Cleft lip is one of the most common birth defects that may affect children from birth. It is a cleft in the upper lip and may also be accompanied by a cleft in the roof of the throat. It occurs as a result of incomplete healing of tissues during the formation of the fetus in the mother’s womb. The degree of the cleft varies from one case to another, and may affect nutrition, speech, breathing, and the general appearance of the face. With medical progress within Al Mousa Health Hospital, diagnostic and treatment methods have become available and effective, enabling the child to live normally, especially if intervention is done in a timely manner and under the supervision of a specialized medical team that includes surgery.

What is a cleft lip?

It is a congenital deformity that appears at birth and consists of a cleft or opening in the upper lip. This cleft may sometimes extend to the nose or be accompanied by a cleft in the palate. This condition occurs when the parts responsible for forming the lip in the fetus are not completed during the first weeks of pregnancy. 

In addition, the degree of the cleft may vary from a simple one on one side of the lip to a more complex one that includes both sides. It may also affect breastfeeding, speech, breathing, and sometimes hearing or the arrangement of the teeth.

Causes of cleft lip

It is a birth defect that may occur as a result of a group of reasons that include genetic and environmental factors. These reasons can be summarized as follows:

• The genetic factor, as the probability of cleft lip occurring increases if there is a family history of this type of congenital deformity.
• Lack of essential nutrients during pregnancy, especially folic acid, which is necessary for the proper formation of fetal tissues.
• The mother's use of some medications during the first months of pregnancy, such as epilepsy medications or antidepressants, may affect the growth of the face and jaw in the fetus.
• Exposure to harmful chemicals, radiation, smoking, or drinking alcohol during pregnancy are environmental factors that may contribute to this deformity.
• The mother contracting certain diseases during pregnancy, such as viral infections or uncontrolled diabetes, may negatively affect the development of the fetus.

What are the types of cleft lip?

The types of this disease vary based on the location of the incision and the number of affected sides, and can be classified into the following types:​

• Unilateral: In this type, the cleft appears on one side of the upper lip, and the cleft may be incomplete, as it does not extend to the nose, or complete, extending from the side of the lip to the nostril.​
• Bilateral: The cleft appears on both sides of the upper lip, like the unilateral type. The cleft can be incomplete and not reach the nose, or complete and extend from both sides of the lip to the nostrils.​
• Partial cleft lip: It is considered one of the simplest types, as only part of the upper lip is affected without the cleft extending to the nose or palate.​
• Full lip: In this case, the cleft extends from the upper lip through the gums and may reach the base of the nose, which may affect the formation of the teeth and gums.​
• Cleft lip and palate: In some cases, a cleft lip may be accompanied by a cleft palate (cleft palate), which may lead to feeding and speech problems.

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Methods of diagnosing cleft lip

Cleft palate is diagnosed in multiple ways that depend on the timing of discovery, whether before or after birth, to ensure appropriate care for the child. Below is a breakdown of the diagnostic methods as follows:

Prenatal diagnosis:

• Ultrasound imaging: This examination is routinely used during pregnancy to monitor the growth of the fetus. The doctor can detect cleft palate starting from the thirteenth week of pregnancy, as it appears as a cleft in the upper lip. As pregnancy progresses, the diagnosis becomes more accurate and clear. However, it may be difficult to detect cleft palate using ultrasound alone.​
• 3D and 4D ultrasound: These techniques are more accurate in imaging the facial features of the fetus, which helps in determining the presence of a lip more clearly. These examinations are used especially if there are risk factors or suspicion of congenital malformations.​
• Amniocentesis: If cleft lip is discovered or suspected, the doctor may recommend amniocentesis, which is a test in which a sample of the amniotic fluid surrounding the fetus is withdrawn to examine the chromosomes. This test aims to detect any associated genetic syndromes that may be the cause of the occurrence of cleft lip.

Diagnosis after birth:

• Clinical examination: The presence of a cleft lip is usually noticed immediately after birth through a physical examination of the child.
• Evaluation of feeding and swallowing functions: Children with cleft lip may have difficulties with sucking and feeding, so their ability to suck and swallow is evaluated to ensure they receive adequate nutrition.​
• Hearing tests: Because of the increased risk of middle ear infections and hearing loss in children with cleft lip, a hearing test may be done to ensure proper ear function.​
• Genetic evaluation: If there is suspicion of a genetic syndrome associated with cleft lip, the child and his family may be referred to a genetic counselor for a comprehensive evaluation and counseling.

