
       ┌───────────────────────────────┴───────────────────────────────┐
       ▼                                                               ▼
 [Cleft Lip Anomalies]                                       [Cleft Palate Anomalies]
 - System: External Perioral                                 - System: Internal Oro-Nasal Vault
 - Tissue: Cutaneous, Subcutaneous, & Muscle                 - Tissue: Osseous Hard Bone & Soft Mucosa
 - Structure: Orbicularis Oris Disruption                    - Structure: Palatal Shelf Midline Gap

The Extent of a Cleft Lip

A cleft lip is an external structural defect localized within the perioral facial network. It presents as a physical tissue separation slicing through the skin, subcutaneous fat, and specialized muscle fibers of the upper lip. This gap occurs along the embryonic margins where the central philtrum (derived from the frontonasal prominence) meets the lateral segments of the upper lip (derived from the maxillary prominences).

This structural breakdown completely severs the orbicularis oris muscle, which is the sphincter muscle enveloping the mouth opening. In severe variations, the structural defect extends upward through the floor of the nostril, warping the lower nasal cartilages, pulling the nose downward on the affected side, and breaching the alveolar ridge (the upper bony gum line where teeth grow).

The Architecture of a Cleft Palate

In contrast, a cleft palate is an internal structural fissure affecting the horizontal partition that divides the oral cavity from the nasal cavity. This anatomical roof is made up of two distinct areas: the hard palate at the front, which is a bony structural plate formed by the palatine processes of the maxillae, and the soft palate at the back, which is a flexible, muscular valve ending at the uvula.

When a cleft palate occurs, it forms a direct, open channel between the mouth and the nasal passages. This means food, liquids, and air can move freely between these two spaces, which are normally completely separated. Unless paired with a visible split in the lip, this internal structural issue cannot be seen on the outside of the face.

Core Difference 2: Embryonic Developmental Timelines

The upper lip and the roof of the mouth develop during distinct windows of the first trimester. This chronological separation explains why an infant can be born with one condition without necessarily having the other.

Lip Embryology (Weeks 4 to 7)

The development of the upper lip takes place very early in embryonic life. It begins around the fourth week of gestation as facial tissue prominences migrate toward the center of the developing face. For a typical lip to form, the primary medial nasal processes must fuse securely with the lateral maxillary processes.

This process is usually complete by the end of the seventh week. A failure of these tissues to join during this specific 4-to-7-week window results in a split lip. When investigating what causes a cleft lip, research points to a complex mix of genetic factors and environmental triggers during these early weeks that disrupt this cellular migration.

Palate Embryology (Weeks 6 to 12)

The structural formation of the roof of the mouth occurs slightly later in pregnancy. Around the sixth week of gestation, internal tissue extensions called palatal shelves grow downward from the inner sides of the maxillary processes, positioning themselves on either side of the developing tongue. Between the eighth and ninth weeks, the baby’s jaw drops, allowing the tongue to move down. This change lets the palatal shelves swing upward into a horizontal position above the tongue, meeting and fusing along the midline from front to back.

This internal fusion process is typically complete by the twelfth week of pregnancy. If this process is disrupted during the 6-to-12-week window, the roof of the mouth remains split. Because the lip forms first, a severe disruption early on can cascade, blocking the later steps needed for the palate to close. This explains why a combined cleft lip and palate is a common clinical presentation. However, a localized issue occurring after the seventh week will leave the lip intact, resulting in an isolated cleft palate.

Core Difference 3: Physical Presentation and Clinical Visibility

The external nature of a lip split versus the hidden location of an internal palate opening leads to stark differences in how these conditions look and when they are diagnosed.

[External Visual Inspection at Birth] ────► Cleft Lip: Visually apparent; immediate diagnostic identification.
[Internal Manual Oral Assessment]    ────► Cleft Palate: Invisible externally; requires physical palpation to identify.

Visual Characteristics of a Cleft Lip

A split lip is an externally visible condition that is immediately apparent to parents and medical providers at birth. The cosmetic and structural impact ranges from a minor notch in the pink vermilion border of the lip to a wide, complete gap that extends directly into the nostril.

