Cleft lip

• Disease description (causes and symptoms)

  • Definition: Cleft lip is a congenital malformation in which the structures around the upper lip fail to fuse completely during the early stages of fetal development, resulting in a split in the upper lip. It may occur alone and is often accompanied by cleft palate (a split in the roof of the mouth).
  • Causes and pathophysiology: There is no single cause; genetic factors and environmental factors during pregnancy act in combination. Infections during pregnancy (e.g., rubella), exposure to certain medications, smoking, and nutritional status (possible folate deficiency) are known risk factors. The mechanism involves failure of fusion of the maxillary and lateral facial prominences, resulting in defects in various structures, including the skin, muscles, soft tissue, and nasal structures.
  • Main symptoms and effects
    • Split in the upper lip (unilateral or bilateral)
    • Nasal asymmetry and nostril deformity (cleft lip nasal deformity)
    • Difficulty feeding (reduced sucking strength, food passing into the nasal cavity)
    • Dental abnormalities (malocclusion, missing teeth, supernumerary teeth)
    • Speech problems (especially when accompanied by cleft palate), with possible delayed language development
    • Otitis media and hearing problems (when accompanied by cleft palate, middle-ear effusion may occur due to Eustachian tube dysfunction)

• Treatment methods (standard treatment · medications · procedures/surgery · lifestyle management and precautions)

  • Principle: A multidisciplinary team approach is needed, involving plastic surgery, oral and maxillofacial surgery, pediatrics, otolaryngology, pediatric dentistry, speech-language therapists, genetic counseling, and other specialties.
  • Surgery
    • Primary cheiloplasty: Generally performed at around 10 weeks of age (earlier or later depending on the hospital and the child’s condition). Surgery restores the continuity, appearance, and function of the upper lip.
    • Secondary revision surgery (correction of the lip and nasal deformity): Performed according to the child’s stage of growth (from preschool age to before entering elementary school; at around age 3 may also be possible if needed). Definitive rhinoplasty is performed after skeletal and cartilage maturation (after puberty).
    • Nasal stent (nose conformer): Often worn for several months or longer to maintain reshaping after surgery (in the cited case: at least 6 months).
    • Other procedures: If cleft palate is also present, palatoplasty and, when necessary, alveolar bone grafting at the fusion site (during the mixed-dentition period) may be planned.
  • Medications and anesthesia:
    • General anesthesia and relevant examinations are required before and after surgery. Surgery may be postponed if there is a respiratory infection before surgery, such as a cold.
    • Preventive antibiotic administration during surgery and analgesics for pain management, such as acetaminophen, are used.
  • Nonsurgical treatment and management
    • Feeding support: Special nipples (slit-type or with a larger opening), short feeding sessions (recommended: within 30 minutes), a semi-upright position, frequent burping, and other measures.
    • Speech therapy: Speech correction and support for language development (especially important when cleft palate is also present). Regular speech evaluations and treatment after surgery are recommended (an initial evaluation 3–6 months after cleft palate surgery, followed by monitoring every 6–12 months, for example).
    • Dental and orthodontic treatment: Management of abnormalities in the primary and permanent teeth, and collection of baseline information for future orthodontic and surgical planning (models and radiographs).
    • Hearing tests: Monitoring for middle-ear effusion and hearing loss (regular otolaryngology examinations are recommended when cleft palate is also present).
    • Scar management: After suture removal, supportive measures such as tape and silicone gel may be used; taping for the first 2–3 weeks may help reduce scarring.
  • Precautions (including the risk of complications)
    • During the early wound-healing period after surgery, the scar may be red and raised, which is common (improvement occurs around 3 weeks to 3 months, with stabilization after 3–6 months).
    • Surgical complications: Bleeding, infection, anesthesia-related risks, poor wound closure, and others.
    • Long-term problems: Speech disorders, dental malocclusion, psychosocial difficulties (self-esteem and interpersonal relationships), and the need for repeated surgeries.
    • Factors that may delay surgery: Respiratory infections such as a cold before surgery, poor nutrition, abnormal findings on general examinations, and others.

• Checklist before an outpatient visit (including recommended items to bring, information to record, and sample questions)

  • Items to bring (recommended)
    • Current medications (for infants and young children, also include the type of breastfeeding or formula feeding) and allergy history
    • Birth records (birth weight and whether there were feeding problems) and records of previous examinations and surgeries
    • Growth records (weight and feeding volume) and developmental milestones (such as when speech began)
    • Family history (similar malformations or genetic diseases)
    • Previous hearing test, dental, and speech therapy records, if available
    • Facial photographs (front and side views) — useful when discussing the surgical plan
  • Symptom checklist before the outpatient visit (notes)
    • Feeding pattern and whether weight is increasing (bring a weight chart)
    • Whether food passes through the nose during feeding and the frequency of burping
    • Recent respiratory symptoms (cough, runny nose, fever) and symptoms suggestive of otitis media (persistent ear pain, developmental delay)
    • Speech and language development status (unusual pronunciation, whether the child imitates sounds, and so on)
  • Information that may be helpful to provide to the doctor and team during the outpatient visit
    • Feeding support methods (the type of nipple being used) and history of previous assistive device use
    • Family and social support status (availability of care after surgery, and so on)

• