Congenital Fissure of Lip

Congenital fissure of lip is another name for cleft lip. It means a baby is born with a split or gap in the upper lip. This gap happens very early in pregnancy when the parts of the baby’s upper lip do not join together completely. The split can be small, like a notch, or large and go up to the nose. It can be on one side or both sides of the lip. Cleft lip can happen alone or together with a split in the roof of the mouth (cleft palate).

A congenital fissure of the lip is another way to say cleft lip. It means a baby is born with a split (gap) in the upper lip because the left and right parts of the lip did not fully join together early in pregnancy. The gap can be small (a tiny notch) or large (a wide opening), and it may happen on one side or both sides. Some babies also have a cleft in the gum line or roof of the mouth (cleft palate), but some have only the lip. Cleft lip is common, treatable, and many children grow up healthy with the help of a cleft care team. []

A cleft lip can affect feeding, speech, teeth alignment, ear infections, and self-confidence, but not every child has all of these problems. The best care is usually planned by a multidisciplinary cleft team (surgeon, dentist/orthodontist, speech therapist, ENT, nurse, and counselor), because the needs can change as the child grows. []

Another names

Doctors and parents may use many names for congenital fissure of lip. All of these point to almost the same condition, with small differences in detail:

• Cleft lip

• Congenital cleft lip

• Cleft lip with or without cleft palate

• Orofacial cleft (a broader term that includes cleft lip and cleft palate)

• Unilateral cleft lip (split on one side only)

• Bilateral cleft lip (splits on both sides)

• Complete cleft lip (split goes up into the nose)

• Incomplete cleft lip (split is only part way up the lip)

• Microform cleft lip (very small, thin scar-like cleft)

• Cleft lip deformity

The old word “harelip” was used before, but it is now seen as unkind and is not advised, so doctors avoid it.

Types

We can describe the main types of congenital fissure of lip in a simple list:

• Unilateral cleft lip – the split is only on one side of the upper lip, left or right.

• Bilateral cleft lip – there are splits on both sides of the upper lip. This often makes the middle part of the lip and gum (the philtrum and premaxilla) stick forward.

• Midline (median) cleft lip – the gap is in the very center of the upper lip; this is rare and is often linked to other brain or facial problems.

• Complete cleft lip – the split goes all the way from the red part of the lip up into the nostril, and the gum under it is often split too.

• Incomplete cleft lip – the split is only in part of the lip and does not reach the nostril.

• Cleft lip with cleft palate – the lip and the roof of the mouth are both split. Feeding, speech, hearing and teeth problems are more common in this group.

• Isolated cleft lip – only the lip is split; the palate is closed and normal.

• Syndromic cleft lip – the cleft lip happens as part of a larger genetic syndrome with other body problems, such as heart defects or limb differences.

• Non-syndromic cleft lip – the cleft lip happens alone, without other clear birth defects; genes and environment still play a part.

• Microform cleft lip – a very mild form that may look like a small notch, groove, or thin scar line on the lip rather than a big open gap.

Causes

Cleft lip usually has many causes together, not just one. Genes and environment both add to the risk. In many babies, no single clear cause is found.

1. Genetic changes in lip-forming genes
Many genes help control how the face and upper lip form in early pregnancy. Changes (mutations or variants) in some of these genes can make the lip fail to join fully, so a cleft forms. These changes can be inherited from a parent or can happen for the first time in the baby.

2. Family history of cleft lip or palate
If a parent, brother, sister, or close relative was born with a cleft lip or cleft palate, the chance that a baby will also have a cleft is higher than in families with no history. This shows that genes play an important part, even when no single gene test explains it.

3. Cleft part of a genetic syndrome
In some babies, the cleft lip is only one sign of a larger syndrome, such as Van der Woude syndrome or other Mendelian conditions. In these syndromes, a gene problem affects many parts of the body, including the lips and palate, so the cleft is one feature among others.

4. Maternal smoking in pregnancy
Smoking cigarettes during early pregnancy has been linked to a higher risk of cleft lip and palate. Chemicals in cigarette smoke may damage cells or disturb the signals that tell the facial tissues how to grow and join, so the lip may stay open.

5. Maternal alcohol use in early pregnancy
Drinking alcohol, especially heavy use, during the first weeks of pregnancy can add to the risk of orofacial clefts. Alcohol can harm the developing embryo and interfere with normal facial growth, leading to clefts as part of fetal alcohol spectrum disorders or as an isolated problem.

6. Low folic acid or folate intake
Folic acid (a B-vitamin) is needed for normal cell division and tissue growth in the embryo. When a mother has low folate intake, especially before conception and in early pregnancy, the chance of cleft lip and other birth defects may be higher. Enough folic acid reduces this risk.

7. Poor general nutrition in the mother
Lack of good quality food, vitamins, and minerals in the mother can affect the way the baby’s face forms. Nutritional shortages, especially of key vitamins like folate and other micronutrients, have been associated with a higher rate of cleft lip and palate in some populations.

8. Certain anti-seizure (anticonvulsant) drugs
Some older anti-seizure medicines taken in early pregnancy have been linked to facial birth defects, including cleft lip and palate. The drugs may disturb normal tissue fusion in the face. For women with epilepsy, doctors try to choose safer medicines before pregnancy when possible.

9. Other teratogenic medicines (for example retinoic acid)
Some medicines, such as high-dose vitamin A or isotretinoin used for severe acne, are known to cause birth defects when taken in early pregnancy. These drugs can disturb the way facial tissues grow and may contribute to cleft lip among other serious problems.

10. Maternal diabetes
Mothers who have diabetes, especially if blood sugar is not well controlled very early in pregnancy, have a higher risk of having a baby with some birth defects, including cleft lip and palate. High glucose can damage early developing tissues and disturb normal fusion.