In a unilateral presentation, the lip tissue is split on one side, causing the nose to look flattened and pulling the central facial features out of alignment. A bilateral presentation features two distinct gaps that isolate the central portion of the lip and gum line (the prolabium), causing it to project forward from the face. Because this facial difference is so prominent, it can be a source of immediate emotional distress for parents welcoming a newborn.

The Hidden Nature of an Isolated Cleft Palate

An isolated internal opening in the roof of the mouth is not visible on the outside of the face. A newborn with this condition typically features completely typical facial contours and intact lips. The condition is only identified when a healthcare provider carries out a thorough newborn assessment, looking inside the open mouth under bright light and sweeping a gloved finger along the hard and soft palate to check for structural continuity.

If a thorough exam is missed, the first sign of an undiagnosed internal split is often feeding difficulties, such as milk leaking out of the baby’s nostrils during feeding. The condition can be even more hidden in cases of a submucous cleft palate, where the underlying palatal muscles are split but the pink surface lining (mucous membrane) remains completely intact. This subtle variation often goes unnoticed until early childhood, when the child begins to experience distinct speech difficulties.

Core Difference 4: Primary Functional and Physiological Impacts

While both conditions present challenges for a newborn, the specific functional hurdles they create differ significantly due to the distinct roles the lips and palate play in feeding, speech, and ear ventilation.

Challenges unique to a Cleft Lip

The primary functional challenge caused by a split lip centers on the mechanics of infant feeding. To nurse or bottle-feed successfully, a baby must wrap their lips tightly around the breast or nipple to form a secure forward seal. This seal allows the jaw to create the negative pressure (suction) needed to draw milk out efficiently.

A split in the upper lip breaks this forward seal, allowing air to leak into the mouth. This inefficient latch makes sucking difficult, leading to long feeding times, excess air intake, and infant fatigue. However, because the internal roof of the mouth remains solid, parents can often manage this issue by altering the baby’s position or using standard compressible nipples.

Challenges unique to a Cleft Palate

An internal opening in the roof of the mouth causes more widespread functional challenges because it leaves the oral and nasal cavities open to one another:

Inability to Create Suction: Because the roof of the mouth is split, air flows freely between the nose and mouth, making it impossible for the baby to generate the internal suction needed for standard feeding. Liquids can easily escape into the nasal passages (nasal regurgitation), causing choking, coughing, and significant feeding discomfort. Infants with this condition require specialized cleft feeding systems, such as valves that allow milk to flow via compression of the nipple rather than internal suction.

Hypernasal Speech Distortions: The soft palate acts as a muscular valve that lifts against the back of the throat to close off the nasal cavity when speaking. This structural closure builds up the air pressure needed to produce clear consonant sounds (like /p/, /b/, /t/, /d/, and /k/). When the palate is split, air escapes out of the nose during speech, resulting in a hypernasal voice and making it difficult for the child to form clear consonant sounds.

Middle Ear Fluid Accumulation: The muscles of the soft palate (tensor veli palatini) are responsible for opening the Eustachian tubes during swallowing or yawning, which ventilates the middle ear space and drains natural fluids. When these muscles are split, the Eustachian tubes remain non-functional. This leads to persistent fluid buildup in the middle ear, frequent ear infections, and a high risk of conductive hearing loss if left untreated.

Core Difference 5: Surgical Repair Timelines and Approaches

Surgical treatment for these conditions follows different timelines and relies on distinct operative techniques. These are carefully planned to balance tissue healing with natural facial growth and speech milestones.

                           [Surgical Reconstructive Pathways]
                                           │
         ┌─────────────────────────────────┴─────────────────────────────────┐
         ▼                                                                   ▼
 [Cheiloplasty (Cleft Lip Repair)]                                   [Palatoplasty (Cleft Palate Repair)]
 - Ideal Timing: 3 to 6 Months of Age                                - Ideal Timing: 9 to 18 Months of Age
 - Operational Rule: The Clinical "Rule of 10s"                      - Operational Rule: Pre-Speech Pattern Window
 - Reconstructive Scope: Muscle Alignment & Symmetry                 - Reconstructive Scope: Cavity Separation & Muscle Sling

Cleft Lip Repair (Cheiloplasty)

Surgical correction of a split lip is performed early in an infant’s life, typically between 3 and 6 months of age. Surgeons evaluate the baby’s readiness using a classic guideline known as the “Rule of 10s”. This rule requires the infant to be at least 10 weeks old, weigh at least 10 pounds, and have a blood hemoglobin level of at least 10 g/dL, ensuring they can safely undergo anesthesia.

