Cheiloschisis of the Upper Lip

Other names
Types
Causes
Symptoms and signs
Diagnostic tests
Non-pharmacological treatments
Drug treatments
Dietary molecular supplements
Drugs for immunity booster / regenerative / stem-cell
Surgeries (procedures and why they are done)
Preventions (risk-reduction for future pregnancies)
When to see doctors (urgent and non-urgent)
What to eat and what to avoid
FAQs

Cheiloschisis of the upper lip means a split or gap in the upper lip that is present from birth. It happens when the parts of the baby’s face that should join together in early pregnancy do not come fully together. The opening can be small and only in the red part of the lip, or it can be large and go up into the nose.

Cheiloschisis of the upper lip means a baby is born with a split (gap) in the upper lip because the lip parts did not fully join together early in pregnancy. People also call it cleft lip. The gap can be small (a notch) or wide, and it can affect one side (unilateral) or both sides (bilateral). Sometimes it happens with a cleft palate, and sometimes it does not. []

This is a structural birth difference, not an infection and not something the child “caught.” The main treatment is team-based care (feeding support, speech and hearing care, dental/orthodontic care, and planned surgery). Many children do very well after repair, but they may need follow-up for speech, ear infections, hearing, and teeth alignment as they grow. []

This problem begins in the embryo in the first weeks of pregnancy, when the maxillary process and the middle part of the upper lip should fuse. If this fusion is incomplete, a cleft or gap forms. The cleft may be on one side of the lip, on both sides, or very rarely in the center. Many children with cheiloschisis are otherwise healthy, but some have other birth problems as part of a syndrome.

Other names

Cheiloschisis of the upper lip is usually called cleft lip. Doctors may also use the words labial cleft or orofacial cleft when they talk about this problem in the lip and nearby face. The old term “hare lip” is sometimes seen in older books, but it is now considered hurtful and is not used in respectful medical language. When a cleft lip happens together with a split in the roof of the mouth, it is called cleft lip and palate.

Types

Unilateral incomplete cleft lip
This is a cleft on one side of the upper lip that does not go all the way into the nostril. Part of the lip is split, but some skin and muscle still join the lip to the nose. This type may cause mild shape change of the nose but often can be repaired with one surgery.
Unilateral complete cleft lip
Here the cleft is on one side and runs from the lip all the way up into the nostril. The lip, gum, and base of the nose on that side are clearly separated. The nostril may be wider and pulled up. This type usually needs careful surgery and long-term follow-up for teeth and nose growth.
Bilateral incomplete cleft lip
In this type there are clefts on both sides of the upper lip, but they do not fully reach the nostrils. The middle segment of the lip (called the prolabium) stays attached somewhat, but the shape of the lip is still abnormal. Babies may still have trouble getting a good seal for feeding.
Bilateral complete cleft lip
This is the most severe lip form. There are clefts on both sides, and the middle piece of the lip and upper gum is free and sticks forward. The nose is often very flat and wide. These babies almost always need a full cleft team (plastic surgeon, dentist, speech therapist, and others) for many years.
Midline cleft lip (median cheiloschisis)
This type is rare. The split is in the center of the upper lip instead of the side. It is often linked with serious brain or skull problems, so doctors look carefully for other defects when they see a midline lip cleft.
Cleft lip with cleft palate
Sometimes the lip cleft happens together with a cleft in the roof of the mouth. The split then continues behind the lip into the hard and soft palate. These children have more problems with feeding, speech, and ear infections and need more operations over time.

