Children's ENT and Facial Plastic Surgery
Minnesota's Only Pediatric Otolaryngology, Facial Plastic, & Reconstructive Surgery Practice
What is a cleft lip?
A cleft lip is a birth defect that results when tissues of the lip and bone of the upper jaw fail to fuse during early development of the fetus. This failure occurs during the 4th and 6th week of gestation. The condition varies from a small notch in the red part of the lip (Fig. 2) to a wide gap in the lip and gum line extending into the nostril of the nose (Fig. 3). A cleft lip may occur on the left side, the right side, or both sides (Fig. 4).
Fig. 1. Normal lip.
Fig. 2. Small incomplete cleft lip.
Fig. 3. Complete unilateral cleft lip.
Fig. 4. Bilateral cleft lip.
How common are cleft lips?
Roughly 1 out of every 1000 children are born with a cleft lip. About 70% of these children will also have a cleft palate. The other one third will have only a cleft lip. Cleft lip is more common in certain ethnic groups. It is more common in Asians, Latinos, and Native Americans and much less common in Africans.
What causes a cleft lip?
It may surprise you to know that despite years of research we still do not have a great understanding of why cleft lips occur. Most doctors and scientists agree that clefts are a combination of genetic as well as environmental factors including drugs, infections, maternal illness, and possibly vitamin deficiencies. There is recent medical evidence to suggest that mothers with diets rich in folic acid (fruits, vegetables, and other high folate containing foods) who take folic acid supplements during pregnancy have a lower risk of having a baby with a cleft lip.
Other birth defects can occur in children with cleft lips. Some of these defects are obvious and some are more difficult to detect. However, most children born with a cleft lip and/or palate are otherwise normal, healthy children.
Can I breast feed my child with a cleft lip?
That depends! If your child does not have a cleft palate, then he/she can and most likely will successfully nurse at the breast. A cleft lip does not prevent a child from breast feeding successfully (even a wide cleft lip involving the gum line, Fig. 3).
However, if your child also has a cleft palate then he/she does not have the ability to generate an effective "suck" and will not be able to breast feed successfully. Some well-intentioned friends and/or medical professionals may encourage you to try and breast feed your child anyway. Unfortunately encouraging a mother to breast feed a child with a cleft palate only sets mother and baby up for failure. But rest assured, there are ways to successfully feed a child with cleft lip and palate. More specific information is available on our cleft lip and palate feeding page.
How is a cleft lip repaired?
The repair of a cleft lip requires surgery and general anesthesia. Many different techniques have been developed over the years to repair cleft lips. Different techniques are appropriate for different kinds of cleft lips. Your doctor will select the type of repair most appropriate for your child's type of cleft lip.
When is the right time to repair a cleft lip?
Some parents wonder if their baby's cleft lip can be repaired right away. Some even want it done before they take their baby home from the hospital. However, it is best to wait until your child is at least 8 to 12 weeks old before having surgery to repair the lip.
Waiting a short period of time after birth has many advantages. This short period of time allows your child to establish a good pattern of feeding and weight gain which is important during the recovery from surgery. It also allows you and your family to adjust your lifestyles to the joys and stresses of welcoming a new child into your family. It is important to establish the parent-child bond during the first weeks of life before having to cope with the surgical recovery. Also, there is no advantage to repairing the lip any sooner. The results will be the same either way.
Fig. 5. Unilateral cleft lip before and after repair.
Fig. 6. Bilateral cleft lip before and after repair.
| Cleft lip case examples |
Are there any instructions I need to follow before surgery?
Your child must have a physical examination by his or her pediatrician or family doctor within 7 days before surgery to make sure he or she is in good health. The doctor you see needs to complete the History and Physical form provided by our office. You must bring the completed form with you the day of surgery.
For your child’s safety, it is very important that he or she have an empty stomach when anesthesia is given. Please follow our preoperative Eating and Drinking Guidelines. If you do not follow these guidelines, your child's surgery will be cancelled.
What can I expect after surgery?
A cleft lip repair usually takes between 2 and 3 hours. Your doctor will talk to you as soon as the surgery is over.
Your child will wake up in the recovery room after surgery. This may take 45 minutes to an hour. When your child is awake, he or she will be admitted to the hospital for an overnight stay. You can accompany your child when he/she is transferred to your hospital room. Your may begin feeding your child (breast or bottle) as soon as you get settled. One or both parents can stay with your child the entire time he/she is in the hospital. In fact, we encourage at least one parent to stay with your child during the hospitalization.
After surgery, your child will have soft splints wrapped around the arms. These splints prevent your child from rubbing the lip. These splints can easily be removed when you are holding your child and have the ability to prevent your baby from rubbing the lip. The arm splints should be worn at all other times for 2 weeks after surgery.
Children can almost always go home the morning after surgery. In some cases a child may have trouble feeding or need a little more time in the hospital to control pain.
How should I take care of my child after surgery?
In most cases, no cleaning or wound care is required at all. Most cleft lip surgery is performed using self-dissolving stitches protected with water-proof tissue glue. In some special cases, wound cares and cleaning may be recommended. Ask your surgeon if you are unsure.
If your child seems to have discomfort you can safely give Tylenol®, Children's Motrin®, or other pain medicine prescribed by your doctor. If you are not sure what medicines are safe, please call your doctor.
Your doctor may prescribe a short course of antibiotics for your child after surgery.
In most cases, dissolving stitches are used and there is no need to have any stitches removed after surgery. Sometimes your doctor may use stitches that need to be taken out 5 to 7 days after surgery. If you're not sure whether or not you need to have your child's stitches taken out, ask your doctor.
What else do I need to know?
A postoperative visit is usually scheduled 3 to 4 weeks after surgery (unless stitches need to be taken out sooner as described above.) Your doctor will check the lip to see how it is healing and discuss any concerns you have about the lip's appearance.
The scar will stay pink or red for a few months after surgery and then begin to fade. It may take 1 to 2 years before the scar has faded as much as it is going to. It is almost impossible to judge the long-term results of surgery during the first few months after repair. Once the scar has faded completely, you and your surgeon can discuss the role of additional surgery to improve the lip's appearance. In general, more than one operation is needed to achieve the best possible appearance.
Cleft team
Around your child's first birthday Children's Hospitals and Clinics of Minnesota will contact you to arrange for your first visit to the interdisciplinary Cleft Team (more info). The general outline for comprehensive cleft care depends on whether your child also has a cleft palate.
| Cleft Team Timelines |
If you have any questions or would like further information specific to your child, please call our office at (612) 874-1292.
This information is provided as a service to our patients. The information is for educational and informational purposes only and should NOT be used as a substitute for the advice of your child's physician.
Common Procedures
Special Procedures
- Cleft lip
- Cleft palate
- Mandibular distraction