11. Maternal obesity
Being very overweight before pregnancy has been linked in some studies to a higher risk of orofacial clefts. The exact reason is not clear, but it might involve inflammation, hormone changes, or related conditions such as diabetes and poor diet quality.

12. Maternal infections in early pregnancy
Some infections in the first trimester can disturb fetal development. Certain viral or bacterial infections may slightly increase the risk of cleft lip as part of a more general pattern of birth defects, though this is less common than genetic and other environmental causes.

13. Exposure to harmful chemicals or pesticides
Contact with some industrial chemicals, solvents, or pesticides during pregnancy has been studied as a possible factor in orofacial clefts. These substances can be toxic to the embryo and may interfere with the normal growth of the face and lip, especially if exposure is high.

14. High maternal age
Older maternal age has been reported as a risk factor in some studies. Older eggs may carry more genetic changes, and older mothers may have more health problems or be taking more medicines, which together can slightly increase the chance of cleft lip.

15. Very young maternal age
On the other side, very young mothers may have higher risks because of poorer nutrition, less prenatal care, and possibly more smoking or alcohol use. All these social and health factors can contribute to the chance of having a baby with a cleft lip.

16. Lack of prenatal folic acid supplementation
Not taking folic acid tablets before and during early pregnancy is a specific, preventable factor. Studies suggest that regular folic acid use can lower the risk of cleft lip and palate, so when supplements are not used, the risk is higher than it needs to be.

17. Low socioeconomic status and limited prenatal care
Mothers who live in poverty or cannot reach good prenatal care often have more risk factors at the same time: poor diet, untreated illnesses, smoking, and environmental exposures. Together, these can increase the chance of a baby having a cleft lip.

18. Consanguinity (parents who are blood relatives)
In some regions, when parents are related (for example, cousins), recessive gene changes can come together in a baby. This may increase the risk of birth defects, including cleft lip and palate, especially when combined with other environmental factors.

19. Male sex of the baby
Cleft lip with or without cleft palate is seen more often in male babies in many studies. Being male does not “cause” the cleft, but male sex seems to be a risk marker linked to how facial tissues respond to genetic and environmental influences.

20. Unknown or multifactorial causes
In many children, doctors cannot find one exact cause. Instead, the cleft lip is thought to come from several smaller genetic and environmental factors working together. This is called a multifactorial cause, and it is probably the most common situation.

Symptoms

1. Visible split or gap in the upper lip
The most obvious sign is a clear split in the upper lip. It may look like a notch or a wide opening that goes up toward the nose. This is present at birth and is usually seen clearly right away in the delivery room.

2. Opening from lip into the nose
In a complete cleft lip, the gap may pass all the way into the nostril. This can change the shape of the nose on that side and make the nostril wider, flatter, or pulled upward.

3. Feeding and sucking problems
Many babies with cleft lip, especially when cleft palate is also present, have trouble creating a good seal on the breast or bottle. They may swallow a lot of air, get tired quickly while feeding, or take a long time to finish a feed.

4. Milk leaking from the nose while feeding
If the cleft involves the palate as well, milk can pass from the mouth into the nose during feeds, because the normal barrier between the mouth and nose is broken. Parents may see milk or formula coming out of the nostrils.

5. Poor weight gain or failure to thrive
Because feeding is hard work, some babies gain weight slowly. They may not take enough milk, lose calories from frequent vomiting or nasal leakage, and struggle to stay on a normal growth curve until feeding methods are adjusted.

6. Nasal-sounding or hypernasal speech
When a cleft palate is present and not fully repaired, air escapes through the nose during speech. This can make the child’s voice sound very nasal or unclear, and some consonant sounds are hard to pronounce properly.

7. Articulation and language delay
Children with cleft lip and palate may be slow to start talking or may use unusual speech patterns. They may need help from a speech and language therapist to learn clear speech sounds and improve overall language skills.

8. Frequent ear infections (otitis media)
Because the muscles of the palate help to open the Eustachian tube (the tube between the middle ear and the throat), children with cleft palate often have trouble with this tube. Fluid stays in the middle ear, and ear infections happen again and again.

9. Hearing loss, usually conductive
Fluid and repeated ear infections can reduce hearing. This is often a conductive hearing loss, where sound cannot pass well through the middle ear. If not found and treated, it can affect speech and school learning.

10. Dental problems and misaligned teeth
If the cleft passes through the gum, teeth in that area may be missing, small, extra, or badly placed. The upper jaw may not grow normally, causing the teeth of the upper and lower jaws not to meet correctly.

11. Nasal blockage or breathing difficulty on one side
The shape of the nostril and nose can be changed by the cleft, so air may not flow smoothly through the nose. Some children mainly breathe through the mouth and may snore or have noisy breathing.

12. Changes in facial appearance and asymmetry
Cleft lip can cause the nose, lips, and upper jaw to look uneven. This may be mild or very clear. Even after surgery, small differences may remain and may need later orthodontic and cosmetic work.

13. Difficulty chewing and swallowing solid foods
As the child grows, chewing and swallowing may still be harder, especially if teeth and jaw alignment are not correct. Some children take longer to move from soft foods to more solid foods safely.

14. Social, emotional, and self-esteem problems
Children and teenagers with cleft lip may feel different because of their appearance or speech. They might face teasing, feel shy, or avoid social activities, which can affect mood and self-confidence.

15. Dental pain and gum disease risk
Crowded or misplaced teeth in the cleft area are harder to clean. This raises the risk of tooth decay and gum disease, leading to pain and further dental treatment if regular care is not given.

Diagnostic tests

Cleft lip is usually easy to see at birth or even before birth. But extra tests help plan treatment, check hearing and speech, and look for related problems or syndromes.