Causes

Genetic changes in the baby
Some babies have changes in certain genes that control how the face forms. These changes can be part of a known syndrome or can be small gene changes that only increase risk. In many families more than one person may have a cleft lip, showing that genes are important.
Family history of cleft lip or palate
When a parent, brother, or sister has a cleft, the chance is higher that a new baby will also have one. The risk is still not 100%, but it is clearly higher than in families with no clefts at all.
Chromosome problems and syndromes
Some chromosome disorders and multiple-anomaly syndromes include cleft lip as one of many birth problems. In these cases, cheiloschisis is only one sign along with heart, limb, or brain defects.
Maternal smoking during pregnancy
Smoking in early pregnancy lowers oxygen in the baby and adds toxic chemicals. Large studies show that mothers who smoke have a higher chance of having a baby with cleft lip or palate than mothers who do not smoke.
Alcohol use during pregnancy
Drinking alcohol while pregnant can harm the developing facial tissues. Alcohol can disturb the growth of cranial neural crest cells, which help form the lip and palate, so regular drinking in early pregnancy increases the risk of orofacial clefts.
Lack of folic acid and other vitamins
Poor intake of folic acid and other key vitamins before and during early pregnancy has been linked with more cleft lip and palate. Folic acid is needed for normal cell growth and DNA building, so low levels may disturb normal face formation.
Maternal diabetes
Women who have diabetes before pregnancy, especially if blood sugar is not well controlled, have a greater chance of having a baby with a cleft lip or palate. High sugar levels can affect many steps of organ and face development.
Maternal obesity
Being very overweight before pregnancy is another risk factor. Obesity is often linked with insulin resistance, inflammation, and vitamin imbalance, which together may raise the risk of orofacial clefts in the baby.
Certain anti-seizure medicines
Some older epilepsy medicines, such as phenytoin and valproate, are known to increase the chance of cleft lip or palate when used in early pregnancy. These medicines act as teratogens, meaning they can disturb normal embryo development.
Retinoic acid and high vitamin A exposure
Very high doses of vitamin A or retinoic acid drugs used for skin disorders can cause facial defects, including cleft lip. These drugs affect signals that guide facial outgrowth and fusion, so strict pregnancy rules are used when women take them.
Other prescription drugs in early pregnancy
Some blood-pressure medicines and other drugs have been linked to cleft lip in rare cases. Often the risk is small, but doctors try to avoid high-risk drugs during the weeks when the lip is forming.
Low oxygen (hypoxia) in early pregnancy
Animal studies show that low oxygen levels in the mother can increase cleft lip and palate. If the embryo does not get enough oxygen during critical weeks, fusion of the facial processes may fail. Smoking is one common cause of such hypoxia.
Exposure to certain chemicals and pesticides
Some industrial chemicals, organic solvents, and farm pesticides are suspected risk factors. Women who work with these substances without good protection may have a slightly higher chance of having a baby with a cleft lip.
Maternal infections and high fever
Serious infections with high fever in early pregnancy may disturb many organ systems, including the face. Fever and infection-related inflammation can interfere with normal cell growth and fusion of the lip.
Poor overall nutrition
Not only folic acid but overall poor diet and low protein can weaken embryo growth. In some countries, malnutrition is a strong background factor for cleft lip and other birth defects.
Advanced maternal age
Older mothers, especially over 35, may have a slightly higher risk of having a child with cleft lip. This may be due to more chromosome errors, more medical problems, and greater drug exposure with age.
Parental consanguinity (blood relation)
When the parents are close relatives, the chance of passing on the same harmful gene changes is higher. In some regions with frequent consanguineous marriage, cleft lip and palate occur more often.
Environmental pollution and toxins
Air pollutants, heavy metals like lead, and some water pollutants have been studied as possible risk factors. They may not cause clefts alone but can add to the total load of harmful influences on the embryo.
Multifactorial interaction of many small risks
In most babies there is no single clear cause. Instead, there is a mix of small genetic risks and medium environmental risks that together pass a threshold and lead to a cleft lip. This is called multifactorial inheritance.
Unknown cause
Even with modern tests, many cases have no clear reason identified. Parents should be told that they did not “cause” the cleft; most cases appear without any obvious mistake or exposure.

