The cleft lip, also known as cheiloschisis or cleft lip, is a congenital malformation that affects the upper lip and determines, on the latter, the presence of one or two fissures of varying size.

In general, the labbroleporino is associated with another congenital malformation of the face: the so-called cleft palate.

The precise causes of cleft lip are unknown. According to the most reliable hypotheses, the condition would be due to a combination of genetic and environmental factors.

The presence of the cleft lip can lead to difficulties in sucking mother's milk and eating, speaking problems and dental problems.

The cleft lip is a malformation identifiable even before birth, by means of a normal ultrasound examination of the fetus in utero.

The diagnosis at birth is practically immediate and is generally based on a simple physical examination.

Currently, the cleft lip is a treatable condition with excellent results. The main treatment is surgical and consists in closing the or the cracks on the upper lip.

What is the cleft lip?

The cleft lip is a congenital malformation - belonging to the category of oro-facial clefts - which is characterized by the presence of one or two cracks at the level of the upper lip .

The size and extent of the cracks, which distinguish the cleft lip, may vary from subject to subject: in some individuals, the fissure or fissures may be limited to the upper lip and to a minimum part of the overlying skin; in other subjects, however, the fissure or fissures may extend from the upper lip to the floor of one or both nasal nostrils.

Medical meaning of cleft and facial cleft

The word schisi is synonymous with spacing . In medicine, this term indicates the presence, on an anatomical organ, of a tissue fissure along the median line, consequent to a welding error.

Typically, cleft is a congenital condition (ie present since birth). Thus, the welding error, which leads to the appearance of tissue cracking, takes place during embryonic development.

The oro-facial clefts are a group of malformations that involve the presence, on the mouth or on the face, of a fissure or tissue spacing of variable amplitude.

The phenomena of oro-facial cleft can affect the palate (cleft palate), the upper lip (cleft lip), ears, eyes, nose and forehead.


The cleft lip can appear alone or in association with another fairly common and known oro-facial cleft: the so-called cleft palate . Cleft palate presents a crack in the soft palate or hard palate, which can extend to the nasal cavities.

The association between cleft lip and cleft palate is a fairly common medical condition, which is called cleft lip and palate .


The cleft lip is also known as cleft lip or cleft lip .


In the so-called Western World, the cleft lip, associated with cleft palate, affects 1-2 newborns every 1, 000 newborns.

In important countries such as the United Kingdom or the United States, it is the most common congenital physical malformation.

The cleft lip is more widespread in the male population: according to various statistical studies, in fact, the newborn males with cleft lip would be at least double the newborn females.

The cleft lip - and, more generally, all forms of oro-facial cleft - are more widespread in Asian populations, Caucasian whites and so-called Native Americans, while they are uncommon among Africans and African Americans.


The term "cleft lip" refers to the similarity between the mouth of people with cleft lip and the mouth of hares and rabbits.

Although its use is very common, the term in question is to be considered offensive and derogatory.


In humans, the lips form between the fourth and seventh week of fetal development ; they result from a process that sees the tissues of the future aimed to grow from the sides of the face towards the center of the latter and weld together when they are reached.

Therefore, the formation of the lips - as well as the other structures present at the center of the face (nose, palate etc.) - represents the final stage of the embryonic process of creation of the face.

In people with cleft lip, the welding of tissues that, coming from the sides of the head, must give rise to the lips, does not happen or occurs incorrectly. Failure to weld the aforementioned tissues leaves a crack, which is the characteristic cracking present on the upper lip of people with cleft lip.


The precise causes of cleft lip are still unclear, not to say unknown.

According to the most reliable theories of researchers, the malformation in question would be due to a combination of genetic and environmental factors .

With regard to genetic factors, researchers believe that the cleft lip may depend, at least in part, on one or more DNA mutations / anomalies, taking place shortly after conception (therefore in the first moments of embryonic development). Studies carried out in this regard have shown that, in the human genome, there are genes (short but significant DNA sequences), whose alteration (due for example to a mutation) is responsible for a wrong development of facial features (including lips) .

With regard to environmental factors, scholars believe that some behaviors or conditions of the mother, during pregnancy, may compromise the normal development of lip formation processes. Among the behaviors and conditions of the mother that could play a role on the appearance of the cleft lip, are:

  • Smoking . In this regard, the numbers speak for themselves: children with cleft lip or another cleft-facial cleft, who were born to women smokers, are more than children with the same malformations born of non-smoking women. On the basis of this observation, the experts concluded that women who smoke during pregnancy have a greater tendency to give birth to children with a cleft lip than non-smoking women;
  • Use certain drugs . Among the incriminated medicines, we note: the antiepileptics / anticonvulsants (valproic acid, tapiramate etc.), the medicines for acne based on accutane and methotrexate.

    On antiepileptic / anticonvulsants it is worth adding that the assumptions considered most dangerous are those that occur during the first trimester of pregnancy;

  • Diabetes . Statistical studies have shown that women with diabetes are more likely than non-diabetic women to give birth to children with cleft lip;
  • Drinking alcohol . The same applies to smoking;
  • Obesity . Among obese women during pregnancy, researchers observed a greater propensity to give children with a cleft lip;
  • Advanced age . The advanced age of the pregnant woman is a condition associated, in general, with a greater probability of genetic defects affecting the fetus;
  • Folic acid deficiency .