Physical exam tests

1. Newborn facial and lip inspection
Right after birth, the doctor or midwife carefully looks at the baby’s face and lips. They note where the split is, how wide it is, whether it is on one or both sides, and whether the nose is also involved. This simple visual exam is the basic way to diagnose cleft lip.

2. Oral cavity and palate examination
The clinician opens the baby’s mouth and uses a light to look at the gums and roof of the mouth. They check if the palate is also split and whether the gum ridge is affected. This helps to separate isolated cleft lip from cleft lip with cleft palate, which changes the care plan.

3. Ear, nose, and throat (ENT) physical exam
An ENT specialist often examines the ears, nose, and throat to look for signs of fluid in the middle ear, blocked nose, or other structural problems that may affect breathing and hearing. This exam guides further hearing tests and possible early ear tube placement.

4. Growth and nutrition assessment (weight, length, head size)
From birth, the baby’s weight, length, and head circumference are measured and tracked over time. Problems with feeding due to cleft lip and palate may show up as slow weight gain, so regular measurement helps detect nutritional issues early.

5. Full body physical exam for syndromic features
The doctor examines the whole body, including the hands, feet, heart sounds, and nervous system, to see if there are other birth defects suggesting a genetic syndrome. Finding extra features can change the diagnosis and prompt genetic counselling and testing.

Manual tests and bedside assessments

6. Feeding and sucking assessment
A nurse, lactation consultant, or speech-language therapist watches the baby during breast or bottle feeding. They look at how well the baby latches, how strong the suck is, and how quickly the baby tires. This hands-on test tells the team what special bottles or positions are needed.

7. Palpation of the palate and gum with a gloved finger
The clinician gently feels the roof of the mouth and the gum ridge with a clean, gloved finger. This helps detect small or hidden gaps in the palate or gum that may not be easy to see, especially in a crying newborn.

8. Speech and articulation assessment (in older child)
When the child is older and speaking, a speech-language therapist listens carefully to the child’s speech, checks which sounds are hard, and looks for nasal escape of air. This manual clinical test helps decide if more surgery or therapy is needed for good speech.

9. Craniofacial measurements (anthropometry)
In some centers, doctors measure distances and angles between facial points, such as nose width and jaw position. These manual measurements help plan surgery, orthodontic work, and follow growth over time in children with cleft lip and palate.

Lab and pathological tests

10. Complete blood count (CBC) before surgery
Before cleft lip repair and later operations, a blood test called a complete blood count is done. It checks hemoglobin, white cells, and platelets. This helps make sure the child can safely have anesthesia and surgery without unexpected bleeding or infection risk.

11. Basic metabolic and chemistry tests
Simple blood chemistry tests (like electrolytes, kidney and liver function) may be done before surgery. These tests make sure organs are working well enough to handle anesthesia medicines and fluid changes during the operation.

12. Chromosome analysis (karyotype or microarray)
If the child has cleft lip plus other birth defects or developmental delay, doctors may order chromosome tests. These tests look for missing or extra pieces of chromosomes that might explain a syndrome that includes cleft lip.

13. Targeted cleft lip/cleft palate gene panel
Modern genetic labs offer gene panels with many cleft-related genes. A blood or saliva sample from the child (and sometimes the parents) can be tested to see if any known cleft genes carry harmful changes. This helps with prognosis and family planning.

14. Infection screening when syndromes are suspected
If the child has features that suggest an infection during pregnancy (for example, small head, eye or heart defects), doctors may order specific blood tests for infections like rubella or other TORCH infections. This can show whether an infection may have played a role.

15. Nutritional blood tests in the mother (for future pregnancies)
In some settings, the mother’s blood may be tested for folate, vitamin B12, or other nutrients when planning another pregnancy. Low levels may guide stronger folic acid supplementation to reduce the chance of another baby with a cleft.

Electrodiagnostic tests

16. Newborn hearing screening with otoacoustic emissions (OAE)
Most babies with cleft lip and especially cleft palate have early hearing checks. One common test is otoacoustic emissions, where a small ear probe plays soft sounds and measures echoes from the inner ear. Poor or absent echoes can show hearing problems that need more testing.

17. Auditory brainstem response (ABR) test
If the screening shows a possible problem, an ABR test may be done. Small electrodes on the baby’s scalp record brain wave responses to sound clicks. This electrodiagnostic test gives a more exact idea of the type and degree of hearing loss.

18. Electrocardiogram (ECG) before anesthesia in syndromic cases
Some children with syndromic cleft lip also have heart problems. An ECG records the heart’s electrical activity and helps anesthesiologists plan a safe surgery. This test is especially important when a genetic syndrome or heart murmur is suspected.

Imaging tests

19. Prenatal ultrasound (2D or 3D)
During pregnancy, routine ultrasound scans sometimes show a cleft lip in the fetus, especially after mid-pregnancy. Two-dimensional and three-dimensional ultrasound can show the baby’s profile and lip shape, helping parents and doctors plan care before birth.

20. Fetal MRI and postnatal CT or 3D imaging
If ultrasound pictures are not clear, doctors may use fetal MRI to get better images of the lip and palate while the baby is still in the womb. After birth, CT scans or 3D surface imaging of the face and jaw can be used by surgeons and orthodontists to plan complex repairs and jaw surgery later in childhood.

