Cleft Lip

Treatment Overview

Surgery is always needed to treat cleft lip, and sometimes multiple procedures are needed over several years. Some treatments, such as speech therapy, may continue into early adulthood.

Your child's doctor or a health care team will examine your newborn before your baby goes home from the hospital. These professionals can tell you how to care for your child before surgery.

Before surgery

Sometimes cleft lip is treated with presurgical supports, such as special dental splints, soft dental molding inserts, or medical adhesive tape. A child with a cleft lip and palate may be treated with presurgical supports.

Surgical repair of cleft lip

When the surgery takes place depends upon a number of things, including what your doctor suggests, your baby's health, and the cleft itself. Most doctors agree that cleft lip should, in most cases, be repaired by the time your baby is 3 to 6 months old.²

When considering the timing and type of surgery needed to repair a cleft lip, the doctor considers a variety of factors that relate to the classification of the cleft and the baby's overall condition. Such considerations include:

• Whether the cleft is complete or incomplete. A complete cleft lip is a deep split in the upper lip that extends into one or both sides of the nose. An incomplete cleft lip affects only one side of the upper lip and may appear as a slight indentation or as a deep notch. See a picture comparing a complete cleft lip and an incomplete cleft lip.
• How much of the lip is involved. A cleft lip can affect one side of the upper lip (unilateral) or both sides (bilateral).
• Whether the baby has a cleft palate or any defects of the nose. Usually, any additional facial disfigurements make surgical treatment more complex.
• The size and health of the baby.
• Whether it is possible that the baby has a broader health condition.

After surgery

After surgery to correct a cleft lip, your baby may need to wear a head bonnet across the upper lip and taped to the cheeks, face, and head. The bonnet is made of a strap bandage reinforced with wire. This device helps prevent the lip from stretching and protects the stitches from breaking or separating. The head bonnet is worn for as long as it takes your child's lip to heal.

Your baby's arm movements may be restricted with splints or other material for as long as 3 weeks. This is sometimes needed to prevent your baby from touching and damaging the stitches.

After your baby's surgery, you will need to:

• Take measures to prevent infection and promote healing. Your health care team will offer guidance, but in general make sure you keep the area clean and protect the lip from injury.
• Have your child closely monitored by a health care team. It is a good idea to have a children's (pediatric) dentist for your child's general dental care and to consult an orthodontist as your child grows.

Feeding by bottle or at the breast usually doesn't require any special measures.

Usually the lip heals well after surgery, with very little evidence of the cleft. Sometimes there is a slight scar, but it is not usually very noticeable. Males usually develop normal facial hair growth on their upper lip as they mature. Some males grow mustaches to hide the scar. Females usually can cover the scar with makeup and lipstick. Sometimes another lip surgery is needed at 4 or 5 years of age, and surgery on the nose may not occur until adolescence.

Preventing cleft lip

Experts are still trying to find answers about why some babies are born with cleft lip. Although sometimes cleft lip is passed down through families (inherited), in most cases the cause is not known. Research continues on how genes and a mother's health—what she eats and drinks and hazards she is exposed to during pregnancy—can result in the fetus developing cleft lip. Studies show that if you smoke or drink alcohol during pregnancy, you may increase the risk that your child will be born with a cleft lip and/or cleft palate.³

Take good care of yourself before and during pregnancy. You can do some things to help prevent your fetus from developing cleft lip or cleft palate, such as taking prenatal vitamins and folic acid supplements. If you are planning a pregnancy and you have neither previous family history of cleft lip or palate nor a child with cleft lip or palate, taking 400 mcg (0.4 mg) of folic acid daily for 6 to 8 weeks is recommended. If you have a child with a cleft lip or palate or if you have a family history of cleft lip or palate, then 4 mg of folic acid daily for 6 to 8 weeks is recommended prior to pregnancy.⁴ Taking folic acid requires a prescription from your doctor.

Also, do not smoke or drink alcohol while you are pregnant.

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Author:	Debby Golonka, MPH	Last Updated: February 4, 2008
Medical Review:	Michael J. Sexton, MD - Pediatrics Arden Christen, DDS, MSD, MA, FACD - Dentistry
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