Cleft Lip

Topic Overview

What is cleft lip?

Cleft lip is a treatable birth defect that occurs when the tissues of the upper jaw and nose do not join as expected during fetal development, resulting in a split (cleft) in the lip. A cleft lip generally does not cause health problems. Occasionally, some infants with cleft lip have difficulty feeding.

Cleft lip usually involves only one side of the upper lip. It rarely occurs in the lower lip. Cleft lip often occurs with cleft palate; the two are the most common birth defects of the head and neck.¹

What causes cleft lip?

Cleft lip may be caused by genetic and environmental factors. If you were born with a cleft palate or cleft lip, your children will have an increased risk for being born with one of these.

A baby may be at higher risk for being born with cleft lip if during pregnancy the mother uses certain medicines, is exposed to radiation or infections, takes illegal drugs, smokes, or drinks alcohol.

What are the symptoms?

A cleft lip is visible at birth. Beyond the distinctive physical appearance, no other symptoms usually are noticed. Babies with cleft lip typically do not have any problems breast-feeding or bottle-feeding. But babies with both cleft lip and cleft palate may have feeding problems. See a picture of a cleft palate .

How is cleft lip diagnosed?

Cleft lip usually is diagnosed at birth from the distinct way a newborn's face looks. A baby's first physical exam shortly after birth can provide more details about the condition, such as whether the baby also has a cleft palate.

Sometimes a fetal ultrasound during pregnancy can detect a cleft lip. But it is not always reliable for this purpose.

How is it treated?

When the surgery takes place depends upon a number of things, including what your doctor suggests, your baby's health, and the cleft itself. Most doctors agree that cleft lip should, in most cases, be repaired by the time a baby is 3 to 6 months old.

The exact timing of treatment and surgery takes into account the severity of the cleft lip, the size and health of the baby, and other concerns the health care team may have for the baby.

The type of surgery to correct a cleft lip depends on how much of the lip is involved, whether the baby has any defects of the nose, and whether cleft palate is also present. Additional surgeries may be done as the child grows to help the mouth adapt and to improve the appearance of a scar. The number and type of surgeries depend on other aspects of your baby's health, such as whether other facial defects are present. For example, if your baby's nose is irregularly shaped, additional surgery may be done later to correct it for health or cosmetic reasons.

Other treatment is specific to the kinds of problems that can develop, such as speech therapy for word pronunciation problems.

Frequently Asked Questions

Symptoms

A cleft lip is obvious at birth. Beyond the distinctive physical appearance, a cleft lip usually does not cause other symptoms or feeding problems. Babies born with cleft lip often can breast-feed successfully. And bottle-feeding usually is not a problem if you use special nipples with hole openings that are slightly bigger than newborns usually require.

Feeding problems usually only occur in babies with cleft lip if they also have cleft palate.

Usually cleft lip is not related to other health problems. But cleft lip with cleft palate can be linked to other health conditions, such as fetal alcohol syndrome or chromosomal disorders. A baby born with cleft lip who has other physical abnormalities or symptoms, such as an irregularly shaped head or respiratory problems, will be evaluated for these other types of health problems.

Exams and Tests

Diagnosis of cleft lip is based on a physical exam of your baby's mouth. Cleft lip usually is obvious at birth because of distinctive facial characteristics. A baby with cleft lip should be examined carefully for the presence of other birth defects, such as cleft palate.

If cleft lip occurs with cleft palate, it is sometimes associated with another health condition, such as fetal alcohol syndrome or chromosomal disorders. For this reason, it is important for children to be evaluated for other conditions beginning at birth, especially if other symptoms are present, such as other facial deformities or learning disabilities.

Some children with cleft lip may need testing for complications, such as speech and hearing problems.

Early detection

Fetal ultrasound can sometimes detect cleft lip as early as 14 to 16 weeks of gestation. But fetal ultrasound is not reliable for this purpose. Cleft lip may go completely undetected or its appearance on the ultrasound may be misinterpreted.

Cleft lip or cleft palate can be passed down through families (inherited). If you have a family history of cleft lip or cleft palate, you may benefit from genetic counseling. A genetic counselor can help you understand your chances of having a child with a cleft lip or cleft palate.

Sometimes an inherited disease or condition causes a number of defects that includes cleft lip and/or cleft palate. If you have had a fetal ultrasound that shows your fetus is likely to have cleft lip and/or cleft palate along with other defects, you may decide to have genetic counseling along with amniocentesis or karyotype testing. These tests and genetic counseling can help you learn whether your fetus is likely to have a condition caused by chromosomes that aren't normal. Karyotype testing can also be done after your baby is born.

Treatment Overview

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

Your child's doctor or a health care team will examine your newborn before your baby goes home from the hospital. These professionals can tell you how to care for your child before surgery.

Before surgery

Sometimes cleft lip is treated with presurgical supports, such as special dental splints, soft dental molding inserts, or medical adhesive tape. A child with a cleft lip and palate may be 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 baby's health, and the cleft itself. Most doctors agree that cleft lip should, in most cases, be repaired by the time your baby is 3 to 6 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 a picture 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 across the upper lip and taped to the cheeks, face, and head. The bonnet is made of a strap bandage reinforced with wire. This device helps prevent the lip from stretching and protects the stitches from breaking or separating. The head bonnet is worn for as long as it takes your child's lip to heal.

