See also: Cleft palate 
What is cleft lip?
A cleft lip occurs when the right and left sides of the lip fail to grow together as the baby develops in the womb. A cleft lip occurs within the first trimester of pregnancy between the sixth and eighth week of gestation. A cleft may result from a family history (genetic predisposition), a spontaneous change (mutation) of a gene in the case of a syndromic cleft, or exposure to some medication, chemical or infection prenatally. Most often, the cause is never determined and is identified as an isolated incidence. The frequency of cleft lip is approximately 1 in 700 live births.
How do you know if your child has a cleft lip?
Common characteristics of cleft lip may include:
- Cleft of the upper lip can be as mild as a slight notch in the red portion of the lip to a complete separation of the lip that extends up and into the nose.
- The gum line (alveolus) can be affected. Cleft of the alveolus can range from a slight notch to complete separation.
- Clefts of the lip can occur on one side or both sides.
How does a doctor diagnose a cleft lip?
In terms of diagnosis, a cleft lip may be detected during routine prenatal ultrasound testing or it may be diagnosed at the time of delivery. Prenatal consultation with the Inova Children's Craniofacial Program nurse manager and/or plastic and reconstructive surgeon (craniofacial surgeon) offers expecting parents a unique opportunity to learn about their infant's condition and be well prepared for his or her birth. It is also an opportunity to reassure parents that they did not do anything to cause the cleft nor was there anything they could have done to prevent it.
Please call 703-776-6920 to schedule a prenatal consultation with the Inova Children's Craniofacial Program nurse manager. We are located at Inova Children's Hospital (on the Inova Fairfax Medical Campus) on Gallows Road in Falls Church, VA.
Treatment for cleft lip
Feeding
- Breastfeeding: A mother should be able to breastfeed with a few minor adjustments. The lactation consultant or speech pathologist can teach new mothers about correct positioning, getting the baby to latch well and maintaining a good seal around the nipple.
- Bottle feeding: Infants who bottle feed can use a regular bottle and nipple. Parents are free to try different nipples to determine which one their baby prefers.
Free cleft lip feeding videos and resources
Watch a series of free "Feeding Your Baby" videos and download other free material from cleftline.org, the website of the American Cleft Palate-Craniofacial Association.
Prior to surgery
- Schedule a consultation with the Inova Children’s craniofacial team soon after birth (703)776-6920.
- The craniofacial surgeon and orthodontist will determine if the baby is a candidate for presurgical molding (Nasoalveolar Molding or NAM). NAM is carried out by the team’s orthodontist. NAM helps to bring the segments of the lip closer together prior to surgery in order to decrease the tension on the suture line after surgery and minimize the scar. NAM will also elevate the nostril on the cleft side to make it symmetric with the other nostril. Symmetry of the nostrils is often the most challenging part of cleft lip repair and NAM helps the surgeon to achieve an excellent result.
Surgery
- Surgery to repair the lip takes place at approximately 10-12 weeks of age.
- The surgery is performed at Inova Children’s Hospital and takes about 1 ½ to 2 hours to complete.
- The surgeon will repair the lip muscles, position the cupid’s bow and close the soft tissue to restore lip symmetry and lip function. The stitches are placed in the line that goes from the nose to the lip (philtral column). They are placed there so that, over time, they will blend in with the lip and face.
- Length of hospital stay is usually one night. Parents are welcome to stay overnight.
After surgery
- An IV will help keep baby well hydrated until he/she is interested in feeding.
- The nurses will help keep baby comfortable with pain medication and will assist with feeding.
- It is not unusual for the baby to be fussy and need extra TLC (tender loving care) on the day of surgery.
- The stitches will be visible but they are protected by a spray on bandage.
- Baby's face may be bruised and swollen around the lip and tip of the nose. This area may continue to swell for the first 24-48 hours and then will slowly resolve. The scar will be red and raised at first but will fade with time.
- A little bloody discharge may also be seen after surgery.
- Parents, family and friends need to take great care to protect the suture line. The first surgery on a child's lip is the best opportunity the surgeon has to achieve excellent results.
- Elbow restraints or "no-nos" may be used to keep the baby from rubbing or accidentally scratching the area.
Feeding after a cleft lip repair
- An IV will provide fluids until the baby is ready to begin feeding again.
- The feeding method used prior to surgery may be used after surgery.
- Continue to feed breast milk or formula as before surgery.
Sun exposure risk
Always protect the scar from damaging sun rays with a large brimmed hat and sunblock.