Cleft Lip

If the infant does not pass the screening hearing test in the birth hospital, a follow-up secondary hearing test will be recommended. Follow-up testing is important to evaluate whether or not the child has hearing loss. A special hearing test, called an ABR (auditory brainstem evoked response), may be scheduled to obtain more detailed information about the baby’s hearing. If there are concerns for hearing loss the infant will be referred to our ear, nose and throat doctor. Regular assessment of hearing, typically at least once a year, is recommended for the first few years of life. 

Children with isolated cleft lip do not have a higher chance of developing ear infections or fluid behind their ear drums. However, ear disease is common in children under 3 years in general, so if there are concerns evaluation with the ear, nose and throat physician is advised. 

• Two weeks: presurgical treatment for nasoalveolar molding, if indicated. Visits to dental clinic every one to two weeks until cleft lip repair.
• Two to four months: first visit with craniofacial team
• Three to six months: cleft lip repair
• 15 to 18 months: craniofacial team visit
• Five to fourteen years: craniofacial team visit every one to two years, possible revision of lip/nose
• Fifteen to twenty years: craniofacial team visit every two years, consider final correction of external nose and septum

Parents should expect one surgery within the first year and a half after birth, for cleft lip repair.

Before surgery, our specialists sometimes recommend Naso-Alveolar Molding (NAM), which is a special technique to bring the gums and lip together with special dental molds and tape. The dentist will take the impression of your baby’s mouth in our office and create the appliance. We have found this makes the surgery easier and provides the best possible result.

Cleft lip surgery is usually scheduled around three to six months of age. Children should be at least 10 pounds in weight to be considered good candidates for surgery. 

During the operation, the surgeon releases the lip pieces where they are attached in the wrong place, and puts them in the correct location. The repair is held together with tiny, dissolving stitches. There will be one office visit two weeks after surgery.

Your baby will be asleep for the operation. The specialist who gives the sleeping medications, an anesthesiologist, is one of a staff of experts trained and experienced in giving anesthesia to young infants and children.

Most children usually stay just one night in the hospital and can go home the next day. The length of time that your baby is in the hospital depends on your child’s ability to drink fluids and feed comfortably after surgery. Sometimes, children may be in the hospital for two or more days if they have a fever or need some extra time to feed appropriately after surgery.

Parents may stay in the hospital room with their children. We recommend that you pack for at least 2 days in the hospital, just to be safe.

After surgery, you should try to keep fingers, pacifiers, and toys out of the baby’s mouth for two weeks. The feeding method used before surgery, either breast or bottle and nipple, may be used. 

Postoperative pain and discomfort is managed with a combination of infant-strength acetaminophen (Tylenol) or prescription pain medicine when something stronger is needed. Doses are based on body weight. We avoid the use of aspirin and ibuprofen (Advil, Motrin, Nuprin) two weeks before surgery due to the effect of decreased blood clotting that can be happen with that medicine. Ibuprofen may be used after surgery. An antibiotic may be prescribed for a few days after discharge.

Your baby can have the same nipple and bottle used before surgery after the cleft lip repair.  The baby may feed poorly for two to three days, usually because the nose is stuffy after surgery. Sometimes the baby needs a different nipple for the first days or week after surgery to slow down the flow of milk but can go back to the original method afterwards. If your baby eats cereal or food, the normal diet can start again after discharge, as tolerated by the baby. 

To keep the baby’s hands and fingers out of the mouth, arm restraints may be used to keep the elbows straight. These restraints are completely optional and are provided for the convenience of the family. 

Download cleft lip repair post-operative patient instructions (PDF) »

Most babies will not have any teeth at the time of cleft lip repair. However, in older children, the tooth next to the cleft may be missing.  Sometimes the tooth erupts in another place, such as the palate. In the baby teeth, we suggest that you keep all of the teeth clean by brushing or by wiping the teeth off after eating.  If the permanent tooth is missing, the pediatric dentist will discuss ways to make a tooth for that spot.