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 be 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 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.

Clefts are grouped into classifications based on the side of the lip where the cleft is and how severe it is. The classifications are as follows:

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

Before your baby’s surgery, we may use the following pre-surgical techniques:

• A NAM (nasal-alveolar molding) device helps mold the lip tissues into a more favorable position in preparation for the lip repair.
• A taping regimen has also been shown to be effective. With this technique, tape is placed across the cleft and helps to mold the tissues closer to each other prior to surgery.

Before your baby’s cleft lip repair, he or she will be seen by a plastic surgeon within the first two months. 

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.

Repair of a cleft lip is usually performed when your baby is 3 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. If your child has a complete cleft lip, the surgery will also involve correction of the nose during the same surgery.

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 (physician dependent) to keep 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.

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 results in children with clefts growing 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.

9 Months Old
If your child also has a cleft palate, it is repaired at this time.

Any problems with the ears 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.

3-5 Years Old
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 also evaluate the best type of surgery for your child in order to improve speech outcomes.

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 7-9, the bone graft is done in the hospital. Bone is taken from the hip for this graft.

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.