Symptoms and signs

Visible split in the upper lip
The main sign is an obvious opening in the upper lip. It can be small or large, on one side or both sides. This gap is usually clear as soon as the baby is born.
Opening that may reach the nose
In more severe forms, the cleft continues up into the nostril. The nose opening may look wider, higher, or pulled to one side.
Flattened or twisted nose shape
The cleft pulls the muscles and cartilage of the nose. This can make one side of the nose flat or crooked. The base of the nose can also be low or wide.
Gap in the gum (alveolus)
Many babies with cleft lip also have a gap in the upper gum where the teeth should grow. Later, this may cause missing teeth or teeth that grow in the wrong place.
Feeding difficulty in newborns
Babies need a good lip seal to suck milk from breast or bottle. A cleft lip makes it hard to get this seal, so feeding can be slow, and the baby may tire easily or swallow more air.
Milk leaking from the nose (if palate also cleft)
When cleft lip occurs with cleft palate, milk can pass up into the nose during feeding. Parents may see milk coming from the nostrils when the baby sucks or cries.
Poor weight gain in early months
Because feeding is harder, some babies do not gain weight as quickly as expected. Doctors watch growth charts closely and may suggest special bottles or feeding plates.
Frequent ear infections (with palate involvement)
A cleft in the palate can affect the muscles that open the eustachian tube in the ear. This can lead to fluid build-up and repeated middle-ear infections, which may also affect hearing.
Hearing problems
Long-term fluid and infection in the middle ear can cause mild hearing loss. This makes it harder for the child to hear speech clearly and can slow language learning if not treated.
Nasal-sounding speech
After surgery, some children still have speech that sounds very nasal, especially if the palate was also cleft. Air escapes through the nose instead of the mouth when they speak.
Trouble saying certain consonants
Sounds that need full lip closure (like “p” and “b”) or pressure in the mouth (like “s” and “t”) may be hard for children with a history of cleft lip and palate. They may need speech therapy to learn correct sound patterns.
Dental crowding and tooth problems
Teeth near the cleft area may be missing, extra, or rotated. The jaw may not grow evenly, which can cause crowding, cross-bite, or open bite that needs orthodontic care.
Dryness or cracking at cleft edges
The skin at the edge of the cleft or around scars after surgery may dry out and crack easily. This can cause minor pain or bleeding but is usually manageable with simple skin care.
Psychological and social stress
As the child grows, visible facial difference and speech problems can lead to teasing, low self-esteem, or shyness. Family and school support and, when needed, counseling can help.
Anxiety in parents and caregivers
Parents may feel shock, guilt, or fear when they first see the cleft. They may worry about feeding, surgery, and the child’s future. Good education and support from the cleft team are important for family well-being.

Diagnostic tests

Physical examination tests

General newborn physical exam
Right after birth, the doctor examines the whole baby from head to toe. They look at the lip, nose, mouth, hands, feet, heart, and other organs to see if the cleft lip is alone or part of a wider syndrome.
Focused inspection of lip, nose, and gum
The doctor looks closely at the size and shape of the cleft, the nostrils, and the upper gum. They check whether the cleft is unilateral or bilateral, complete or incomplete, and whether the gum ridge is also split. This helps plan surgery.
Examination of the palate and inside of the mouth
With a light and a tongue depressor, the doctor looks inside the mouth to see if the palate is also cleft. They check the hard and soft palate for visible gaps and for signs of a hidden (submucous) cleft.
Growth and nutrition assessment
The baby’s weight, length, and head size are measured and plotted. This shows whether feeding is adequate or if special feeding help is needed before surgery.
General physical exam for other anomalies
The doctor also looks for heart murmurs, limb differences, or facial features that might suggest a genetic syndrome. This helps decide if more specialist tests are needed.

Manual tests

Palpation of the upper lip and muscles
By gently feeling the lip, the surgeon can judge how much muscle is present on each side and where it is attached. This guides how they will bring the muscles together during repair.
Palpation of hard and soft palate
Sometimes the lining of the palate looks normal, but there is a split under the surface. The doctor uses a gloved finger to feel for notches or gaps in the bone or soft tissue that show a submucous cleft.
Manual assessment of sucking and swallowing
A gloved finger placed in the baby’s mouth lets the clinician feel how strong the sucking is and whether the baby can coordinate suck, swallow, and breath. This helps in choosing the best feeding method.
Simple nasal airflow check
The doctor may place a small cold mirror or finger under each nostril while the baby breathes to see how air flows in and out on each side. Differences in fogging or airflow can show how the cleft affects the nose passage.

Lab and pathological tests

Basic blood tests for surgery preparation
Before the first lip-repair operation, doctors often check a complete blood count, clotting tests, and basic chemistry. These tests make sure the baby is healthy enough for anesthesia and surgery.
Genetic consultation and targeted gene tests
If there are other birth problems or a strong family history, the team may send blood for specific gene tests. These can look for known cleft-related genes or genes linked with certain syndromes.
Chromosomal microarray or karyotype
In some babies, a chromosome test is done to look for missing or extra pieces of chromosomes that could explain the cleft and other anomalies. Finding a syndrome helps with prognosis and family planning.
Metabolic or other special lab tests (when indicated)
When the baby shows unusual features, failure to thrive, or organ problems, extra lab tests may be ordered. These can help rule out rare metabolic or genetic diseases that include cleft lip.

Electrodiagnostic tests

Electrocardiogram (ECG) before anesthesia
Before surgery, many centers do an ECG to check the baby’s heart rhythm and electrical activity. This is especially important if there is a heart murmur or known heart disease.
Brainstem auditory evoked response (BAER) test
If hearing problems are suspected, a BAER test can be done. Small electrodes on the head record brain responses to clicking sounds. This helps find hearing loss in babies who cannot do hearing tests that need cooperation.
Nerve conduction or EMG (rare, for special cases)
In very rare situations where a nerve problem is suspected, doctors may use electrical tests to study nerve and muscle function in the face. This is not routine but may be used in complex cases with facial weakness.

