“…Among environmental factors, tobacco smoking has been found to influence facial morphology (Xuan et al, 2016), and is reported to be the most consistent and strongest risk factor for OFCs (Raut et al, 2019). Such perturbation of the early life environment affects developmental programming in the embryo, with sustained changes potentially detectable in tissues from medial nasal and maxillary sides of the upper lip in cases with nonsyndromic cleft lip with or without cleft palate (nsCL/P) as observed by our group in recent studies (Khan, Little, Abelli, et al, 2018;Khan, Little, Mossey, Steegers-Theunissen, Autelitano, et al, 2018;Khan, Little, Aleotti, et al, 2019;Khan, Little, Nag, et al, 2019).…”