The birth of any child is cause for the greatest of joy. It also represents the beginning of a lifetime of welcome responsibility. A child born a cleft lip (with or without a cleft palate) may require specialized medical attention and supervision in early childhood, but there is no reason to greet his or her birth with undue anxiety.
Cleft lip is a well-understood congenital deformity, occurring in roughly 1 of every 1000 babies born in the United States (or roughly 4500 children annually). With the help of a capable surgeon, as supported by a team of nurses and doctors, each with specialized training, any child with an isolated cleft lip can expect to live a normal, happy life with only the most minimal of complications.
A parent’s first concern will always be the future happiness of their child.
A parent whose child is born with a cleft lip will, additionally, be concerned about the impact the child’s appearance might have on that happiness. The answer for children in Louisiana and the region should be none, as we have a multidisciplinary craniofacial team in New Orleans, as recognized by the American Cleft Palate/Craniofacial Association (ACPA).
Diagnosis of Cleft Lip
In most cases, a routine ultrasound will reveal evidence of a cleft lip (or other orofacial cleft). Ultrasound cannot generally predict the severity of that cleft, however, as to whether or not the child also has a cleft palate. Only 20% of orofacial clefts are of the lip only, so in all cases the OB-GYN should refer parents to a cleft and craniofacial team that features an ACPA-certified craniofacial surgeon.
The importance of a team approach to surgery to repair cleft lip cannot be understated. Parents will require support and training prior to taking the child home from the hospital. Quite simply: you must be able to feed your baby!
Moreover, whether or not the child has a cleft palate, only a specialized team will be able address both the cosmetic and functional aspects of a surgery to repair cleft lip. Because the success of the repair impacts both facial and nasal symmetry, the team’s concern will be focused, not just on the initial repair, but on the success of the surgery over time and as your child grows.
Cleft Lip Treatment: A Team Approach
No one knows exactly why certain children are born with orofacial clefts. Genetics play a role, as do environmental risk-factors encountered by their mothers during pregnancy.
Even if the causes are not well understood, the requirements for a successful repair and ongoing treatment of cleft lip (with or without a cleft palate) are both well understood and commonly achieved.
Generally, your ACPA-approved team will be led by a plastic surgeon with specialized training in craniofacial surgery. Additional team members usually include a nurse coordinator (who will oversee scheduling and monitor the health of your baby); as well as a psychologist and/or social worker (to help support and educate you, the parent); and a geneticist.
After your child is born, you should expect he or she to be seen by other specialists, such as an audiologist (who will assess the child’s hearing); a pediatric dentist (or other dental specialist); an “ear nose and throat” doctor or ENT; and a pediatrician (to monitor overall health and development).
Later, depending on the severity of the cleft, a speech therapist/pathologist and an orthodontist may be required, as may other specialists.
Most often, children with an isolated cleft lip will overcome only the most minor complications. A skilled plastic surgeon will be able to minimize visible scarring, ensuring normal growth and facial and nasal symmetry. In most cases, a child born with cleft lip only will not have problems with speech.
Cleft Lip and Childhood Development
While you might think of a cleft lip as a cosmetic deformity, there are functional implications that require the attention of a certified and specially-trained plastic surgeon.
The goal of surgery to repair cleft lip is to address immediate function—allowing your child to purse their lips and create suction in order to feed. Thereafter, facial symmetry and the success of the repair as your child grow are the team’s principal concerns.
A cleft lip may be:
- Complete, extending all the way up to the nostril.
- Incomplete, or partial, in which case it does not extend to the nostril.
- Microform (rare), meaning small, with the musculature intact.
- Bilateral (rare), or occurring on both sides of the lip.
The course of treatment and repair for an isolated cleft lip depends on the severity of the cleft and on the presence of other, complicating factors.
(Click here for more information about surgery to repair cleft lip and palate.)
Cleft Lip Timeline
Pre- and Post-Natal Care
The first step is choosing a team, educating yourself, and preparing to feed your child once he or she is able to leave the hospital. It is vitally important to see your surgeon as early as possible, in the first days of life, especially if the child has a cleft palate or other complications.
Surgery to repair cleft lip is participatory: it depends on the parents’ active care.
First Weeks of Life
In the first weeks of life, prior to formal surgery to repair the cleft, we often recommend pre-surgical measures (Dynacleft [link]) in order to prepare the child for surgery, and it has been shown that early intervention reduces scarring.
Surgery at 3 to 4 Months
Most surgeons prefer to wait some number of weeks before surgery. There are many reasons of this, but chief among them is the stability of the child’s overall health. Any ACPA-approved team will want to ensure that the nasal cartilage—the defining structures in the nose—are stable before performing surgery.
Immediate Care Following Surgery to Repair Cleft Lip
In the weeks following surgery to repair cleft lip, the child’s parents will need to be vigilant.
Sutures (stitches) are usually removed under anesthesia a week after surgery, but the success of the surgery depends on the parents’ after-care. The child’s successfully repaired lip will require massage by the parents 4 to 5 times a day, for just 15 to 20 seconds, in order to break up scar tissue that is the natural result of surgery.
Checkup at 10 Months
Your ACPA-certified team will be there for you throughout the growth and maturation of your child. (Click here to read about ongoing care of children who have more complicated orofacial clefts.) At 10 months, any complications of early surgery will likely be evident and a future plan of care can be established.
Yearly Checkups Following Surgery to Repair Cleft Lip
The good news for children who are born with a cleft lip, without other complications, is that they can expect a normal childhood. Yearly checkups should be observed, and ongoing speech therapy—even before they start speaking (at age 2 or thereafter)—is highly recommended. Regular dental cleanings are a must.
Sometimes rhinoplasty is indicated (the child might need a “nose job”), and sometimes braces or other corrective dental surgery are required, but for the most part children with isolated cleft lip do very well.
Regardless, yearly checkups and the support of a well-trained team should give both parent and child all the confidence needed to live a happy, healthy life.