Cleft lip is a condition that occurs as a child is developing before birth in which the lip fails to join, or fuse, together normally. The cleft can be on one or both sides of the lip or, rarely, in the middle. Cleft lip almost always occurs on the upper lip.

Causes of Cleft Lip

Cleft lip occurs due to a combination of environmental and genetic causes. In a large number of cases, we are not able to pinpoint a specific cause.

Environmental factors that may contribute to cleft lip include:

• Vitamin deficiency
• Smoking during pregnancy
• Substance abuse

A cleft lip can also be a result of genetic factors. When your child has been diagnosed with cleft lip, we recommend that you meet with one of our genetic counselors.

Cleft lip is one of the most common birth defects. More than 4,000 babies are born with a cleft lip each year in the United States.

How Does a Cleft Lip Form?

The tissues of the face and lip form during the first two months of pregnancy. Tissue from each side of the face grows toward the center of the face to form the facial features. When these tissues don’t join together entirely, an opening, called a cleft, remains. The cleft can be a small slit or a large opening that reaches into the nose.

Diagnosis of Cleft Lip

Cleft lip is diagnosed at birth but can often be diagnosed before your child is born during an ultrasound. The cleft lip is typically visible on the ultrasound around the 30-week mark or later.

If your child has been diagnosed before birth, we recommend meeting with our prenatal counselors, including team members from Human Genetics, and with our surgeons.

Based on the findings of the ultrasound, team members from Human Genetics may recommend other tests.

Types of Cleft Lip

Clefts are grouped into classifications based on the side of the lip where the cleft is and how severe it is. Almost all clefts affect the nose as well. The classifications are as follows:

• Incomplete unilateral: The cleft lip appears only on one side of the lip and does not continue into the mouth.
• Complete unilateral: The cleft lip appears on one side of the lip and continues into the mouth.
• Incomplete bilateral: The cleft lip affects both sides of the lip and does not continue into the mouth.
• Complete bilateral: The cleft lip affects both sides of the lip and continues into the mouth.

Cleft Lip Repair

Repair of a cleft lip is usually performed when the baby is around 3 or 4 months old. The goal of the cleft lip repair is to close the gap created when the lip failed to form.

During the repair, our surgeons will undo and then stitch together the cleft lip. Depending on the type of cleft and how severe it is, this may be done in more than one surgery. The surgery will also typically involve correction of the nose during the same surgery.

Pre-Surgical Techniques

Before your baby’s surgery, we may use a taping regimen. With this technique, tape is placed across the cleft and helps to mold the tissues closer to each other prior to surgery.

Treatment Timeline

This timeline is a general treatment plan overview. Each child with a cleft lip is unique and will have their own treatment plan.

Before Birth

If your child has been diagnosed with a cleft lip before birth, it’s important to begin educating yourself before delivering your child. This will help you know what to expect when caring for your child after birth.

• Call the Cleft and Craniofacial Center and ask to schedule a prenatal visit. This meeting will include team members from Human Genetics and Plastic Surgery.

Birth-2 Months

• Your baby will see a plastic surgeon in their first month.
• At this visit, you can expect the team to:
  • Ask questions about your family history and your pregnancy
  • Weigh your baby
  • Take photos of your baby
  • Review the best treatment plan for your baby
• You will work with our team members, including a feeding specialist, to ensure your baby is able to feed successfully and is getting the proper amount of nutrition. Our specialists work closely with each family on cleft feeding techniques.

3-6 Months

• Most babies undergo cleft lip repair around 3 to 4 months of age.
• After lip repair, your baby will stay overnight in the hospital. Your baby will wear arm restraints to keep them from accidentally disrupting the lip sutures.
• Your baby will go home when they are able to drink enough fluids.
• As part of a team evaluation, an otolaryngologist (ENT doctor) will see your child. This surgeon will decide whether ear tubes (PE tubes) are needed or not. Ear problems are unlikely in a child with cleft lip only.

9 Months

• If your child also has a cleft palate, it is repaired during this time.
• Any ear problems are typically addressed at this time as well. Ear (PE) tubes are generally not needed in children with cleft lip alone. They commonly are needed in children with cleft lip and palate, and in children with cleft palate alone. If your baby hasn’t yet had ear tubes placed and needs them, they will be inserted at the time of the palate repair.

24 Months

• You will have a team visit with your plastic surgeon and with a member of human genetics to check your child’s progress and evaluate what other medical needs might remain.

3-5 Years Old (for children with both a cleft lip and palate)

• When your child begins to speak in sentences, a speech pathologist will evaluate their speech. Your child may need speech therapy and/or surgery.
• A plastic surgeon will evaluate the best type of surgery for your child to improve speech outcomes.
• Your child will spend at least one night in the hospital after secondary palate surgery to improve speech.

5-9 Years Old

• If your child has a cleft through the gumline, this area may need to be expanded in preparation for a bone graft.
• The pediatric dentist or orthodontist does this in the office. It is like getting braces.
• Between ages 7 to 9, the bone graft is done in the hospital. Bone is taken from the hip for this graft.
• Typically, your child stays overnight in the hospital after surgery.

11-20 Years Old

• Braces (orthodontics) are usually started around this age.
• As your child’s face changes, other revisions of the lip and/or nose may be desired: 
  • Jaw surgery, to bring the upper jaw forward and/or the lower jaw back
  • Septorhinoplasty, to straighten and refine the nose
  • Cheek implants, to build up the mid-face, revision of the lip and nose
• For some of the procedures it is necessary to wait until your child is finished growing.
• The plastic surgeon will discuss these options with you. 
• The length of hospital stay depends on the type of surgery performed.

Care After Cleft Lip Repair

Immediately following surgery, your child’s incision and the area around the nostrils will need to be gently cleansed of bloody drainage and dried blood. Gently cleanse with water using a cotton swab daily.

Your baby will have elbow restraints for one to two weeks after surgery to keep their hands away from the surgical site. Restraints need to be removed to exercise the arms. Remove one restraint at a time, on a rotating basis, every hour or so to exercise and massage the arms. Your child must be supervised when the elbow restraint is off.

Long-Term Outlook

With treatment, children with clefts do very well. Our team is here to help you through all of your child’s treatments. The coordinated care we offer means your child’s medical needs will be addressed appropriately, which help children with clefts grow up to lead active, healthy lives.

Your child may require additional surgeries after the initial repair to revise the lip or nose reconstruction. It is common for children with clefts to receive dental and orthodontic care and speech therapy as they get older.

Your child may experience emotional difficulties coping with multiple surgeries and social stigmas of facial scars. Our craniofacial team works closely with psychologists and social workers to support your child through these types of challenges.

Associated Conditions and Complications

Cleft lip often occurs along with cleft palate (when the tissues in the roof of the mouth fail to join together properly).

Children with cleft lip and palate frequently have problems with feeding and speaking clearly. They also might have problems with their teeth, ear infections, and hearing loss.