Facial clefting is the commonest congenital malformation to affect the head and neck. There are worldwide variations in the incidence of cleft lip and/or palate (CL/P) and cleft palate (CP) but in general they occur in around 1 in 600–800 live births. The diagnosis of CL/P or CP may be missed on mid-trimester screening anomaly scans, as the appropriate facial views may not be required as a routine. In a recent survey of ultrasound departments and with reference to the mid-trimester screening scan, only 50% sought a view of the lips and 25% a view of the palate. Facial clefts may occur as part of a recognised genetic syndrome or chromosomal condition. Structural anomalies associated with such syndromes will prompt a detailed fetal assessment, with greater sensitivity of detection for CL/P and CP than where the defect is isolated. Under such circumstances however, the facial cleft may be less significant than the accompanying abnormalities. Treatment of facial clefts has improved over recent years, not only with advances in surgical care but also with the development of a multidisciplinary approach to ensure that continued care is provided from infancy through to adult life.