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What is Cleft Lip and Alveolus (CLA)? Understanding Your Baby's Diagnosis

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Cleft Lip and Alveolus (CLA) is a separation affecting the upper lip and gumline, but not the roof of the mouth. Because the palate is intact, babies with CLA generally avoid severe feeding and speech issues. With standard surgical care, children grow up to thrive with healthy smiles.

Key Takeaways

  • • Cleft lip and alveolus (CLA) involves a separation in the upper lip and gumline, but the roof of the mouth is completely closed.
  • • Babies with CLA typically do not experience the severe feeding, speech, or ear challenges seen in babies with a cleft palate.
  • • CLA occurs very early in pregnancy due to a complex mix of genetics and environment, and is not caused by anything the parents did wrong.
  • • Surgical repair is highly successful and typically includes repairing the lip in infancy and an alveolar bone graft for the gumline later in childhood.

Receiving a diagnosis of Cleft Lip and Alveolus (CLA) for your baby—whether through a prenatal ultrasound or at the time of birth—can feel like a whirlwind of emotions. It is natural to feel shocked, worried, or even overwhelmed [1]. Please know that you are not alone, and with modern medical care, children born with CLA grow up to thrive, eat well, and have beautiful smiles [2][3].

What is Cleft Lip and Alveolus (CLA)?

A Cleft Lip and Alveolus (CLA) is a specific type of orofacial cleft where there is a separation in the upper lip that extends into the alveolus (the upper gumline where teeth eventually grow) [4][5].

The most important thing to understand about a CLA diagnosis is what it is not:

  • It is not a Cleft Palate: In CLA, the palate (the roof of the mouth) is completely intact and closed [4]. This is a significant distinction because babies with an intact palate do not typically experience the severe feeding, speech, and ear challenges associated with a cleft palate [4][6].
  • It is a rarer subtype: CLA accounts for approximately 1.3% to 14% of all orofacial clefts, making it much less frequent than a combined cleft lip and palate (CLP) [7][8].

Why Did This Happen?

A cleft occurs very early in pregnancy, typically between the 4th and 8th weeks of development, when the tissues of the face do not fully fuse together [9][10].

Parents often immediately wonder if they did something to cause the cleft. Please know that you did not cause this. CLA is almost always multifactorial, meaning it is caused by a complex, unpredictable mix of genetics and the environment [11][12].

While research points to environmental factors (like folic acid levels or certain medications) and genetics (like family history or specific genes such as IRF6), these are just pieces of a very complex puzzle [12][13]. In many cases, a mother does absolutely everything “right” during pregnancy, and a cleft still occurs. Do not carry the burden of guilt; instead, focus on the excellent, highly successful care path ahead.

Navigating This Guide

This resource is designed to help you understand your baby’s diagnosis and prepare for the journey ahead. We have broken down the information into the following sections:

Your child’s diagnosis is just one part of their story. With the support of your medical team, your baby will grow, play, and smile just like any other child [2].

Frequently Asked Questions

What is the difference between cleft lip and alveolus (CLA) and a cleft palate?
In CLA, the separation only affects the upper lip and the upper gumline. The palate, or roof of the mouth, is completely intact, which means babies typically avoid the severe feeding and speech challenges associated with a cleft palate.
Did I do something during pregnancy to cause my baby's cleft?
No, you did not cause your baby's cleft. CLA is multifactorial, meaning it happens early in pregnancy due to an unpredictable mix of genetic and environmental factors. Many mothers do everything perfectly during pregnancy and a cleft still occurs.
How will a CLA diagnosis affect my baby's ability to feed?
Because the roof of the mouth is intact in a baby with CLA, feeding is usually much easier than for babies with a cleft palate. Your cleft care team will provide specific feeding expectations and strategies to ensure your baby gets proper nutrition in their first few weeks.
Will my baby need surgery for their cleft lip and alveolus?
Yes, children with CLA usually require surgical repair. This often involves initial surgeries to close the lip during infancy, and an alveolar bone graft later in childhood to repair the gumline so adult teeth can grow properly.

Questions for Your Doctor

  • • Is my baby's cleft unilateral (one side) or bilateral (both sides), and is it considered 'complete' or 'incomplete'?
  • • Since the palate (roof of the mouth) is intact, what specific feeding expectations should we have in these first few weeks?
  • • Which specialists will be on our care team, and when should we schedule our first multidisciplinary team meeting?
  • • Will my child likely need an alveolar bone graft (surgery for the gumline) later in childhood, and what is the general timeline for that?

