Facial Clefts

(See the details in the section “Specific abnormalities”.)

Fig 1, Fig 2

Premaxillary protrusion is an important clue to the presence of cleft lip and cleft palate and may be more conspicuous than the cleft itself.

Differential diagnosis for facial clefts

  • Artifact: normal philtrum with midline groove of the upper lip misinterpreted as cleft
  • Lateral cleft: Fig 3, Fig 4
    • most common facial abnormalities, more common on the left side
    • paramedial location
    • bilateral in 20% of cases
  • Midline cleft: Fig 5
    • rare
    • holoprosencephaly
    • median cleft face syndrome
  • Atypical cleft:
    • associated with amniotic band syndrome in most cases
    • asymmetric and bizarre
    • other anomalies are commonly seen.

Fig 1: Schematic drawing: acial abnormality related to holoprosencephaly: Bilateral clefts

Fig 2: Schematic drawing: Facial abnormality related to holoprosencephaly: Midline cleft

Fig 3:Paramedian cleft  Coronal view of the face: paramedian cleft lip

Fig 4:  Paramedian cleft  Coronal view of the face: paramedian cleft lip (arrow)

Fig 5: Median cleft lip  Coronal view of the face: median cleft lip in fetal trisomy 13

Video clips of facial clefts

Cleft lip:  Coronal scan of the face: small paramedial cleft (arrow)

Cleft lip:  Coronal scan of the face: paramedial cleft (arrow)

Bilateral cleft lips :  Coronal scan of the face: bilateral paramedial cleft (arrow)

Cleft lip and palate :  Transverse scan of the face: incomplete alveolar ridge (*) of the maxilla

Midline cleft lip:  Coronal scan of the face: midline cleft (arrow) (arrowhead = lens in the orbit)

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