Imaging tests

Prenatal ultrasound of the fetal face
Many cleft lips are first seen on a detailed ultrasound around 18–22 weeks of pregnancy. The sonographer looks at the profile and front view of the baby’s face to see if the lip line is continuous or broken.
Fetal MRI (magnetic resonance imaging)
When the ultrasound picture is not clear or when the doctor needs more detail about the palate and other structures, a fetal MRI can be done. MRI uses magnets, not X-rays, and gives a clearer view of soft tissues like the lip and palate.
Postnatal facial and dental X-rays
As the child grows, orthodontists may use X-rays to see the teeth buds, jaw bones, and cleft gap in the gum. This helps plan bone grafts and braces at the right age.
CT scan or 3-D imaging of the face
In more complex cases, a CT scan or 3-D imaging gives detailed pictures of the bones of the face and skull. Surgeons use these images to plan advanced operations for the nose, jaw, or midface later in childhood.

Non-pharmacological treatments

Feeding assessment and coaching: A feeding specialist checks latch, breathing, and milk flow, then teaches safer feeding positions and pacing. Purpose: help baby gain weight. Mechanism: reduces milk leakage and fatigue by improving technique and rhythm. []
Specialty cleft bottles/teats: Using bottles designed for cleft feeding can make milk flow easier without needing strong suction. Purpose: steady nutrition. Mechanism: controlled flow and squeeze-assist reduces energy use during feeds. []
Frequent weight monitoring: Regular weight checks catch slow growth early. Purpose: prevent malnutrition before surgery. Mechanism: quick detection lets the team adjust feeding plan and calories. []
Burping and pacing strategies: Babies with clefts often swallow more air while feeding. Purpose: reduce vomiting and discomfort. Mechanism: paced feeding and frequent burps lower stomach air and reflux stress. []
Positioning for safer feeding: Upright or semi-upright feeding positions are often advised. Purpose: reduce choking and nasal leakage. Mechanism: gravity and airway alignment improve swallow safety. []
Lactation support (if breastfeeding is possible): Some babies can breastfeed; many need mixed methods. Purpose: maximize breast milk benefits. Mechanism: tailored latch and supplementation plan supports intake while protecting supply. []
Presurgical lip taping: Gentle taping can bring lip segments closer in selected infants. Purpose: make later repair easier. Mechanism: steady light force guides soft tissues toward better alignment over time. []
Nasoalveolar molding (NAM): A custom device can shape gum segments and the nose before surgery in some babies. Purpose: reduce cleft gap and improve nasal form. Mechanism: slow molding uses newborn cartilage flexibility and guided pressure. []
Other presurgical orthopedics: Some teams use appliances other than NAM depending on the cleft type. Purpose: improve alignment for surgery. Mechanism: controlled guidance influences maxillary segments as the baby grows. []
Hearing screening and ENT follow-up: Ear infections and hearing issues are more common. Purpose: protect speech and learning. Mechanism: early detection and treatment reduces long-term hearing loss risk. []
Speech-language therapy (early monitoring): Even before speech starts, therapists monitor sounds and feeding-swallow patterns. Purpose: prevent speech delays. Mechanism: early exercises and parent coaching support correct sound development. []
Dental and gum (alveolar) monitoring: Teeth and bite can be affected as the child grows. Purpose: prevent severe malocclusion and dental problems. Mechanism: early checks guide timing of orthodontics and later procedures. []
Orthodontic planning: Some children need braces or expansion later. Purpose: improve bite and facial balance. Mechanism: gradual forces move teeth and guide jaw growth patterns. []
Psychological support for child and family: Visible differences can affect confidence. Purpose: reduce stress and support healthy self-image. Mechanism: counseling and coping skills lower anxiety and social withdrawal. []
Genetic counseling (when indicated): Some clefts occur with syndromes or family patterns. Purpose: explain recurrence risk and related checks. Mechanism: history + exam + testing (if needed) clarifies cause and guides future pregnancy planning. []
Prenatal detection and planning: Many cleft lips can be seen on ultrasound. Purpose: prepare feeding plan and team care at birth. Mechanism: early planning reduces delay in support and improves early weight gain. []
Scar care education after repair: Parents learn safe cleaning and scar protection. Purpose: better cosmetic outcome. Mechanism: gentle care reduces irritation, infection risk, and pigment changes. []
Sun protection for scars: Sun can darken scars. Purpose: reduce noticeable scar color. Mechanism: UV blocking limits pigment over-production during healing. []
Sleep and airway observation: Some babies have breathing or obstruction concerns, especially with associated conditions. Purpose: safety. Mechanism: early identification leads to timely ENT/sleep evaluation and safer positioning. []
Long-term team follow-up schedule: Care often continues for years (speech, hearing, dental, facial growth). Purpose: prevent missed problems. Mechanism: planned checkups catch issues early and treat step-by-step. []

