Cleft Lip

Treatment Overview

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

Before surgery

Sometimes cleft lip is treated with presurgical supports, such as special dental splints, soft dental moulding inserts, or simple medical adhesive tape. A child with a cleft palate is always 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 babies health and the cleft itself. Most doctors agree that cleft lip should, in most cases, be repaired by the time your baby is three 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 an illustration 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 (made of a strap bandage reinforced with wire) across the upper lip, which also is taped to the cheeks, face, and head. This device helps prevent the lip from stretching and protects the stitches from breaking or separating.

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

Also, after your baby's surgery you will need to:

• Take measures to prevent infection and promote healing. Your health professional will offer guidance, but in general make sure to keep the area clean and protect the lip from injury.
• Feeding at the breast or by bottle usually doesn't require any special measures.
• Have your child closely monitored by a health professional. It is a good idea to include a children's (pediatric) dentist in your child's general dental care and to consult an orthodontist as your child grows.

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 grow moustaches to hide the scar. Females usually can cover the scar with makeup and lipstick.

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 and drink alcohol during pregnancy, you may increase the risk that your child will be born with a cleft lip or cleft palate.³

Take good care of yourself before and during pregnancy so that your baby will be as healthy as possible. 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. 400 µg (micrograms) of folic acid 6-8 weeks before getting pregnant is recommended for mothers who have had no previous family history, or child with a cleft lip, or palate. Women who are at risk (such as those who have already had a child with spina bifida) should take 4,000 µg of folic acid a day.⁴ Folic acid may be obtained from vitamin supplements and by eating foods that are rich in folic acid. Also, do not smoke or drink alcohol while you are pregnant.

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Author:	Amy Fackler, MA Carrie Henley	Last Updated: April 21, 2006
Medical Review:	Adam Husney, MD - Family Medicine Michael J. Sexton, MD - Pediatrics Arden Christen, DDS, MSD, MA, FACD - Dentistry
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