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

After your baby's surgery, you will need to:

• Take measures to prevent infection and promote healing. Your health care team will offer guidance, but in general make sure you keep the area clean and protect the lip from injury.
• Have your child closely monitored by a health care team. It is a good idea to have a children's (pediatric) dentist for your child's general dental care and to consult an orthodontist as your child grows.

Feeding by bottle or at the breast usually doesn't require any special measures.

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 males grow mustaches to hide the scar. Females usually can cover the scar with makeup and lipstick. Sometimes another lip surgery is needed at 4 or 5 years of age, and surgery on the nose may not occur until adolescence.

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

Take good care of yourself before and during pregnancy. 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. If you are planning a pregnancy and you have neither previous family history of cleft lip or palate nor a child with cleft lip or palate, taking 400 mcg (0.4 mg) of folic acid daily for 6 to 8 weeks is recommended. If you have a child with a cleft lip or palate or if you have a family history of cleft lip or palate, then 4 mg of folic acid daily for 6 to 8 weeks is recommended prior to pregnancy.⁴ Taking folic acid requires a prescription from your doctor.

Also, do not smoke or drink alcohol while you are pregnant.

Home Treatment

Before your newborn goes home from the hospital, your child's doctor or a health care team will examine your baby and can tell you how to care for your child before surgery. After surgery to correct a cleft lip, you'll need to keep your baby's lip and nose area clean and free of infection. You will get specific instructions to guide you through this process. For example, the doctor may tell you to:

• Clean the lip and nose area in a certain way.
• Apply a generous coating of antibacterial ointment to the area after cleaning, typically for the first 3 days after the surgery.

Caring for a child with a birth defect requires extra time, patience, and energy. Although it is easy to ignore your own needs, remember that it is important that you be physically and emotionally healthy in order to give your child the best care.

What to think about

If your child is born with cleft lip, it is normal to experience concerns and feelings, including anger, fear, guilt, depression, or denial. You may find it helpful to talk with your child's doctor or see a counselor. Also, you may find a support group helpful. A support group allows you to interact with other parents who have babies with cleft lip.

Fortunately, cleft lip is usually corrected with surgery with only slight scarring. During the first weeks or months before surgery can be performed, you may wonder how your friends, relatives, other children, and even strangers will react to your baby's appearance. Try to focus on developing a bond with your baby. The rest will fall into place over time.

It may be helpful to talk to your other children about the condition. Let them know that no one is responsible, that it does not hurt, and that it can be corrected with surgery.

As your child grows, consider explaining how clefts develop. Emphasize your pride and love for your child, who successfully handled surgery as a baby. Convey that being born with a cleft lip has been a part of making your child strong and special. Teach your child how to answer questions from peers and adults about the scar. You can help minimize concerns or self-consciousness about the scar by helping your child understand and accept it as one of many life experiences.

Other Places To Get Help

Organizations

Related Information

• Alcohol Effects on a Fetus
• Birth Defects Testing
• Cleft Palate
• Cosmetic Surgery and Procedures
• Pregnancy
• Tongue-Tie

References

Citations

1. Kirschner RE, LaRossa D (2000). Cleft lip and cleft palate. Otolaryngologic Clinics of North America, 33(6): 1191-1215.

2. Beers MH, et al., eds. (2006). Craniofacial abnormalities. Merck Manual of Diagnosis and Therapy, 18th ed., pp. 2422-2424. Whitehouse Station, NJ: Merck Research Laboratories.

3. Lorente C, et al. (2000). Tobacco and alcohol risk during pregnancy and risk of oral clefts. Occupational Exposure and Congenital Malformation Working Group. American Journal of Public Health, 90(3): 415-419.

4. American College of Obstetricians and Gynecologists (2003). Neural tube defects. ACOG Practice Bulletin No. 44. Obstetrics and Gynecology, 102(1): 203-210.

Other Works Consulted

• Edwards SP, et al. (2007). Cleft lip and palate. In DM Laskin, AO Abubaker, eds., Oral and Maxillofacial Surgery, pp. 135-151. Chicago: Quintessence Publishing.

• Hoffman WY (2008). Cleft lip and palate. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology-Head and Neck Surgery, section 6, pp. 323-339. New York: McGraw-Hill.

• Mueller WA (2007). Oral medicine and dentistry. In WW Hay et al., eds., Current Pediatric Diagnosis and Treatment, 18th ed., chap. 16, pp. 449-458. New York: McGraw-Hill.

• Wilcox AJ, et al. (2007). Folic acid supplements and risk of facial clefts: National population based case-control study. BMJ. Published online January 26, 2007 (doi:10.1136/bmj.39079.618287.0B).

• Wolfe SA, et al. (2006). Surgical treatment of clefts of the lip and palate from birth to age ten. In S Berkowitz, ed., Cleft Lip and Palate: Diagnosis and Management, 2nd ed., chap. 22, pp. 459-475. Berlin: Springer.

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