During the procedure, the surgeon carefully aligns the separated edges of the orbicularis oris muscle, linking them to form a functional muscle ring around the mouth. The skin and tissue borders are then meticulously closed to create a natural Cupid’s bow and restore symmetry to the base of the nose and nostrils. Closing the lip early helps improve feeding efficiency and provides immediate emotional relief for the family.

Cleft Palate Repair (Palatoplasty)

Surgical repair of the roof of the mouth is performed later, typically between 9 and 18 months of age. This timing is a strategic compromise designed by craniofacial teams to balance two competing growth needs:

• Midfacial Jaw Growth: Delaying the surgery allows the upper jaw (maxilla) to grow naturally, reducing the risk of surgical scar tissue restricting future facial development.

• Speech Development: The repair must be completed before the child begins forming complex speech patterns, which typically start around 18 to 24 months of age, ensuring they have the proper physical structures in place to learn clear articulation.

During the procedure, the surgeon elevates tissue flaps from the sides of the mouth, shifting them inward to close the gap between the nose and mouth. Crucially, the surgeon reconstructs the separated muscles of the soft palate, stitching them into a functional muscle sling that can lift and close against the back of the throat to support speech and improve ear drainage.

Core Difference 6: Long-Term Associated Health Complications

The long-term care plans for these conditions focus on different areas of development, requiring regular follow-up with a dedicated, multidisciplinary craniofacial team.

Complications linked to a Cleft Lip

Long-term challenges following a lip repair are primarily dental and orthodontic. When the structural split extends through the upper gum line (the alveolar ridge), it alters the development of primary and permanent teeth in that area. Children often experience missing teeth (frequently the lateral incisor), extra teeth, or poorly formed teeth that erupt at atypical angles.

This requires ongoing orthodontic care, starting with early jaw expansion and culminating in braces during adolescence. Additionally, between the ages of 8 and 12, these children often require an alveolar bone graft surgery. This procedure uses a small piece of bone (typically taken from the hip) to fill the gap in the upper gum line, providing a solid foundation to support the eruption of the permanent canine teeth. Cosmetic touch-ups to address lip scars or asymmetry of the nose may also be considered as the child grows.

Complications linked to a Cleft Palate

Long-term challenges following a palate repair focus heavily on hearing health and speech articulation. Because Eustachian tube dysfunction is almost universal when the palatal muscles are affected, these children are highly prone to chronic middle ear fluid buildup. To prevent hearing loss and recurrent infections, ear specialists usually insert small pressure equalization (PE) tubes into the eardrums during early infancy, often combining this with the palate surgery. These tubes are monitored regularly through routine audiology appointments.

Furthermore, even after a successful surgical closure, many children need targeted speech therapy. Therapy helps them learn how to coordinate their reconstructed soft palate muscles correctly and eliminates compensatory speech habits—such as throat clicks—that they may have developed before surgery. If the repaired palate cannot completely seal against the back of the throat during speech (a condition called velopharyngeal insufficiency), secondary surgeries may be required to improve speech clarity.

Understanding the Multifactorial Origins of Orofacial Clefts

To understand what is a cleft lip or palate from an etiologic standpoint, medical research looks beyond anatomy to explore the underlying causes of these birth defects. Orofacial clefts are considered multifactorial conditions, meaning they are caused by a combination of genetic predispositions and specific environmental influences during early pregnancy.

                          [Multifactorial Etiology Web]
                                        │
         ┌──────────────────────────────┴──────────────────────────────┐
         ▼                                                             ▼
 [Genetic Predispositions]                                     [Environmental Catalysts]
 - Inherited Risk Genes (e.g., IRF6)                           - First Trimester Maternal Smoking
 - Is Cleft Lip Genetic: Elevated Risk Profiles                - Maternal Diabetes & Nutrient Deficiencies
 - Syndromic vs. Non-Syndromic Markers                         - Early Gestational Medication Exposures

Is Cleft Lip Genetic?