Drug treatments

Important: cheiloschisis/cleft upper lip is mainly treated with surgery + team care; medicines are usually used for peri-operative care, pain, infection prevention/treatment, nausea control, or reflux when needed. Doses depend on age, weight, and the surgeon/anesthesia plan—never self-dose a child. []

Cefazolin (IV): A common surgical antibiotic used to help prevent wound infection. Class: cephalosporin antibiotic. Dose/time: given right before surgery; team may repeat based on surgery length. Purpose: infection prevention. Mechanism: blocks bacterial cell wall building. Side effects: allergy, diarrhea, rash. []
Clindamycin (IV/PO): Often used if a patient cannot take beta-lactam antibiotics. Class: lincosamide antibiotic. Dose/time: peri-op alternative; sometimes short course if infection risk is high. Purpose: infection prevention/treatment. Mechanism: blocks bacterial protein making. Side effects: diarrhea, C. difficile risk, rash. []
Amoxicillin (PO): Used when a child has an oral/skin infection risk or confirmed bacterial infection (doctor decision). Class: penicillin antibiotic. Dose/time: usually in divided daily doses for days. Purpose: treat susceptible bacteria. Mechanism: disrupts bacterial cell wall. Side effects: rash, diarrhea, allergy. []
Amoxicillin–clavulanate (PO): Used when broader coverage is needed (provider choice). Class: penicillin + beta-lactamase inhibitor. Dose/time: divided doses with meals for days. Purpose: treat mixed bacteria. Mechanism: amoxicillin kills; clavulanate blocks resistance enzymes. Side effects: diarrhea, rash, liver enzyme rise. []
Cephalexin (PO): Sometimes used for skin/soft-tissue bacterial coverage if needed after evaluation. Class: cephalosporin antibiotic. Dose/time: divided doses for days. Purpose: treat susceptible bacteria. Mechanism: blocks bacterial cell wall. Side effects: stomach upset, rash, allergy. []
Acetaminophen/Paracetamol (IV or PO): Common first-line pain and fever medicine after surgery. Class: analgesic/antipyretic. Dose/time: scheduled or as needed (clinician-set). Purpose: pain control. Mechanism: acts on pain/fever pathways in the brain. Side effects: liver injury if overdosed. []
Ibuprofen (PO): Often used for pain and inflammation when the surgeon says it is safe. Class: NSAID. Dose/time: given with food; pediatric dosing is weight-based. Purpose: reduce pain/swelling. Mechanism: lowers prostaglandins (COX inhibition). Side effects: stomach irritation, kidney stress, bleeding risk. []
Ketorolac (IV/IN): Strong NSAID sometimes used short-term for post-op pain under supervision. Class: NSAID. Dose/time: short course only. Purpose: reduce pain without opioids. Mechanism: COX inhibition reduces inflammatory pain chemicals. Side effects: bleeding risk, kidney injury, stomach ulcer risk. []
Morphine (IV/PO): Used for moderate to severe post-op pain when needed. Class: opioid analgesic. Dose/time: carefully titrated by clinicians. Purpose: pain relief. Mechanism: activates opioid receptors to reduce pain signals. Side effects: sleepiness, constipation, nausea, breathing suppression. []
Fentanyl (IV): Common anesthesia-related opioid for surgery and early recovery. Class: opioid analgesic. Dose/time: given in the operating room or recovery by anesthesia team. Purpose: pain control during surgery. Mechanism: strong opioid receptor activation. Side effects: breathing suppression, chest rigidity (rare), nausea. []
Sevoflurane (inhaled): Widely used inhaled anesthetic for pediatric surgery. Class: volatile anesthetic. Dose/time: controlled by anesthesiologist during surgery. Purpose: keep patient asleep and pain-free. Mechanism: alters brain signaling to cause unconsciousness. Side effects: low blood pressure, nausea, agitation on wake-up (some patients). []
Propofol (IV): IV anesthesia drug used for induction or maintenance in some cases. Class: anesthetic/sedative. Dose/time: given by anesthesia team in monitored setting. Purpose: start/maintain anesthesia. Mechanism: boosts GABA calming signals in the brain. Side effects: low blood pressure, breathing suppression, injection pain. []
Lidocaine (local): Local numbing medicine sometimes used with or without epinephrine. Class: local anesthetic. Dose/time: injected locally by clinician. Purpose: reduce pain and bleeding. Mechanism: blocks nerve sodium channels so pain signals stop. Side effects: numbness, toxicity if overdosed (medical emergency). []
Bupivacaine (local): Longer-acting local anesthetic used for longer pain relief after surgery. Class: local anesthetic. Dose/time: local injection; dose is carefully limited. Purpose: longer pain control. Mechanism: blocks nerve signal conduction. Side effects: heart rhythm problems if toxic dose occurs. []
Epinephrine (with local anesthetic or emergency use): Often added in tiny amounts to local anesthetic to reduce bleeding; also an emergency drug. Class: adrenergic agonist. Dose/time: clinician-controlled. Purpose: reduce bleeding, support blood pressure if needed. Mechanism: tightens blood vessels and stimulates heart. Side effects: fast heart rate, anxiety, high blood pressure. []
Ondansetron (IV/PO): Common anti-nausea medicine after anesthesia. Class: 5-HT3 blocker antiemetic. Dose/time: single dose or short course. Purpose: prevent vomiting (important after lip repair). Mechanism: blocks serotonin signals that trigger vomiting. Side effects: headache, constipation, rare rhythm changes. []
Dexamethasone (IV): Often used by anesthesia teams to reduce swelling and nausea risk. Class: corticosteroid. Dose/time: peri-op single dose or short course (doctor decision). Purpose: decrease inflammation and vomiting. Mechanism: calms immune/inflammatory signals. Side effects: blood sugar rise, mood changes, infection risk with longer use. []
Midazolam (IV/IN/IM): Used for calming anxiety and for sedation in monitored settings. Class: benzodiazepine. Dose/time: procedural, short-term use. Purpose: reduce anxiety and help with anesthesia start. Mechanism: increases GABA calming effect in the brain. Side effects: sleepiness, breathing suppression, paradoxical agitation (rare). []
Oxymetazoline (nasal): A nasal decongestant that can reduce nasal swelling/bleeding in selected situations (clinician-guided). Class: topical alpha-agonist decongestant. Dose/time: short use only. Purpose: reduce nasal congestion/bleeding. Mechanism: tightens nasal blood vessels. Side effects: rebound congestion if overused; dangerous if swallowed by children. []
Omeprazole (PO): Used when reflux is significant and a clinician decides acid control is needed. Class: proton pump inhibitor (PPI). Dose/time: daily course; reassess need. Purpose: reduce acid irritation. Mechanism: blocks stomach acid pumps. Side effects: diarrhea, headache; long use may affect minerals/infection risk. []