Non-pharmacological treatments (therapies and other care)

1. Cleft team care (team-based plan)
   A cleft team brings all needed specialists into one plan so the child does not miss important steps. The purpose is safe feeding, correct timing of surgery, good speech, healthy teeth, and emotional support. The mechanism is simple: when experts coordinate, problems are found early (like poor weight gain or ear trouble) and treatment is smoother. This also helps parents understand the journey in clear steps. []

2. Feeding support and weight-gain monitoring
   Many babies with cleft lip (especially if there is also cleft palate) may struggle to create suction. The purpose is to prevent dehydration and poor growth. The mechanism is choosing better feeding positions, pacing, and checking weight often so feeding plans can be adjusted quickly. Good growth makes surgery safer and recovery faster. []

3. Special cleft bottles and nipples
   Some bottles are made to help milk flow with less suction. The purpose is easier, safer feeding and less tiredness during feeds. The mechanism is a nipple and bottle design that allows milk to flow when the baby compresses the nipple, sometimes with caregiver assistance. This can reduce choking and improve calorie intake. []

4. Upright feeding position and pacing
   Holding the baby more upright and giving short pauses can reduce coughing and milk coming out of the nose. The purpose is safer feeding and calmer breathing. The mechanism is gravity and slower flow, which lowers the chance of aspiration and reduces air swallowing. Parents can learn this quickly with coaching. []

5. Presurgical lip taping
   Lip taping uses skin-safe tape to gently guide the lip segments closer before surgery (in selected babies). The purpose is to reduce gap width and make repair easier in some cases. The mechanism is gentle, continuous pressure over time, guided by the cleft team. It must be done carefully to avoid skin irritation. []

6. Nasoalveolar molding (NAM)
   NAM is a small custom mouthpiece (and sometimes nasal stents) used before surgery in some infants. The purpose is to improve alignment of the gum ridge and shape the nose/lip area before repair. The mechanism is slow, guided molding of soft tissues and cartilage during early infancy when they are more flexible. This can support better symmetry for some babies. []

7. Early dental and gum care (even in infancy)
   Even before teeth come in, mouth hygiene matters. The purpose is to reduce infection risk and prepare for healthy teeth later. The mechanism is gentle cleaning of gums and later brushing teeth, plus early dentist visits so tooth position and enamel problems are found early. []

8. Orthodontic follow-up as the child grows
   Many children with cleft need braces or other orthodontic help later. The purpose is to guide teeth into better positions for chewing, speech, and appearance. The mechanism is steady pressure from appliances that move teeth slowly and safely, usually over months to years, based on growth stages. []

9. Speech and language therapy (early and ongoing when needed)
   Some children have speech sound issues or nasal speech, especially if cleft palate is also present. The purpose is clearer speech and better communication skills. The mechanism is guided practice of correct mouth movements, airflow control, and sound patterns, with home exercises for steady improvement. []

10. Hearing checks (audiology) and ear monitoring
    Children with cleft palate are at higher risk of middle-ear fluid and hearing problems. The purpose is early detection to protect speech and learning. The mechanism is regular hearing tests and ear exams so fluid or infection is treated quickly, preventing long-term hearing loss. []

11. ENT care (ear, nose, throat specialist follow-up)
    ENT doctors help manage repeated ear infections, fluid, and breathing issues. The purpose is better hearing, fewer infections, and safer breathing during sleep. The mechanism is checking the ears and airway over time and choosing the right step (watchful waiting, tubes, or other care). []

12. Psychological support for child and parents
    A cleft can affect confidence, school experiences, and parent stress. The purpose is emotional health and resilience. The mechanism is counseling, coping skills, and supportive parenting strategies, which lowers anxiety and improves social comfort during visible treatment stages. []

13. Family education (clear home-care training)
    Parents do best when they know exactly what to do at home. The purpose is safer feeding, wound care, and follow-up attendance. The mechanism is step-by-step teaching (how to feed, how to clean, what warning signs look like) so parents act early when something changes. []

14. Post-surgery wound care (non-drug parts)
    After repair, gentle cleaning and protecting the lip is important. The purpose is good healing and less scarring. The mechanism is keeping the area clean, preventing the child from rubbing the wound too hard, and attending scheduled reviews so problems are corrected early. []

15. Scar management (massage, silicone, sun protection)
    Scars often improve over time, but good care helps. The purpose is a softer, flatter scar and better color match. The mechanism is pressure and hydration from silicone products, gentle massage (when approved), and sun protection to reduce darkening of the scar. []

16. Nutrition counseling for growth and healing
    Good nutrition supports brain development and wound healing. The purpose is healthy weight gain and stronger recovery after surgery. The mechanism is a tailored plan for calories, protein, and micronutrients, adjusted for feeding difficulties and age. []

17. Genetic counseling (especially if other findings exist)
    Sometimes cleft lip is isolated, but sometimes it is part of a genetic syndrome. The purpose is to understand recurrence risk and check for associated conditions. The mechanism is family history review, exam, and (if needed) genetic testing guidance so families get clear answers and planning help. []

18. Prenatal ultrasound counseling (for future pregnancies)
    When a cleft is seen on ultrasound, families need a plan before birth. The purpose is to reduce fear and prepare feeding and team care early. The mechanism is prenatal counseling, choosing a delivery location with cleft support, and early appointment scheduling. []

19. School support and anti-bullying planning
    School-age children may face teasing or questions. The purpose is safe social development and learning. The mechanism is teacher awareness, supportive communication, and early intervention if bullying occurs, which protects mental health and confidence. []

20. Long-term follow-up (growth-based timing of care)
    Cleft care is not “one and done.” The purpose is to adjust treatment as the face grows (speech, teeth, jaw, nose). The mechanism is scheduled follow-ups at key ages so the team can time orthodontics, revisions, or jaw procedures when they will work best. []

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Drug treatments

Important safety note: Cleft lip itself is corrected mainly by surgery + team care, not by medicines. The drugs below are commonly used for surgery, pain, nausea, anesthesia, and infections/ear problems when they occur. Dose and timing must be chosen by a licensed clinician (especially for infants/children). []

