Abstract Background Cleft lip and palate (CLP) is a malformation traditionally attributed to muscle dysfunction but with deep anatomical origins. While early radiological signs of nasopharyngeal carcinoma often present as an asymmetric obliteration of the Rosenmüller fossa (RF), the impact of congenital CLP-related variations on this clinical detection remains a subject of debate with no definitive consensus. This study investigates these hypotheses by evaluating nasopharyngeal structural remode