Questions for You

  • • What are my primary concerns or fears right now that I need the medical team to address immediately?
  • • How am I feeling emotionally, and would it be helpful to speak with a counselor or social worker who specializes in supporting parents of children with clefts?
  • • What support systems (family, friends, or parent groups) do I have in place to help me navigate the upcoming appointments and initial surgeries?

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References

  1. 1

    The application of three-dimensional ultrasound with reformatting technique in the diagnosis of fetal cleft lip/palate.

    Ji C, Yang Z, Yin L, et al.

    Journal of clinical ultrasound : JCU 2021; (49(4)):307-314 doi:10.1002/jcu.22994.

    PMID: 33665816
  2. 2

    Outcome of Patients with Complete Cleft Lip and Alveolus: 20-Year Follow-Up.

    Hattori Y, Pai BC, Saito T, et al.

    Plastic and reconstructive surgery 2025; (155(4)):746e-757e doi:10.1097/PRS.0000000000011622.

    PMID: 38991117
  3. 3

    Examining Risk of Speech-Language Disorders in Children With Cleft Lip.

    Deatherage J, Bourgeois T, O'Brien M, Baylis AL

    The Journal of craniofacial surgery 2022; (33(2)):395-399 doi:10.1097/SCS.0000000000008000.

    PMID: 35385904
  4. 4

    Long-term Morphological Changes of the Velum and the Nasopharynx in Patients With Cleft Palate.

    Harada T, Yamanishi T, Kurimoto T, et al.

    The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association 2022; (59(10)):1264-1270 doi:10.1177/10556656211045287.

    PMID: 34662220
  5. 5

    A New Technique for Retracting the Protrusive Premaxilla With Fewer Patient Visits.

    Erüz M, Yagci A, Ozyazgan I

    The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association 2019; (56(4)):543-547 doi:10.1177/1055665618784810.

    PMID: 29940128
  6. 6

    Nasal Airway Dysfunction in Children with Cleft Lip and Cleft Palate: Results of a Cross-Sectional Population-Based Study, with Anatomical and Surgical Considerations.

    Sobol DL, Allori AC, Carlson AR, et al.

    Plastic and reconstructive surgery 2016; (138(6)):1275-1285 doi:10.1097/PRS.0000000000002772.

    PMID: 27537228
  7. 7

    Variations in Orofacial Clefts.

    Jahanbin A, Jamalinasab A, Niazi AE

    The Journal of craniofacial surgery 2021; (32(2)):e179-e182 doi:10.1097/SCS.0000000000007027.

    PMID: 33705067
  8. 8

    Clinical Characteristics of the Cleft Lip and/or Palate: Association with Congenital Anomalies, Syndromes, and Chromosomal Anomalies.

    Fujii N, Doi R, Narai T, et al.

    Yonago acta medica 2023; (66(4)):440-447 doi:10.33160/yam.2023.11.009.

    PMID: 38028265
  9. 9

    Assessing an avoidable and dispensable reoperative entity: Self-referred flawed cleft lip and palate repair.

    Foroglou P, Tsimponis A, Goula OC, Demiri E

    Hellenic journal of nuclear medicine 2015; (18 Suppl 1()):140.

    PMID: 26665223
  10. 10

    The developmental bases of cleft lip and cleft palate: cellular and molecular mechanisms.

    Guarino M

    Anatomy & cell biology 2025; (58(3)):344-356 doi:10.5115/acb.25.060.

    PMID: 40664514
  11. 11

    Identification of Novel Genomic Variations in Susceptibility to Nonsyndromic Cleft Lip and Palate Patients.

    Avasthi KK, Muthuswamy S, Asim A, et al.

    Pediatric reports 2021; (13(4)):650-657 doi:10.3390/pediatric13040077.

    PMID: 34941638
  12. 12

    Current concepts on cleft lip and palate etiology.

    Candotto V, Oberti L, Gabrione F, et al.

    Journal of biological regulators and homeostatic agents 2019; (33(3 Suppl. 1)):145-151. DENTAL SUPPLEMENT.

    PMID: 31538461
  13. 13

    A Large Multicenter Brazilian Case-Control Study Exploring Genetic Variations in Interferon Regulatory Factor 6 and the Risk of Nonsyndromic Cleft Lip With or Without Cleft Palate.

    Machado RA, Martelli DRB, Reis SRA, et al.

    International journal of molecular sciences 2025; (26(7)) doi:10.3390/ijms26073441.

    PMID: 40244393

This page provides educational information about Cleft Lip and Alveolus (CLA). Always consult your child's pediatric specialist or cleft care team for specific medical advice and treatment planning.

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