1. Acetaminophen injection (OFIRMEV) / acetaminophen (pain/fever control)
   This medicine reduces pain and fever and is often used around surgery or during illness. Class: non-opioid analgesic/antipyretic. Dosage/time: follow the FDA label and the child’s weight; it is often given before pain becomes severe and continued for a short period after surgery if needed. Purpose: comfort and lower stress. Mechanism: acts in the central nervous system to reduce pain signaling and fever response. Side effects: nausea, liver injury with overdose, allergic reactions. []

2. Ibuprofen injection (CALDOLOR) / ibuprofen (pain and inflammation)
   Ibuprofen helps with pain and swelling and may be used peri-operatively when appropriate. Class: NSAID. Dosage/time: label-based dosing (often weight-based in children) and usually short-term; timing depends on bleeding risk and surgeon preference. Purpose: reduce pain and inflammation and lower need for opioids. Mechanism: blocks COX enzymes and lowers prostaglandins. Side effects: stomach irritation, kidney strain, bleeding risk, allergy. []

3. Ketorolac (TORADOL) (strong short-term NSAID pain control)
   Ketorolac is a stronger NSAID used for short-term moderate to severe pain, sometimes after surgery in older children/adults when appropriate. Class: NSAID. Dosage/time: strictly short term per label; timing is usually after surgery with careful bleeding assessment. Purpose: strong non-opioid pain relief. Mechanism: COX inhibition reduces prostaglandins. Side effects: bleeding risk, stomach ulcer/bleed, kidney injury, asthma/allergy reactions. []

4. Morphine sulfate injection (opioid pain control)
   Morphine may be used for severe pain right after surgery in a monitored setting. Class: opioid analgesic. Dosage/time: individualized (often weight-based) and given only under clinical monitoring; used for the shortest time needed. Purpose: relieve severe pain and allow rest and feeding recovery. Mechanism: activates opioid receptors to reduce pain signals. Side effects: sleepiness, slowed breathing, constipation, nausea, dependence risk. []

5. Fentanyl citrate injection (opioid for anesthesia and severe pain)
   Fentanyl is a strong opioid often used during anesthesia and sometimes for short post-op pain control in hospitals. Class: opioid analgesic/anesthetic adjunct. Dosage/time: clinician-controlled dosing during procedures and recovery. Purpose: stable anesthesia and strong pain relief. Mechanism: opioid receptor activation reduces pain transmission. Side effects: slowed breathing, chest wall rigidity (rare), nausea, sedation, dependence risk. []

6. Midazolam injection (sedation/anxiety control)
   Midazolam is used before or during procedures to reduce anxiety and help with sedation. Class: benzodiazepine. Dosage/time: short-term procedural dosing directed by anesthesia; timing is usually pre-op or intra-op. Purpose: calm the patient and support safe procedures. Mechanism: increases GABA activity in the brain, creating sedation and relaxation. Side effects: sleepiness, slowed breathing (especially with opioids), agitation (rare). []

7. Propofol injectable emulsion (general anesthesia)
   Propofol is a common medicine used to start and maintain anesthesia during surgery in controlled settings. Class: general anesthetic (IV). Dosage/time: given by anesthesia professionals with continuous monitoring. Purpose: unconsciousness and comfort during surgery. Mechanism: enhances inhibitory signaling in the brain (including GABA pathways). Side effects: low blood pressure, slowed breathing, injection pain, rare severe reactions. []

8. Ondansetron injection (anti-nausea)
   Ondansetron helps prevent nausea and vomiting after anesthesia and surgery. Class: 5-HT3 receptor antagonist antiemetic. Dosage/time: given around the time of surgery or if vomiting occurs, based on clinician judgment. Purpose: reduce vomiting (important for comfort and wound protection). Mechanism: blocks serotonin receptors involved in vomiting reflex. Side effects: headache, constipation, QT prolongation risk in some patients. []

9. Lidocaine injection (XYLOCAINE) (local anesthesia)
   Lidocaine can numb tissues for local pain control and may be used during procedures. Class: local anesthetic (amide). Dosage/time: clinician-administered; timing is during procedures or local blocks. Purpose: reduce pain signals and sometimes reduce need for systemic pain medicines. Mechanism: blocks sodium channels in nerves so pain signals cannot travel. Side effects: numbness beyond target area, ringing in ears, seizures/heart rhythm problems if overdose (rare in proper use). []

10. Bupivacaine injection (MARCAINE) (longer local anesthesia)
    Bupivacaine provides longer numbness than lidocaine and is used for nerve blocks or infiltration for post-op pain relief. Class: local anesthetic (amide). Dosage/time: clinician-administered during surgery. Purpose: longer pain control so recovery is smoother. Mechanism: blocks sodium channels in nerve fibers. Side effects: heart rhythm risk if accidental high blood levels, numbness/weakness in blocked area, allergy (rare). []

11. Dexamethasone injection (swelling and nausea support)
    Dexamethasone is a corticosteroid sometimes used to reduce swelling and help prevent nausea after anesthesia (based on clinician plan). Class: corticosteroid. Dosage/time: individualized; often a single peri-operative dose in some surgical settings. Purpose: reduce inflammation and improve comfort. Mechanism: decreases inflammatory signals and immune activation. Side effects: high blood sugar, mood changes, infection risk with repeated/high dosing. []

12. Cefazolin injection (peri-operative antibiotic prophylaxis)
    Cefazolin is commonly used before surgery to lower surgical site infection risk. Class: first-generation cephalosporin antibiotic. Dosage/time: given shortly before incision and sometimes re-dosed during long surgeries, per protocol and label guidance. Purpose: prevent infection. Mechanism: blocks bacterial cell wall building. Side effects: allergy (especially in beta-lactam allergy), diarrhea, rare severe skin reactions. []