When parents ask is cleft lip genetic, the answer is that genetics play a significant role in creating a susceptibility to the condition. Orofacial clefts can be split into two broad genetic categories:

• Non-Syndromic Clefts (Approx. 70% of cases): The child is born with a split lip or palate, but has no other physical or developmental issues. This is not caused by a single inherited gene; instead, multiple genes (such as variations in the IRF6 gene family) interact to create a vulnerability. If a parent or sibling was born with a cleft, the statistical risk of the condition occurring in future pregnancies is elevated.

• Syndromic Clefts (Approx. 30% of cases): The cleft occurs as part of an underlying genetic syndrome that affects multiple organ systems. Examples include Van der Woude syndrome, Stickler syndrome, and Patau syndrome (Trisomy 13). In these scenarios, the condition follows specific genetic inheritance patterns.

Environmental Factors and Prevention Strategies

Understanding what causes cleft lip or palate also involves looking at maternal environmental exposures during the critical first two months of pregnancy, often before a woman knows she is pregnant. Key factors that increase the risk of an orofacial cleft include:

• Maternal Smoking and Alcohol Exposure: Smoking during the first trimester is one of the most clearly established risk factors, as toxins can restrict oxygen delivery to the developing fetal face.

• Nutritional Deficiencies: A lack of maternal folic acid (folate) before conception and during the early weeks of pregnancy is linked to a higher risk of clefts. This has led to global healthcare recommendations for women of childbearing age to take daily folic acid supplements.

• Maternal Health Conditions: Poorly controlled pre-existing maternal diabetes or a high fever during the first trimester can disrupt embryonic development.

• Medication Exposures: Taking certain medications during the early weeks of pregnancy—such as anti-seizure drugs (like topiramate or phenytoin) or strong acne medications (retinoids)—has been shown to increase the risk of clefts.

Additional information is vital for understanding cleft conditions

Beyond a direct comparison, a deeper understanding of cleft conditions requires knowledge of their classifications, diagnostic methods, underlying causes, and the comprehensive, team-based approach necessary for effective treatment and long-term care. Furthermore, grasping the nuances of different cleft types and the collaborative roles of various medical specialists provides crucial context for families navigating this journey. This broader perspective helps clarify why treatment is a multi-stage process that addresses not just the visible separation but also associated challenges in feeding, hearing, speech, and dental development.

Classifications and Structural Types of Orofacial Clefts

Orofacial clefts are classified based on their anatomical location, the completeness of the tissue separation, and whether they affect one or both sides of the face.

                       [Orofacial Cleft Classification Matrix]
                                          │
         ┌────────────────────────────────┴────────────────────────────────┐
         ▼                                                                 ▼
 [Cleft Lip Categories]                                            [Cleft Palate Categories]
  ├── Unilateral (Left or Right Side Only)                          ├── Incomplete (Soft Palate Muscle Only)
  ├── Bilateral (Left and Right Sides Combined)                     ├── Complete (Soft and Hard Palate Breached)
  └── Incomplete vs. Complete (Nostril/Alveolar Breach)             └── Submucous (Hidden Muscle Split Beneath Mucosa)

Cleft Lip Classifications

• Unilateral Cleft Lip: The physical split occurs on only one side of the upper lip (more frequently manifesting on the left side).

• Bilateral Cleft Lip: The tissue separation occurs on both the left and right sides of the upper lip. This leaves the central structural segment of the lip and gum line (the prolabium) isolated, often causing it to project forward from the baby’s face.

• Incomplete vs. Complete: An incomplete cleft lip is a localized gap or notch that does not extend into the floor of the nose. A complete cleft lip is a total separation that runs from the lip all the way up into the nostril, splitting the underlying orbicularis oris muscle and breaching the alveolar ridge (the upper gum line).

Cleft Palate Classifications

• Incomplete Cleft Palate: The internal fissure is confined to the flexible, muscular tissue at the back of the mouth, known as the soft palate.

• Complete Cleft Palate: The opening runs the entire length of the roof of the mouth, creating a wide channel through both the muscular soft palate and the bony hard palate.

