Real-time ultrasonography in pregnancy can accurately detect gestational age, position of the fetus, position of the placenta, sex of the fetus, and many congenital anomalies before birth. To date, however, there has been no report of detection of a cleft lip-palate deformity by ultrasound. Two cases, in approximately 200 scans, have been found in patients with no previous family history of cleft lip-palate. The first case was a bilateral cleft lip-palate visualized at 28 weeks gestation. The second was a unilateral cleft lip-palate detected at 33 weeks gestation. Diagnosis of cleft lip-palate is dependent on appreciation of facial topography in multiple planes, adequate experience in the technique, and observation of the degree of excursion of the undulating tongue. Detection of the facial clefting in utero by ultrasound has resulted in our formulation of a routine for informing the parents of the deformity and referring them for consultation with a plastic surgeon. This is recommended before birth, so that the parents are well acquainted with what the deformity will look like and the sequential steps necessary for its correction. We encourage plastic surgeons, obstetricians, pediatricians, and ultrasonographers to be aware of the ability to diagnose cleft lip-palate before birth.