This is a separation of the lip and can range from a lip known as a “forme fruste,” or notch in the red part of the lip, to a complete cleft extending through the lip and into the nose.
Cleft lips can occur on one side (unilateral) or on both sides (bilateral). The term “incomplete cleft” refers to a deformity that does not go through the gums, while the term “complete” includes the gums and the entire primary and secondary palates of the mouth. The opening includes separation of muscle, soft tissue, and the gum line. Our surgeons do surgery on the lip around 3-4 months of age. Timing can vary depending on gestational age at birth, pre-surgical orthodontics, and other circumstances which we will discuss with you prior to any surgical intervention at the time of the initial visit. The sutures will need to be removed in one week. The baby should only stay overnight in the hospital and be able to go home the next morning.
Timeline of Treatment
Increasingly, diagnosis of a cleft happens before the baby is born, given the sophisticated ultrasounds that are routinely performed on expectant mothers. We enjoy seeing families at this time because we can reassure them and establish a starting point for our team relationship. The plastic surgeon emphasizes that his or her job is an important part of the baby’s future, but that the parents’ is much more important. We are able to show them photographs, educate them on what to expect, and introduce them to other members of our team.
Assuming the parents have been properly prepared, the focus here should be on the usual things that happen during the birthing experience. Very few cleft babies have breathing difficulties (exceptions are Pierre Robin sequence and associated birth abnormalities affecting airway). If the parents were unaware of their baby’s cleft, they should be comforted and reassured by the doctors and nurses delivering the baby. When we see a baby with a cleft, we don’t see an abnormality: We see the baby in the light of what he or she will look like after correction of the cleft. If babies have trouble generating the suction force necessary to breastfeed properly, they would benefit from the use of a special nipple that easily delivers breast milk or formula (Pigeon, Haberman). Most mothers will choose to pump and deliver breast milk through a bottle. We offer a 24/7 hotline for parents or healthcare workers faced with the arrival of a baby with a cleft, 512-289-1904.
1st Week of Life
We begin 3-4 months of NAM therapy to ensure a better surgical result.
3-4 Months of Age
The optimal time to surgically repair the cleft lip, whether it be unilateral or bilateral, is between 3 to 4 months of age, provided the NAM therapy has been completed. At this time, the baby is physiologically more mature, including lip muscle and landmarks, and is optimally developed and sized for repair.
At Wellspring, we repair the cleft lip using a rotation advancement, also known as the Millard Repair, which was developed by the plastic surgeon Dr. Ralph Millard in Miami. It aligns the nose and lip anatomically, provides the least visible scars, and is appropriate for a unilateral or bilateral cleft lip, complete or incomplete.
After the surgical repair, we look forward to seeing our patients annually to ensure their mid-face is growing proportionately.
For consults with Dr. Hobar & Dr. Cone, call us in Austin at 512-600-2888 or in Dallas at 972-566-7300.