• Submucous Cleft Palate: A hidden structural variation where the underlying palatal muscles fail to fuse correctly, but the overlying pink surface lining (mucous membrane) remains completely intact. It is invisible upon basic external inspection and is often identified by a split (bifid) uvula, a thin translucent zone in the hard palate, or unexplained speech delays.

Clinical Diagnostic Methods

The timeline and method for diagnosing an orofacial cleft depend on whether the defect involves external facial skin or internal oral structures.

Prenatal Diagnostic Screening

A cleft lip, especially a complete or bilateral variation, is frequently detected before birth during a routine 20-week anatomy ultrasound scan. High-resolution imaging can visualize the physical gap in the upper lip and any associated flattening of the nose. This early detection gives families and medical providers a window to coordinate with a craniofacial team before delivery.

However, minor, incomplete cleft lips or isolated cleft palates are rarely caught on prenatal ultrasounds. The fetal tongue often blocks the view of the roof of the mouth, making it difficult to see an internal opening on a standard scan.

Postnatal Diagnostic Confirmation

Because isolated cleft palates are hidden internally, they are typically diagnosed immediately after birth during the newborn physical examination. A clinician inspects the inside of the open mouth under a bright light and manually sweeps a gloved finger along the entire length of the hard and soft palate to check for any hidden gaps or muscle separation.

A submucous cleft palate is the most difficult type to identify at birth because the surface tissue appears intact. It is often diagnosed later in childhood when food or liquids leak into the nose during feeding, or when the child begins to speak with a distinct, hypernasal tone.

Underlying Causes and Genetic Risk Factors

Orofacial clefts are multifactorial conditions, meaning they are caused by an interaction between an underlying genetic susceptibility and specific environmental exposures during the first trimester of pregnancy. The facial structures must fuse between the fourth and ninth weeks of embryonic development; any disruption during this critical window can halt the process.

[Genetic Susceptibility (Risk Genes / Family History)] + [Environmental Catalyst (Exposures / Deficiencies)] 
                                           │
                                           ▼
                     [Disrupted Process Fusion (Weeks 4-9)] ──► Orofacial Cleft

Genetic and Syndromic Influences

Genetics play a major role in creating a vulnerability to orofacial clefts. If a parent or sibling was born with a cleft, the statistical risk of the condition occurring in future pregnancies is elevated.

Cleft conditions can occur in isolation (non-syndromic) or as part of over 400 recognized genetic syndromes (syndromic). For instance, Van der Woude syndrome is an autosomal dominant condition linked to cleft lip and palate alongside minor pits in the lower lip. Pierre Robin sequence is characterized by an underdeveloped lower jaw (micrognathia) that forces the tongue upward, physically blocking the palatal shelves from closing and resulting in a wide, U-shaped isolated cleft palate.

Environmental Modifiers and Prevention

• Nutritional Deficiencies: A lack of maternal folic acid (vitamin B9) during the early weeks of gestation is a known risk factor for cleft conditions. Healthcare guidelines recommend that women of childbearing age take daily folic acid supplements before conception to support healthy cell division and facial fusion.

• Maternal Health Conditions: Pre-existing maternal conditions, such as poorly controlled type 2 diabetes or maternal obesity, are associated with a higher incidence of orofacial clefts.

• Teratogenic Exposures: Smoking tobacco or drinking alcohol during the first trimester significantly increases the risk of clefts by restricting oxygen delivery to the fetus. Additionally, first-trimester exposure to certain medications, such as anti-seizure drugs (like topiramate or phenytoin), increases the risk of these birth defects.

The Multidisciplinary Cleft Care Team Model

Because an orofacial cleft affects multiple functional areas, managing the condition requires a coordinated, long-term approach involving a multidisciplinary team of specialists. This team provides integrated care from infancy through adolescence and early adulthood.

The Core Craniofacial Team

• Craniofacial/Plastic Surgeon: Leads the surgical plan, performing the early lip repair (cheiloplasty) around 3 to 6 months of age, followed by the palate repair (palatoplasty) between 9 and 18 months. They also perform any necessary secondary procedures, such as scar revisions or nose adjustments, as the child grows.

• Speech-Language Pathologist (SLP): Joins the care plan during infancy to guide parents on specialized feeding techniques. As the child grows, the SLP monitors speech development, working to eliminate hypernasal speech or compensatory habits (such as throat clicks) that can develop when the palate muscles are split.

