Cleft lips vary in their degree of severity. Cleft lip is distressing for parents, as they don’t want their child to feel self-conscious or to be the focus of ridicule.
Cleft lip has historically been referred to as “hare lip.” This moniker came about because of the natural split that is present in the upper lip of rabbits/hares. The term hare lip is no longer used in the medical community as it is viewed as derogatory.
Cleft lip and cleft palate are different. A cleft lip affects the upper lip, whereas a cleft palate is a gap in the roof of the mouth. Not all individuals with cleft lips have a cleft palate. And not all individuals with a cleft palate have a cleft lip. It is possible for an individual to have both a cleft lip and a cleft palate.
In this article, you will learn the names of the parts of a normal lip. Knowing what a normal lip looks like will help you better understand what parts of the lip are abnormal in a cleft lip. You will also learn about the different types of cleft lips — unilateral versus bilateral, complete versus incomplete.
Unilateral means the lip has a cleft on one side. Bilateral means there is a cleft on both sides. Complete indicates that the cleft extends from the lip all the way into the nose. Incomplete involves the lip but spares the nose.
Causes of Cleft Lip
The cause of cleft lip is not well understood. During fetal development, nasal and lip elements do not come together properly. Researchers believe some cleft lips may have genetic causes. Others could happen because of something in the environment or a medication taken during pregnancy. For example, people who smoke during pregnancy are more likely to have a baby with a cleft lip.
White roll: The white roll is a prominent ridge just above where the lip skin meets the facial skin. Vermillion: The vermillion is the pigmented part of the lip. The color ranges from red to brown based on the pigmentation of the individual. It has a dry component (visible when lips are closed) and a wet component (visible when the lips are parted). Philtral Columns: The vertical pillars that extend from the lips to the nose. The inferior/lower aspect of the philtral columns makes the peaks of the upper lip. The superior/upper aspect makes up the nasal sill, the floor of the nostril. Philtral Dimple: The hollow or depression between the two philtral columns. Cupid’s Bow: The curvature at the central part of the white roll. It is flanked by two peaks on either side. The peaks are the lower portion of the philtral columns. Orbicularis Oris: The orbicularis oris muscle surrounds the lips. The muscle is important in providing the ability to speak, eat and drink normally. If an incomplete cleft is less than two-thirds of the lip height, some muscle fibers may cross the cleft. In more severe clefts, there is a complete disruption of the muscle fibers. Nasal Sill: The nasal sill makes up the bottom or the floor of the nostril. The nasal sill is missing in some forms of cleft lip. Simonart’s Band: A bridge of skin that crosses the bottom of the nostril on the cleft side of a cleft lip. A Simonart’s band gives the appearance of an intact nasal sill. Alar Rim: The alar rim is the part of the nose the surrounds the nostril.
While a microform cleft may not be obvious, there may still be a problem with functionality. There is some disruption of the continuity of the orbicularis oris muscle. This may cause eating and drinking issues as well as speech issues.
The nose is usually normal with a microform cleft deformity. The actor, Joaquin Phoenix, has a microform cleft lip. It appears as if he has a surgical scar from repair of a cleft lip. In actuality, that is his natural appearance.
The orbicularis oris muscle is not in continuity in a complete cleft lip. Instead of encircling the mouth, the muscle inserts into the base of the nose on both sides of the cleft. This disruption creates difficulty speaking, eating and drinking.
The nose is distorted with a cleft lip deformity. The nostril is widened and the floor of the nostril is missing in a complete cleft lip deformity.
Incomplete cleft lips can take on a variety of appearances. There may be just a small gap or cleft in the vermillion or it may slightly extend into the skin above the lip or extend almost to the nostril.
As with a complete cleft lip deformity, the nose has some distortion. The distortion is usually to a lesser degree. The nostril may be widened, but the floor of the nostril is intact. Additionally, there is a bridge of tissue at the base of the nostril on the cleft side. This is known as a Simonart’s band.
On both sides, the cleft extends from the vermillion to the nostril. The lack of continuity in the muscle makes clear speech difficult for these individuals. Feeding can be more difficult.
There is nasal distortion with a bilateral complete cleft lip. Both alar rims are widened, the nasal sills are missing and the nose takes on a flattened appearance.
In a bilateral incomplete cleft lip deformity, the nose is affected, although not to the same degree as with a bilateral complete cleft lip deformity. In those individuals with a bilateral cleft lip deformity, one side may be an incomplete deformity and the other side a complete deformity.
