Cleft lip is a congenital craniofacial anomaly characterized by a physical separation or split in the upper lip. It results from failure of the embryonic facial tissues to fuse properly between the 4th and 7th week of gestation. The cleft can be unilateral or bilateral and can vary in severity from a small notch in the lip (incomplete cleft) to a complete fissure extending into the nose. Frequently, cleft lip co-occurs with a cleft of the gum (alveolus) and/or the palate, but it can also present in isolation. Cleft lip with or without cleft palate is one of the most common birth defects worldwide, occurring in approximately 1 in 700 live births.
Management of cleft lip is multidisciplinary, involving surgeons, speech-language pathologists, orthodontists, and other specialists from birth through adolescence. In the neonatal period, the priority is ensuring adequate feeding and weight gain. Parents are instructed in adaptive feeding techniques and may use specialized nipples or bottles to compensate for the infant’s inability to create suction. Definitive treatment is surgical: lip repair is usually performed in infancy (often around 10–12 weeks old under the classic “rule of 10s”) to restore the continuity of the lip and the underlying orbicularis oris muscle. This early cheiloplasty also improves nasal shape and oral function.
Post-surgically, SLPs monitor speech and language development. Most children with isolated cleft lip do not require extensive speech therapy, but brief intervention may be needed for residual articulation issues. Orthodontic care and alveolar bone grafting (around 8–10 years of age) address any gaps in the dental arch when the gum ridge is involved. Psychosocial support is provided as needed to support self-esteem, especially in cases of visible scarring. Coordinated cleft team follow-up is critical to achieving optimal long-term outcomes across speech, dental, hearing, and emotional health domains.
Unrepaired cleft lip can lead to immediate feeding difficulties in infancy. Infants have trouble achieving an adequate seal for sucking, resulting in poor intake and nasal regurgitation of milk. Feeding problems are a primary concern in babies with cleft lip, and special bottles or techniques are often required until surgical repair. Unlike cleft palate, an isolated cleft lip has minimal direct effect on speech articulation once repaired. However, it may interfere with early bilabial sound production and contribute to temporary speech delays prior to surgery.
Cleft lip also carries psychosocial significance: the visible facial difference can affect parent–infant bonding and impact the child’s self-image and social interactions later in life. Modern cleft lip repair (cheiloplasty), typically performed around 3–4 months of age, yields excellent cosmetic and functional outcomes. After timely lip repair, most children develop normal speech and resonance if the palate is intact. Children with cleft lip involving the alveolus may still be at risk for dental anomalies and require orthodontic intervention. Ongoing monitoring by a cleft team is essential to address potential issues with hearing, speech, and psychosocial development.
Schaffrath, K., Ooms, M., Seidel, S., Hölzle, F., & Modabber, A. “An Evaluation of Speech Therapy Care in the Surrounding Area of an Interdisciplinary Cleft Lip and Palate Tertiary Care Center.” Scientific Reports 15 (2025).
Subramaniyan, B., & Nagarajan, R. “Communication Disorders in Individuals with Cleft Lip and Palate: An Overview.” Indian Journal of Plastic Surgery 43, Suppl. 1 (2010).
Gritli-Linde, A. “Molecular Control of Secondary Palate Development.” Developmental Biology 301, no. 2 (2007).