• Pediatrician: Manages the child’s routine medical care, tracks physical growth, and ensures the infant is gaining enough weight to safely undergo surgeries.

Dental, Otologic, and Psychosocial Support

Orthodontist and Oral Surgeon: Monitor jaw growth and dental development, which are frequently disrupted if the cleft crosses the gum line. The orthodontist uses appliances to align the jaw segments, preparing the child for an alveolar bone graft surgery (typically performed by the oral surgeon between ages 8 and 12) to stabilize the upper jaw for permanent teeth.

Otolaryngologist (ENT) and Audiologist: Manage ear health and hearing function. Because split palate muscles cannot properly open the Eustachian tubes, fluid regularly accumulates in the middle ear. The ENT surgeon often inserts small ventilation tubes (ear tubes) into the eardrums during early infancy, while the audiologist conducts regular hearing tests to protect against conductive hearing loss.

Craniofacial Psychologist or Social Worker: Provides emotional and mental health support for the child and family. They help navigate the stress of multiple surgeries, address concerns about facial differences, and build social confidence as the child grows.

Conclusion

Cleft lip and cleft palate are related conditions, but they are not the same. Cleft lip mainly affects the upper lip and facial appearance, while cleft palate affects the roof of the mouth and may have a greater impact on feeding, speech, and ear health. Both conditions can often be repaired with surgery, though timing, treatment steps, and follow-up needs may differ. If a baby is diagnosed with cleft lip, cleft palate, or both, early care from a specialized cleft team can help support feeding, development, speech, hearing, dental health, and confidence over time.

Read more: 10 Things to Know About Polymyositis and Muscle Inflammation

Frequently Asked Questions

1. What is a cleft lip?

A cleft lip is an opening or split in the upper lip that forms before birth. It happens when the tissues that make up the lip do not fully join during fetal development. The opening may be small, or it may extend upward toward the nose. A cleft lip can occur on one side, both sides, or in the center, though center clefts are less common.

2. What is the difference between cleft lip and cleft palate?

A cleft lip affects the upper lip, while a cleft palate affects the roof of the mouth. A baby may have a cleft lip, a cleft palate, or both conditions together. Cleft lip is often more visible from the outside, while cleft palate may be found during an exam inside the mouth. Both can affect feeding and development, but cleft palate is especially linked with speech and ear concerns.

3. Can cleft lip and cleft palate happen together?

Yes, cleft lip and cleft palate can happen together in the same baby. This occurs when both the lip and the roof of the mouth do not close fully during development. The combination may affect appearance, feeding, dental growth, speech, and hearing. A specialized cleft care team can help plan treatment from infancy through childhood.

4. How are cleft lip and cleft palate treated?

Treatment usually involves surgery, but the timing depends on whether the child has cleft lip, cleft palate, or both. Cleft lip repair is commonly done during infancy, while cleft palate repair may happen later in the first one to two years of life. Some children may also need feeding support, speech therapy, dental care, orthodontics, or additional surgeries as they grow. The treatment plan is personalized based on the child’s anatomy, health, and developmental needs.

5. What causes cleft lip?

Cleft lip is usually caused by a mix of genetic and environmental factors, though the exact cause is often unknown. Some risk factors may include family history, smoking during pregnancy, diabetes before pregnancy, and use of certain medicines during pregnancy. Not every baby with a cleft lip has an identifiable risk factor. Parents should not blame themselves, and a healthcare provider or genetic counselor can help explain possible causes and recurrence risk.

Sources

• Cleft Lip and Cleft Palate – Symptoms and Causes (Mayo Clinic)
• Cleft Lip and Cleft Palate – Diagnosis and Treatment (Mayo Clinic)
• Cleft Lip and Palate (MedlinePlus)
• Cleft Lip and Palate: MedlinePlus Medical Encyclopedia
• Cleft Lip and Palate Repair (MedlinePlus Medical Encyclopedia)
• Cleft Lip/Cleft Palate | Birth Defects (CDC)
• Cleft Lip & Cleft Palate: Causes & Treatment (Cleveland Clinic)
• Cleft Lip and Palate (National Institute of Dental and Craniofacial Research)