Dietary molecular supplements

Supplements are not a “cure” for cleft lip, but good nutrition supports growth, surgery readiness, and healing. Babies and children should only use supplements chosen by a clinician to avoid wrong dosing. []

Folic acid (for future pregnancies): Important before conception and early pregnancy to lower neural tube defect risk; evidence for cleft reduction is mixed, but folate is still recommended for pregnancy health. Dose: commonly 400 μg daily when trying to conceive through early pregnancy (unless doctor says otherwise). Function/mechanism: supports DNA formation and cell growth. []
Prenatal multivitamin (for mothers planning pregnancy): Helps cover key micronutrients (folate, iodine, iron, etc.). Dose: product-specific. Function/mechanism: supports maternal nutrient stores needed for fetal development. []
Vitamin D: Supports bone and immune function; deficiency is common in many regions. Dose: clinician-set (especially for infants). Function/mechanism: helps calcium absorption and immune regulation. []
Zinc: Helps wound healing and immune function, especially if dietary intake is low. Dose: clinician-set. Function/mechanism: supports enzyme systems for tissue repair and immunity. []
Vitamin C (ascorbic acid): Supports collagen formation for healing. Dose: clinician-set. Function/mechanism: helps build connective tissue and acts as antioxidant. []
Iron: Used if iron deficiency or anemia is confirmed. Dose: clinician-set; too much can be harmful. Function/mechanism: improves oxygen delivery for growth and healing. []
Vitamin B12: Important for nerve function and blood formation; used if deficiency is present (especially in restrictive diets). Dose: clinician-set. Function/mechanism: supports red blood cell production and DNA synthesis. []
Omega-3 (DHA/EPA): Supports brain development; often discussed for infant nutrition. Dose: clinician-guided (especially in infants). Function/mechanism: supports cell membranes and brain/eye development. []
Choline: Important nutrient for fetal brain development (relevant to pregnancy planning). Dose: diet-first; supplement only if advised. Function/mechanism: supports methylation and cell membrane signaling. []
Protein supplementation (food-based first): If a child is not gaining weight, clinicians may increase calories/protein using formula fortification or nutrition plans. Dose: individualized. Function/mechanism: protein provides building blocks for healing tissue. []