13. Clindamycin phosphate injection (alternative peri-op antibiotic)
    Clindamycin may be used if a patient cannot receive cephalosporins/penicillins. Class: lincosamide antibiotic. Dosage/time: peri-operative dosing per clinician and label. Purpose: prevent or treat certain bacterial infections. Mechanism: inhibits bacterial protein synthesis. Side effects: diarrhea and risk of C. difficile colitis, rash, liver enzyme changes. []

14. Amoxicillin (common oral antibiotic for ear/respiratory infections)
    Amoxicillin is often first-line for many childhood bacterial ear infections when they occur. Class: aminopenicillin antibiotic. Dosage/time: weight-based dosing per clinician/label, usually for a short course; timing depends on infection diagnosis. Purpose: treat bacterial infections that can complicate hearing and speech development. Mechanism: inhibits bacterial cell wall synthesis. Side effects: rash, diarrhea, allergy reactions. []

15. Amoxicillin/clavulanate (Augmentin) (broader antibiotic coverage)
    This combination is used when bacteria may resist plain amoxicillin or when infections are recurrent. Class: penicillin antibiotic + beta-lactamase inhibitor. Dosage/time: clinician sets dose by weight and infection severity. Purpose: treat resistant ear/sinus infections. Mechanism: amoxicillin blocks cell walls; clavulanate blocks enzymes that break amoxicillin. Side effects: diarrhea, nausea, rash, allergy. []

16. Ceftriaxone injection (serious infections or when oral meds fail)
    Ceftriaxone may be used for severe bacterial infections or certain ear infections when oral therapy is not possible. Class: third-generation cephalosporin. Dosage/time: clinician-directed dosing (often once daily) depending on diagnosis. Purpose: strong infection control. Mechanism: blocks bacterial cell wall synthesis. Side effects: diarrhea, allergy, injection site pain, bile sludge (rare). []

17. Cefdinir (OMNICEF) (oral cephalosporin option)
    Cefdinir is sometimes used for otitis media or respiratory infections when an alternative is needed. Class: third-generation oral cephalosporin. Dosage/time: short course based on age/weight and diagnosis. Purpose: treat susceptible bacterial infections. Mechanism: inhibits bacterial cell wall production. Side effects: diarrhea, rash, red stools with iron products (benign but confusing). []

18. Cefuroxime axetil (CEFTIN) (oral antibiotic alternative)
    Cefuroxime is another option for some bacterial infections (ear, sinus, throat) based on clinician choice. Class: second-generation cephalosporin. Dosage/time: label-guided dosing; taken with meals for best absorption in many cases. Purpose: infection treatment to protect hearing and overall health. Mechanism: blocks cell wall synthesis. Side effects: stomach upset, diarrhea, allergy. []

19. Azithromycin (ZITHROMAX) (macrolide alternative)
    Azithromycin may be used in some infections, especially when penicillin allergy exists (depending on local resistance patterns). Class: macrolide antibiotic. Dosage/time: short course; clinician decides schedule and dose. Purpose: treat selected bacterial infections. Mechanism: blocks bacterial protein synthesis. Side effects: stomach upset, QT prolongation risk in some, liver issues (rare). []

20. Ofloxacin otic solution (FLOXIN Otic) (ear drops for selected ear infections)
    Ofloxacin ear drops are used for certain ear infections, including infections with ear tubes or external ear canal infections, when the clinician thinks drops are best. Class: fluoroquinolone antibiotic (otic). Dosage/time: clinician-directed course and technique. Purpose: reduce ear infection and protect hearing. Mechanism: blocks bacterial DNA enzymes. Side effects: local irritation, taste disturbance, rare allergy. []

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Dietary molecular supplements (support healing and growth)

Important: Supplements do not “fix” a cleft lip. They may help only when a child has a deficiency or poor intake. Always ask a clinician first for infants and children. []

1. Vitamin C
   Vitamin C supports collagen formation, which is important for normal tissue repair and wound healing. Dosage: follow age-based guidance from a clinician (too much can cause stomach upset). Function: supports connective tissue strength and antioxidant protection. Mechanism: helps enzymes that build collagen and supports immune cell function. Best source is food (fruits/vegetables) unless deficiency risk exists. []

2. Zinc
   Zinc supports immune function and normal wound healing. Dosage: use age-appropriate dosing and avoid excess (too much zinc can cause nausea and reduce copper levels). Function: helps growth, immune defense, and tissue repair. Mechanism: acts as a cofactor for many enzymes used in cell division and protein production. Zinc is often adequate from diet, so supplements should be targeted. []

3. Vitamin D
   Vitamin D supports bone health and muscle function, which matters for overall growth (and later dental/jaw development). Dosage: clinician-guided, especially in infants. Function: helps calcium absorption and bone mineral balance. Mechanism: regulates genes involved in calcium transport and bone remodeling. Too much can be harmful, so dosing should be careful. []

4. Calcium
   Calcium is a major building block for bones and teeth. Dosage: usually best met through food; supplement only if intake is low or advised. Function: supports teeth and bone development. Mechanism: provides mineral material for bone and tooth structure and supports muscle/nerve function. For children, balanced intake matters more than high-dose pills. []

5. Iron
   Iron supports oxygen delivery in blood and helps energy and growth. Dosage: supplement only if deficiency is confirmed or strongly suspected, because too much iron can be harmful. Function: supports hemoglobin production and normal development. Mechanism: iron is part of hemoglobin, which carries oxygen to tissues needed for healing and growth. []

6. Folate (folic acid)
   Folate is famous for helping reduce neural tube defect risk in pregnancy, and it also supports normal cell division. Dosage: supplement when advised (especially for pregnancy planning or deficiency). Function: supports DNA synthesis and rapid growth tissues. Mechanism: folate helps make and repair DNA, which is needed for new cells during growth and healing. []

