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Craniofacial Conditions

 

Cleft Lip

What is cleft lip?

Cleft lip is an opening in the skin and muscle between the nose and upper lip; often the gum ridge is also involved. During the first four to six weeks of pregnancy, the skin and muscle normally grow in from the sides of the face to join with skin growing down from the tip of the nose. If these parts fail to join, the baby is born with a cleft lip. There are several types of cleft lip, depending on which parts of the skin have joined. The cleft can be on one side (unilateral) or on both sides (bilateral).

Cleft Lip
Why was my child born with a cleft lip?

In most cases, there is no family history, although some children born with a cleft lip have one or more relatives with the condition. Some researchers believe that environmental factors play a role. A specialist on your child's care team can discuss these issues with you.

What are the chances that any future children will have a cleft lip?

The chances are different for each family. The members of your child's care team, especially the geneticist, will give you a more detailed answer to this question. Research indicates that certain precautions may reduce the chance of developmental anomalies. Prior to conception, mothers should be sure to take a daily multivitamin that includes folic acid. Avoid alcohol, smoking, and medications. (If you must take medication, discuss it with your physician.)

Can a cleft lip be repaired?

Yes. An operation can correct the cleft so that your child's mouth and nose will be nearly normal in appearance and function.

When will my child's cleft lip be repaired?

Usually before your child is six months old. The plastic surgeon on your child's care team will talk with you about the best operative plan for your child.

How is a cleft lip repaired?

Some types of cleft lip can be repaired in one operation; others require staged procedures. The plastic surgeon will use existing muscle and tissue from your child's lip to close the cleft and correct the nose. The procedure is performed in an operating room under general anesthesia. Your child will stay in the hospital one or two nights after the operation. Parents are encouraged to stay with the child in the hospital. The nurse will teach you how to care for your child after the procedure.

An incomplete cleft lip is usually repaired in one operation when a child is three to five months old. During this procedure, the plastic surgeon will close the cleft of the lip and shape the nose.

Closure of a unilateral complete cleft lip can be performed in either one or two steps; the gum cleft is closed as well. Some surgeons perform a preliminary operation at three to four months of age, called a "lip adhesion," which is a simple closure of the lip along with the first stage of the nasal repair. The cleft of the gum is also closed, whenever possible. The second operation, at about four to six months, is a more complete repair of the cleft lip and correction of the nose.

Repair of a bilateral complete cleft lip and nasal correction is accomplished in one operation at four to six months of age. 

In many centers, a dental appliance is recommended for the infant with a complete cleft lip, either unilateral or bilateral. The appliance helps to align the gums. It is custom-made for your child and requires regular adjustments until the gums are in the correct position for cleft lip repair. The appliance is removed in the operating room just prior to closure of the lip and nasal correction.

Will my child look normal after the cleft lip is repaired?

After the operation the lip, nose, and cheeks may be swollen for several days. The scar may become red after 5-6 weeks. It will take six to 12 months for the scar to soften and fade. Although the scar will never disappear, it should become difficult to see. Your child's lip and nose should be nearly normal in appearance and symmetrical.

As my child gets older, will he or she need another operation on the lip or nose?

In some children, the nose cannot be permanently corrected in one operation. As your child grows, the lip and/or nose changes in shape and appearance; a revision may be needed before your child begins school or during adolescence. In children with an incomplete cleft lip, revision of the nose or lip is almost never necessary.

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