Drugs for immunity booster / regenerative / stem-cell

There are no routine FDA-approved “stem cell drugs” to repair cleft lip tissue in everyday cleft care. Be careful of clinics promising stem-cell cures for cleft conditions; the U.S. Food and Drug Administration warns that many regenerative products are marketed without approval for most uses. []

Filgrastim (G-CSF; NEUPOGEN): Used to raise neutrophils in specific medical conditions (like chemotherapy-related neutropenia), not to “treat cleft lip.” Dose: weight-based, doctor-controlled. Function/mechanism: stimulates bone marrow to make neutrophils. Use in cleft context: only if a child has a separate neutrophil problem. []
Becaplermin (PDGF gel; REGRANEX): A growth-factor gel for certain diabetic ulcers, not for cleft repair. Dose: thin layer to ulcer area (per label). Function/mechanism: signals cells involved in repair and blood vessel growth. Use in cleft context: generally not used; only a specialist decides in rare wound cases. []
Palifermin (keratinocyte growth factor; KEPIVANCE): Used to reduce severe mouth sores in specific cancer therapy settings, not for cleft repair. Dose: clinician-controlled IV schedule. Function/mechanism: supports growth of mouth lining cells. Use in cleft context: not routine; only if another serious condition exists. []
Hematopoietic progenitor cells, cord blood (cell therapy category): These are approved for blood/immune system reconstitution in transplant medicine, not for cleft lip. Dose: transplant-specialist selected cell dose. Function/mechanism: replaces damaged blood-forming system. Cleft context: unrelated unless the child has a separate blood disease. []
DUCORD (HPC, Cord Blood): An FDA-regulated cord blood product used in hematopoietic stem cell transplantation, not cleft repair. Dose: chosen by transplant team. Function/mechanism: provides CD34+ stem/progenitor cells to rebuild blood and immunity after conditioning. Cleft context: not a cleft treatment. []
ALLOCORD (HPC, Cord Blood): Another FDA-regulated cord blood product for transplant indications, not cleft repair. Dose: transplant-team selected. Function/mechanism: immune and blood reconstitution after transplant conditioning. Cleft context: not used unless separate transplant indication exists. []

Surgeries (procedures and why they are done)

Primary cleft lip repair (cheiloplasty): The surgeon closes the gap, rebuilds the lip muscle ring, and shapes the lip for function and appearance. Why done: improve feeding, speech development support, and facial symmetry. Timing is often within the first year of life depending on health and center practice. []
Rotation-advancement type repair (common technique family): The surgeon rotates and advances lip tissue flaps to recreate a natural lip curve and Cupid’s bow. Why done: better lip shape and muscle alignment, aiming for natural movement and scar placement. []
Nasal correction at time of lip repair (primary rhinoplasty elements): Many teams adjust the nose cartilage and nostril shape during lip repair. Why done: improve nasal breathing and symmetry early, reducing later deformity. []
Secondary lip revision (scar or asymmetry revision): Some children need a later small operation to improve lip shape, scar, or muscle function. Why done: refine appearance and function as the face grows. []
Secondary rhinoplasty / nasal revision (later childhood/teen years): A later nose surgery may be planned after growth milestones. Why done: improve nasal symmetry, breathing, and final facial balance when growth is more stable. []

Preventions (risk-reduction for future pregnancies)

Many cleft cases have no single known cause, but risk can be reduced by improving health before and during pregnancy. []