7. Vitamin B12
   Vitamin B12 supports nerve health and blood cell production. Dosage: clinician-guided, especially if diet is low in animal foods or absorption is a concern. Function: supports red blood cells and nervous system. Mechanism: needed for DNA synthesis and myelin maintenance. Deficiency can reduce energy and slow growth. []

8. Vitamin A
   Vitamin A supports immune function and normal cell growth. Dosage: be careful—too much preformed vitamin A can be toxic; only supplement when advised. Function: supports epithelial (skin and lining) health. Mechanism: retinoids regulate gene expression that controls cell differentiation and immune activity. Food sources are often safest. []

9. Omega-3 fatty acids (DHA/EPA or ALA)
   Omega-3s support cell membranes and may help general health, especially when diet is low in fish or omega-3 sources. Dosage: clinician-guided for children; avoid very high doses without supervision. Function: supports brain development and inflammatory balance. Mechanism: omega-3s are part of cell membranes and influence signaling molecules linked to inflammation. []

10. Probiotics (selected strains)
    Probiotics may help gut balance in some situations (for example, during or after antibiotics), but they are not needed for everyone. Dosage: strain-specific; choose products with clear labeling and clinician guidance for infants. Function: may support digestive comfort and reduce some antibiotic-related diarrhea. Mechanism: beneficial microbes compete with harmful microbes and may support barrier and immune signaling in the gut. []

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Drugs for immunity booster / regenerative / stem cell

Very important truth: There is no FDA-approved “stem cell drug” that repairs a cleft lip. If anyone markets stem cells/exosomes as a cleft-lip cure, be cautious and ask for FDA authorization and strong clinical evidence. []

1. Filgrastim (NEUPOGEN) (immune support in severe neutropenia)
   Filgrastim is used when the body has dangerously low neutrophils (a type of white blood cell), often during cancer treatment—not for cleft lip itself. Dosage: weight-based, label-directed. Function: boosts neutrophil production to reduce infection risk in specific medical conditions. Mechanism: G-CSF stimulates the bone marrow to produce neutrophils. Side effects: bone pain, fever, spleen issues (rare). []

2. Pegfilgrastim (NEULASTA) (long-acting neutrophil booster)
   Pegfilgrastim is a long-acting form that also treats severe neutropenia risk in specific settings. Dosage: label-based, usually once per chemotherapy cycle (not for routine use). Function: supports immune defense by raising neutrophils. Mechanism: G-CSF pathway stimulation with longer duration. Side effects: bone pain, rare spleen rupture, allergic reactions. []

3. Sargramostim (LEUKINE) (white cell growth factor in selected conditions)
   Sargramostim can stimulate bone marrow recovery in certain transplant or severe immune suppression settings. Dosage: clinician-directed per label. Function: supports recovery of white blood cells in specific medical cases. Mechanism: GM-CSF stimulates growth and function of several blood cell lines. Side effects: fever, fluid retention, bone pain, allergic reactions. []

4. Becaplermin gel (REGRANEX) (growth factor for chronic ulcers—not cleft lip)
   Becaplermin is a topical growth factor approved for certain diabetic foot ulcers, not for cleft lip wounds. Dosage: label-directed topical use for specific ulcer types only. Function: supports healing in approved chronic wounds. Mechanism: platelet-derived growth factor signals cells involved in tissue repair. Side effects: local irritation; use restrictions apply. []

5. Palifermin (KEPIVANCE) (epithelial growth factor for severe mouth sores)
   Palifermin is used to reduce severe mouth sores (mucositis) in people receiving intense cancer therapy, not for cleft lip. Dosage: label-based IV schedule in that specific setting. Function: helps mouth lining cells recover in approved cases. Mechanism: keratinocyte growth factor stimulates epithelial cell growth and protection. Side effects: rash, taste change, mouth/throat effects. []

6. HPC, Cord Blood (HEMACORD) (stem-cell–based transplant product, not for cleft lip)
   HEMACORD is an FDA-licensed cord blood product used for blood and immune system rebuilding in serious hematologic diseases, not for cleft lip repair. Dose selection and use must be done by transplant specialists. Function: provides hematopoietic progenitor cells for immune and blood reconstitution. Mechanism: donor stem/progenitor cells engraft in bone marrow and produce blood cells. Risks include graft-versus-host disease and infection. []

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Surgeries (procedures and why they are done)

1. Primary cleft lip repair (cheiloplasty)
   This is the main surgery to close the lip gap and improve lip shape. It is done to support feeding comfort, facial balance, and later speech and social confidence. Surgeons also try to align muscle layers for a more natural lip movement. Timing depends on the child’s health and the cleft team plan. []

2. Primary cleft rhinoplasty (nose shaping at the time of lip repair, in some cases)
   Some surgeons adjust the nose cartilage during lip repair to improve symmetry. It is done because the cleft can pull the nose shape to one side. The goal is better nasal form and airflow while keeping growth considerations in mind. Not every child needs the same approach. []

3. Lip revision / scar revision
   As a child grows, the lip scar or shape may need refinement. This is done to improve function (lip seal, movement) or appearance (scar thickness, asymmetry). It is usually considered after healing and growth changes are clear. Good scar care may reduce the need, but revision is sometimes helpful. []

4. Alveolar bone graft (if the gum/alveolus is involved)
   If the cleft extends into the gum line, a bone graft may be needed later so teeth can erupt more normally and the upper jaw becomes stronger. It is done to support dental stability and close the bony gap. Timing is often linked to tooth development stages. []

5. Orthognathic (jaw) surgery (for selected adolescents/adults)
   Some people with cleft conditions develop jaw alignment problems that affect bite and facial balance. Jaw surgery is done to correct chewing function, speech support, and facial harmony. It is usually planned after most facial growth is complete and often combined with orthodontics. []

