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What is cleft lip?

Cleft lip is a birth defect that occurs when a baby’s lip does not form properly during pregnancy. The tissue that makes up the lip does not join completely before birth, which results in an opening in the upper lip. The opening in the lip can be a small slit or it can be a large opening that goes through the lip into the nose. A cleft lip can be on one or both sides of the lip or in the middle of the lip, which occurs very rarely

Cleft lip can sometimes occur with cleft palate. Together, these birth defects commonly are called “orofacial clefts” Isolated orofacial clefts (clefts that occur with no other major birth defects) are one of the most common types of birth defects in the U.S. Affected children often have problems with feeding and speaking clearly and can have ear infections. They also might have hearing problems and problems with their teeth.

Cohen Children’s offers superior diagnostic, medical and surgical care for infants and children with cleft lip. Our expert multidisciplinary team features pediatric plastic surgeons, oral surgeons, dentists, orthodontists, prosthetic specialists, ear/nose/throat specialists, geneticists, social workers, speech and hearing professionals and dedicated cleft coordinator nurses. We also perform revision surgeries in children, as well as adults, if they are not happy with the appearance of their lip or nose.

What to expect

We usually diagnose prenatally, around the 20 week ultrasound. We work closely with expectant parents to help them understand the situation, answer any questions and concerns they have and develop a plan of action before their baby is even born.

As soon as the baby is born, we do a feeding evaluation, as it can be challenging for a baby with a cleft lip to suck. We usually provide special bottles that make it easier to feed, and we order additional shipments to the house.

One to two weeks after birth, we provide nasoalveolar molding (NAM) when necessary. The NAM device is inserted into the mouth and up the nose. It helps close the hole in the mouth (cleft palate) which makes feeding easier, and it works like a retainer to bring everything as close together as possible prior to surgery. It also helps shape the nose and increase the columella (piece of skin between the nostrils). We will adjust the retainer every week, and over time, it will minimize the amount of stretching required at the time of surgery and produce a better outcome. The device is removable, easy to clean and noninvasive.

We perform the first cleft lip and nose surgery when the baby is 3 or 4 months old. It’s an outpatient procedure performed under general anesthesia. The surgery takes about two hours or less. The surgeon will sew the tissues together to improve function and appearance.

Risks

  • One risk of surgery is asymmetry (one side of the mouth and nose does not match the other side).
  • Another risk is scarring. (However, we offer the latest scar therapy with silicone gels, as well as pulse dye light laser therapy to help reduce scarring. We aim to have scars mimic the normal shadows and creases in the face.)
  • A final risk is the patient needing additional surgical procedures as they get older, even after a successful surgery.

Recovery

Your child will go home the same day of surgery. We remove stitches a week later and glue tape over the recovery area to protect it. (This is done in lieu of using arm restraints.) Your child may need pain medication for the first few days after surgery, and their mouth will be swollen for the first week or two. The incision should heal in three to four weeks, and the scar will fade over time. During the weeks following surgery, your child will need to be on a liquid or semi-liquid diet. 

Children with cleft lips often require a variety of services throughout childhood and into adolescence and sometimes adulthood. (Additional nasal surgery is most often required, typically when maturity is reached.) Thus, our multidisciplinary team consists of expert healthcare providers from different specialties that can provide this long-term care in a coordinated manner.

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