Stop smoking before pregnancy: Smoking is linked with higher risk of orofacial clefts. []
Avoid secondhand smoke: Smoke exposure also increases risk in studies. []
Control diabetes before pregnancy: Pre-pregnancy diabetes is linked with higher birth defect risk, including orofacial clefts. []
Review epilepsy medicines with a doctor: Some anti-seizure medicines are linked with higher cleft risk; never stop suddenly—plan safely with a clinician. []
Take folic acid when trying to conceive: Recommended for early pregnancy health; it clearly prevents neural tube defects and may help overall congenital anomaly prevention. []
Avoid alcohol during pregnancy: Alcohol increases birth defect risk; safest level in pregnancy is none. []
Avoid unnecessary teratogenic medicines: Ask a clinician before using retinoids, certain hormones, or unneeded drugs in early pregnancy. []
Treat maternal infections and fever safely: High fever and illness can raise risk; seek early prenatal care. []
Healthy weight and nutrition before pregnancy: Balanced nutrition supports normal fetal development and lowers some risks. []
Early prenatal care + ultrasound screening: Early care helps detect clefts and plan feeding/surgery support immediately after birth. []

When to see doctors (urgent and non-urgent)

See a cleft/craniofacial team as early as possible after birth (or even prenatally) to plan feeding and surgery timing. If the baby has poor weight gain, choking, breathing trouble, repeated ear infections, or delayed speech milestones, do not wait—get assessment quickly. []

Seek urgent care immediately if there are signs of dehydration (very few wet diapers, very sleepy), blue color or breathing struggle during feeding, or persistent vomiting with poor intake, because feeding safety and growth are the first priorities before surgery. []

What to eat and what to avoid

Eat: breast milk or formula as advised; Avoid: forcing feeds when baby is exhausted—use pacing and specialist guidance. []
Eat: small, frequent feeds to reduce fatigue; Avoid: long stressful feeding sessions that burn more calories than they give. []
Eat: higher-calorie plan if prescribed (fortified milk/formula); Avoid: random calorie boosters without clinician approval. []
Eat: soft foods after surgery when allowed; Avoid: hard, sharp foods that can injure the repair (follow surgeon’s exact instructions). []
Eat: protein-rich foods (eggs, fish, lentils, dairy) for older children; Avoid: low-protein “junk” calories during healing. []
Eat: fruits/vegetables for vitamins; Avoid: very spicy/acidic foods soon after mouth surgery if they irritate. []
Eat: clean water (age-appropriate); Avoid: sugary drinks that increase dental risk. []
Eat: iron-rich foods if advised; Avoid: giving iron supplements without testing or a clinician plan. []
Eat: yogurt/soft nutritious snacks (older child); Avoid: sticky sweets that cling to teeth, especially if dental alignment is difficult. []
Eat: balanced meals for steady growth; Avoid: smoking exposure around the child (harms healing and overall health). []

FAQs

Is cheiloschisis the same as cleft lip? Yes. Cheiloschisis is a medical word for cleft of the upper lip present at birth. []
Did the parents cause it? Most of the time the exact cause is unknown; it is usually a mix of genes and other factors. []
Can cleft lip be seen before birth? Often yes, especially cleft lip, by routine prenatal ultrasound. []
Will my baby be able to eat? Yes, with the right plan. Many babies need special feeding support and sometimes special bottles. []
Does cleft lip always include cleft palate? No. Some babies have only cleft lip, some only cleft palate, and some have both. []
When is surgery usually done? Timing depends on health, cleft type, and center practice; cleft lip repair is often in the first year of life. []
Will my child need more than one surgery? Some children do, especially for revision, nose shape, or related dental/jaw stages. []
Will speech be normal? Many children speak well, but some need speech therapy and monitoring, especially if palate is involved. []
Why are ear infections common? Children with clefts can have ear/hearing issues more often, so ENT and hearing checks matter. []
Is NAM required? Not always. Some teams use it, some do not; evidence and protocols vary by center and cleft type. []
Are there medicines that “heal” the cleft without surgery? No—cleft lip is a structural difference. Medicines are supportive (pain control, infection prevention, nausea control) around care. []
Are “stem cell cures” real for cleft lip? Routine stem-cell cures are not part of standard cleft treatment; be cautious with unapproved regenerative claims. []
Can cleft lip be prevented 100%? No, but risk can be reduced (no smoking, good diabetes control, safe medication planning, folic acid). []
Will my child look normal after repair? Many children have excellent results; scars usually fade but may still be visible, and some need revisions. []
What is the best next step after diagnosis? Get care with a coordinated cleft/craniofacial team so feeding, surgery, speech, hearing, and dental care are planned together. []

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: January 30, 2025.

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