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Preventions (risk reduction, especially for future pregnancies)

1. Folic acid before and early in pregnancy can reduce some birth-defect risks, and it is strongly recommended for people who could become pregnant. []

2. Avoid smoking during pregnancy because smoking is linked with higher risk of orofacial clefts in many studies. []

3. Avoid alcohol during pregnancy to reduce risk of multiple birth defects and poor fetal development. []

4. Manage diabetes before and during pregnancy (good glucose control lowers congenital anomaly risks). []

5. Review medicines with a clinician before pregnancy (some drugs are teratogenic and should be changed safely). []

6. Healthy nutrition and adequate micronutrients (balanced diet supports fetal development). []

7. Reach a healthy weight before pregnancy (obesity is associated with higher risk of some congenital anomalies). []

8. Treat severe infections and fever promptly in pregnancy with professional care (high fever can be harmful in early development). []

9. Genetic counseling when there is family history of clefts to understand recurrence risk and planning options. []

10. Early prenatal care and ultrasound follow-up so any cleft can be detected early and a feeding + cleft team plan is ready at birth. []

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When to see a doctor

See a doctor (or cleft team) as soon as possible after birth if the baby has trouble feeding, poor weight gain, breathing difficulty, or repeated choking during feeds. After surgery, seek care urgently for fever, worsening redness/swelling, pus, bleeding that does not stop, dehydration, or if the wound looks like it is opening. Regular follow-up matters even when the child looks “fine,” because hearing, speech, and teeth issues can appear later. []

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What to eat and what to avoid

For babies, the “best diet” is the one that supports safe feeding and growth, which may include breast milk (direct or expressed) or formula using techniques recommended by the cleft team. The main goal is enough calories, enough fluids, and calm feeding with good weight gain. For older children after surgery, follow the surgeon’s food texture rules (often soft foods for a short time) so the lip repair is protected. []

1. Eat: adequate protein (eggs, fish, lentils, yogurt) for healing. Avoid: very hard foods right after surgery if told not to. []

2. Eat: vitamin C foods (citrus, guava, peppers) to support collagen. Avoid: ultra-spicy foods if they irritate the mouth after procedures. []

3. Eat: zinc sources (meat, beans, nuts) for immune support. Avoid: high-dose zinc supplements unless prescribed. []

4. Eat: iron-rich foods (meat, legumes) if iron is low. Avoid: iron pills without medical advice for children. []

5. Eat: calcium foods (milk, yogurt, small fish with bones) for teeth/bone. Avoid: excessive soda that displaces nutritious foods. []

6. Eat: omega-3 sources (fish, flax/chia) for overall health. Avoid: very high-dose fish oil without clinician guidance. []

7. Eat: fruits/vegetables daily for micronutrients. Avoid: sugary snacks that raise dental decay risk. []

8. Eat: plenty of fluids (water, soups) to prevent dehydration. Avoid: dehydration during fever/illness—seek help early. []

9. Eat: soft, easy-to-chew foods after surgery if instructed. Avoid: straws or sucking actions if your surgeon says not to (to protect the repair). []

10. Eat: balanced meals to support steady growth. Avoid: “miracle supplement” claims—verify with your cleft team. []

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FAQs

1. Is congenital fissure of lip the same as cleft lip?
   Yes. “Congenital fissure of lip” is a descriptive phrase meaning a baby is born with a split in the upper lip—cleft lip. []

2. Did parents cause it?
   Usually, no single person “causes” it. Cleft lip can happen from a mix of genetics and pregnancy factors, and many times the exact cause is not known. []

3. Can cleft lip be treated successfully?
   Yes. With team care and surgery, many children do very well in feeding, speech, and appearance over time. []

4. Will my baby be able to breastfeed?
   Some babies can, and some need expressed milk or special bottles. A cleft team can guide the safest feeding method for your baby. []

5. Do medicines cure cleft lip?
   No. Medicines help with pain, anesthesia, nausea, or infections, but the cleft itself is corrected mainly by surgery and supportive therapies. []

6. When is surgery done?
   Timing depends on the child’s health, weight, and the cleft team plan. Your surgeon will choose the safest time window for repair. []

7. Will my child have a scar?
   Yes, but scars often fade and soften over time. Scar care and follow-up can improve the final look, and revisions are sometimes possible. []

8. Will my child need speech therapy?
   Some children do, especially if cleft palate is also present. Speech therapy can greatly improve clarity when started at the right time. []

9. Are ear infections more common?
   They can be, especially when cleft palate is present, because middle-ear ventilation can be weaker. Regular hearing checks help catch issues early. []

10. Will my child need braces?
    Many children with cleft conditions need orthodontic care as teeth come in and the jaw grows. The timing is planned around growth stages. []

11. Can cleft lip happen again in the family?
    Sometimes the risk is higher when there is family history or a genetic syndrome. Genetic counseling can explain recurrence risk clearly. []

12. Can folic acid prevent cleft lip?
    Folic acid is strongly recommended before and early in pregnancy to reduce some birth defect risks and is a key public health recommendation for pregnancy planning. []

13. Are “stem cell injections” a real cure for cleft lip?
    No FDA-approved stem cell therapy repairs cleft lip, and FDA has warned about unapproved stem cell/exosome products marketed for many conditions. Always verify FDA authorization and strong clinical evidence. []

14. What if my baby is not gaining weight?
    Contact your doctor/cleft team quickly. Feeding plans can be adjusted (positioning, bottle type, pacing) to protect growth and hydration. []

15. What is the most important first step after birth?
    Get connected to a cleft team early. Early feeding support and a clear surgery plan reduce stress and improve outcomes. []

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.