What cleft lip and palate is, and why it was called “harelip”
Cleft lip and palate is a congenital condition that arises during the first weeks of pregnancy, when the structures that form the upper lip and the palate do not fully join. The result is an opening — a cleft — that can affect only the lip, only the palate, or both at once. “Harelip” is the historical term by which this condition was known, and it comes from the comparison between the cleft in the lip and the split lip of the hare (lepus, in Latin). It is an old, descriptive comparison that for generations was the most common way of naming what we now understand with greater medical precision.
In consultation we still hear “harelip” very often, because it is the word families know and search for. We do not avoid it or correct it as if it were a mistake: we use it as a bridge towards a fuller explanation. What we do is pair that term with current clinical vocabulary, because naming the condition well helps you understand it better and make informed decisions about treatment.
Why medicine prefers “cleft lip and palate” to “harelip”
Medicine prefers “cleft lip and palate” because it describes exactly which structures are affected — lip, palate or both — without resorting to an animal comparison that, although it was not intended to offend, is now considered outdated in clinical settings and disrespectful towards families. Medical terminology has moved towards more descriptive, neutral language: we say cleft lip when only the lip is affected, and cleft palate when the palate is affected, whether on its own or combined with a cleft lip.
This distinction is not merely semantic. Each combination — lip, palate, or lip and palate together, unilateral or bilateral — involves a different surgical approach, a different schedule of operations and its own follow-up needs in speech and language therapy, ear, nose and throat care, orthodontics, paediatric dentistry and psychology. Using the correct term from the start helps the family understand which type of cleft their child has, and why the treatment plan is designed in a specific, personalised way.
When and how is a cleft lip and palate detected?
A cleft lip and palate can be detected before or after birth, and either moment is equally valid for starting to plan care. Prenatal diagnosis by ultrasound can usually identify cleft lips, and sometimes cleft palates, as early as the second trimester of pregnancy, which gives families time to find information and connect with the medical team before the birth. When a cleft is not detected before birth — common with clefts that affect only the soft palate, which are harder to see on ultrasound — the diagnosis is confirmed at the newborn’s physical examination.
Either route allows follow-up to begin properly. What matters is not the exact moment of diagnosis, but that a multidisciplinary team — maxillofacial surgery, paediatrics, ear, nose and throat care, speech and language therapy — is brought in as soon as possible after it, to guide the family throughout the whole process, from the first weeks of life into adulthood if necessary.
Why is it important to use the right term when talking with the family?
Using the right term matters because language shapes how a family experiences the diagnosis from the very first moment. Hearing “cleft lip and palate” rather than an expression with an animal connotation helps place the conversation on medical, technical and hopeful ground, not on a label that can bring rejection or shame — something many adults who grew up with the old term still remember feeling. Part of our work as a team is to explain the condition honestly, without dramatising it and without minimising it, using the words that best describe what is really happening.
This does not mean censoring the term “harelip” when someone uses it to explain themselves. It means calmly offering the right word and the reason for it, so that each family can decide which vocabulary they feel most comfortable with as they move through a process that, with good guidance, has produced consolidated functional and aesthetic results over decades of surgical practice.