Risk factors for cleft lip (from the mother's point of view):

  • Smoking and / or drinking alcohol during pregnancy;
  • Suffering from diabetes during pregnancy;
  • Obesity during pregnancy
  • Folic acid deficiency during pregnancy
  • Old age
  • Taking drugs against epilepsy

Some of the genes with a possible role on the appearance of the cleft lip:

  • CLPTM1
  • GAD1
  • IRF6
  • BMP4
  • TBX22
  • AXIN2
  • FGFR1


In the past, after having noticed a recurrence of the cleft lip in certain family nucleuses, some researchers advanced the hypothesis that the cleft lip could, in some cases, have a hereditary origin.

However, subsequent researches, aimed at proving the aforementioned hypothesis, have failed; therefore, the experts have discarded the idea that, on the development of the cleft lip, some hereditary component may affect.

Symptoms, signs and complications

The typical symptoms of cleft lip consist of:

  • Difficulty sucking mother's milk and eating . In the human being, the lips of the mouth are fundamental to suck the milk from the mother, during the first years of life, and to take food at a later stage.

    A malformation such as the cleft lip makes it difficult to suck milk from the mother's breast, in infants, and to take food in older untreated children.

  • Speech problems . People with cleft lip tend to express themselves in an unclear way and, for this reason, to have different difficulties in relating to others.

    Furthermore, as they age, they have a tendency to develop a nasal voice.

  • Teeth problems . Those suffering from cleft lip often develop an anomalous dentition, misaligned and easily subject to caries.


In addition to the difficulties and problems discussed above, people with cleft lip and cleft palate (cleft lip and palate) also complain of recurrent infections of the middle ear ( otitis ). The propensity to otitis depends on the cracking present on the palate, typical of cleft palate. In fact, this cracking is responsible for a deformation of the Eustachian tube, such that the middle ear of the cleft palate has the tendency to accumulate liquid inside it.

The abnormal accumulation of fluid in the middle ear promotes bacterial proliferation and the consequent appearance of otitis.

Failure to treat otitis leads, in the long run, to a hearing loss, sometimes even very evident.


For some time now, there has been the possibility of diagnosing the cleft lip before the birth of the affected subject ( prenatal diagnosis ), through a simple ultrasound of the fetus in utero ( prenatal ultrasound ).

If, for some reason, the malformation escaped those who perform the prenatal ultrasound scan (so the prenatal diagnosis did not take place), the diagnosis of cleft lip is easily established immediately after birth, with a simple physical examination . The anomalies on the upper lip, in fact, are evident from the first moments of life.


The treatment of the cleft lip includes surgical operations and medical therapies aimed at improving the symptomatology (therefore the difficulties in speaking, in sucking the mother's milk, etc.).


During the lifetime, patients with cleft lip must undergo at least a couple of surgical procedures

The first operation usually takes place between the 2nd and 3rd month of life - therefore quite early - and involves the closure of the cracks on the upper lip .

It should be noted that, if there are two cracks, the surgeons perform the surgery in two sessions, at least seven days apart.

The or subsequent interventions take place when the patient is a teenager and have a predominantly aesthetic purpose, as they are aimed at making the appearance of the upper lip and the portion of skin between the upper lip and nose as normal as possible.

The number of surgeries that an individual with a cleft lip must undergo depends mainly on the severity of the malformation. This means that the more the labial anomaly is severe, the more it is likely that multiple operations are needed.

Important note : the doctors agree that, in order to obtain good results from the first operation, the latter must be practiced within the first year of life.


The medical therapies implemented in the case of cleft lip include dental care, treatment and prevention of otitis (if the condition is associated with cleft palate), a therapy focused on improving speech and speech skills, etc.


The treatment of the cleft lip involves a team of specialists, who work closely together for a common purpose: the good of the patient.

Among the professional figures that generally deal with subjects with cleft lip, include:

  • The plastic surgeon. He is the specialist responsible for the assessment of the labial malformation and who establishes the most appropriate surgical treatment.
  • The oral surgeon (or odontostomatologist). It is the specialist who, together with the cosmetic surgeon, provides for the repair of the malformed lip, with the final aim of eliminating or, at least, considerably reducing the difficulties in eating.
  • The orthodontist. He is the specialist in charge of giving the teeth a normal, aligned appearance.
  • The dentist. It is the professional who takes care of caries, in order to preserve teeth.
  • The prostodontist. It is the specialist who creates dental prostheses for those patients with cleft lip who develop very serious dental problems.
  • The speech therapist. He is the expert who has the task of improving language skills.
  • The psychologist. It is the figure that has the task of relating to the patient's family, to understand what the mood of the entire family unit is.

In the presence of cleft lip and palate, the team of specialists, who follow the patients, also includes the otolaryngologist. The latter has the task of assessing the extent of ear problems and finding a preventive remedy against otitis episodes.


Thanks to modern surgical techniques, today the cleft lip presents a prognosis, in most cases, favorable.

In fact, although lasting for several years, cleft lip treatments guarantee excellent results, so that many patients, at the end of treatment, tend to have a normal-looking face, to speak clearly and to feed themselves adequately and without problems.


As long as its triggering causes are not clear, the cleft lip will remain an impossible condition to prevent.


To reduce the risk of giving birth to a child with a cleft lip, doctors advise pregnant women to control presumed environmental factors, therefore they recommend: not smoking, controlling body weight, monitoring blood sugar and avoiding intake of those drugs associated with the onset of the cleft lip (anticonvulsants, anti-acne based accutane etc.).