Cleft lip is a visible facial/oral deformity characterized by the insufficient development of skin or lip tissue, resulting in a split or opening. Cleft lip can be mild, appearing as a simple notch or scar in the soft, pink tissue of the lip or the skin above the lip. Severe cases of cleft lip appear as a gap or opening in the lip that extends up into the nose.
Cleft lip deformities are categorized based on the location of the abnormality or defect and how much of the lip is involved.
Unilateral Incomplete: A cleft on one side of the mouth that does not extend into the nostril.
Unilateral Complete: A cleft on one side of the mouth that extends into the nostril.
Bilateral Complete: Clefts on both sides of the mouth, each of which extends into the nostril.
Microform Cleft: Considered a mild form of cleft lip, a microform cleft appears as a small, insignificant notch in the pink area of the lip or a minor scar stretching up from the lip into the nose. Some microform clefts that involve muscle tissue in the lip underneath the cleft may require surgery, but other types of microform clefts may not.
The success and safety of your child’s cleft lip procedure starts with a consultation with Dr. Cherry and depends very much on your complete candidness.
Be prepared to discuss:
- Your concerns and an evaluation of your child’s condition
- The options available for cleft lip repair
- The likely outcomes of surgery and the potential risks and complications associated with the procedure
- A recommended course of treatment
Be candid about your concerns for your child and your plastic surgeon’s ability to meet his or her special needs. The success of your child’s procedure, and his or her safety and overall satisfaction require that you:
- Honestly share your concerns.
- Fully disclose your child’s health history, including current medications, vitamins and herbal supplements.
- Sincerely commit to precisely following all of Dr. Cherry’s surgical and after-care instructions.
Cleft lip surgery is typically performed within two to three months after birth; however, treatment decisions are dependent upon each individual and the patient’s care team.
If the cleft lip is unilateral (affecting one side), only one surgery may be necessary. There are a number of procedures that can be performed, depending upon the extent of the cleft, the amount of lip and skin tissue present and what the treatment team determines will produce the best result.
Prior to cleft lip surgery, a special retainer called a nasoalveolar molding appliance (NAM) is worn in the baby’s mouth before the lip is repaired. This helps close the cleft gap inside the mouth and shape the nose. It also helps the surgeon perform a better surgical repair of the cleft lip and nose. Taping across the cleft lip also helps bring the two sides of the upper lip together for easier surgical repair.
In general, incisions are made alongside the cleft and below the nostril. This enables the two parts of the lips separated on either side of the cleft to be joined together and sutured (stitched), so that the lip will appear normal. The surgery includes joining the skin and muscles together.
If the cleft is bilateral (affecting both sides) and extensive, two surgeries may be necessary – one for each side, performed several weeks apart – to close the clefts.
A short hospital stay is usually required for both unilateral and bilateral cleft repair.
No dressing over the lip will be needed, but an antibiotic ointment will be applied once the strips of tape are removed. The lip sutures should be cleaned thoroughly and gently. Crusted drainage may be removed using hydrogen peroxide diluted with water. A thin layer of antibiotic ointment should be kept on the suture line at all times. Your child may have to wear soft arm restraints to prevent scratching at the suture line. These restraints, called “no-nos” will be necessary for 10–14 days after the surgery. They can be removed, one at a time, every two to three hours in order to exercise the baby’s arms.
- After surgery, feeding is resumed using a soft crosscut nipple.
- Infants remain hospitalized for intravenous hydration until oral intake is sufficient (usually 24 hours).
- The suture lines are kept clean by gentle application of a dilute hydrogen peroxide solution, and a small amount of antibiotic ointment is applied to the repair three times daily and after feeding.
- If nonresorbing suture material is used, the sutures are removed by the fifth postoperative day.
- Soft elbow restraints are used for 10–14 days after the surgery, to keep the infant from manually disrupting the repair.
Risks & Side Effects
Any surgery carries a small risk of infection or bleeding. Every anesthetic also carries a risk, but this is very small. Your child’s anesthesiologist is a board-certified, pediatric-fellowship-trained anesthesiologist, trained to deal with any complications. The surgeon and anesthesiologist will discuss potential risks with you before the operation. Your child may have a headache, a sore throat or a dizzy feeling afterward. These side effects are usually short-lived and not severe.
Symptoms of infection are:
- Bright redness
- Puslike drainage
Call us if you observe any of these symptoms.
If the patient starts to run a fever (over 101°F) check to make sure that he or she is getting enough liquids. Dehydration can cause the body temperature to rise. Is the child getting a cold? Is anyone else in the home ill? Check these facts and then give us a call. It is important that the patient receives enough nourishment. If he or she won’t eat, try the TLC approach. If you still can’t get your child to take food or liquids, please give us a call.