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How to treat cleft lip

Cleft lip is a congenital deformity that requires multi-stage surgical intervention to ensure the restoration of normal functions and improve the aesthetic appearance of the child. Below is a breakdown of the treatment steps:​

 التدخل الجراحي:

• Cleft lip repair: The first surgery is usually performed when the baby is between 3 and 6 months old. The surgeon makes incisions on either side of the cleft in the lip, then uses the available tissue to close the gap, improving the shape and function of the lip and nose.​
• Cleft palate repair: If there is a cleft in the roof of the mouth, it is usually surgically repaired when the child is between 9 and 18 months old. This surgery aims to close the cleft to improve the ability to eat and speak and reduce the risk of ear infections.​

 Follow-up and complementary treatments:

• Speech therapy: Children with cleft lip may have difficulties with speech.
• Orthodontics: Some cases may require orthodontic interventions to ensure the teeth are properly aligned.
• Follow up with an audiologist: Due to the increased risk of ear infections and hearing loss, your hearing condition should be monitored regularly. Ventilation tubes may be placed in the middle ear to prevent fluid buildup and reduce the risk of hearing loss.​
• Psychosocial support: Psychological support is an important part of treatment, as it can help the child and his family deal with the psychological and social challenges associated with cleft lip.​

 Additional plastic surgeries:

• Improving the appearance of the lip and nose: Additional plastic surgery may be needed to improve the appearance of the lip and nose, especially as the child grows and develops his facial features.

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Complications of cleft lip

Cleft lip may lead to several complications that affect the child’s health and development if not treated appropriately. Below is a breakdown of the most important of these complications:

• Feeding difficulties: Children with cleft lip face difficulty in breastfeeding or artificial feeding due to milk leakage from the mouth into the nose, which may lead to nutritional deficiency and delayed growth.
• Ear infections and hearing loss: Children with cleft palate are more susceptible to fluid accumulation in the middle ear, which increases the risk of recurrent ear infections and may lead to hearing loss if appropriate medical intervention is not provided.
• Teeth and jaw problems: Children with cleft lip may suffer from abnormalities in dental development, such as missing, extra, or irregular teeth, in addition to problems with jaw growth, which requires orthodontic or surgical interventions.
• Speech difficulties: A cleft palate can affect speech development as speech may appear nasal or slurred, requiring speech therapy to improve the child’s communication skills.
• Psychological and social problems: Children with cleft lip may face psychological and social challenges due to their different appearance or speech difficulties, which may affect their self-confidence and their interaction with others.

Frequently asked questions

Does a cleft lip appear on ultrasound?

Yes, a cleft lip can appear on ultrasound, especially during the second trimester of pregnancy, when the doctor can clearly notice the cleft in the upper lip, but in some cases the vision may be incomplete, and a three-dimensional or four-dimensional ultrasound is used to confirm the diagnosis and determine the degree and location of the cleft accurately.

Is cleft lip disease hereditary?

Cleft lip disease may be hereditary in some cases, as it is more likely to occur if there is a family history of it. However, the cause is not always hereditary. Environmental factors such as nutritional deficiency or taking certain medications during pregnancy may also play a role in its appearance.

What is the success rate of cleft lip surgery?

The success rate of cleft lip surgery is very high and in most cases reaches more than ninety percent, especially when performed at the appropriate age. With a specialized medical team, the surgery helps improve form and function and reduces complications. Treatment is sometimes supplemented with speech or orthodontic sessions to achieve the best results.

In the end, cleft lip is one of the conditions that can be treated successfully if it is detected early and the appropriate treatment plan is followed. Surgery at Al Mousa Health Hospital plays an essential role in improving the shape of the lip and the function of the mouth, in addition to psychological support and complementary treatment within the Al Mousa Hospital Well-Being Center, such as speech sessions and dental care. With continuous follow-up, the child can grow and develop normally without this condition affecting his daily life or his future.

Sources and references

Why we should no longer call cleft lip a “harelip” – spaltkinder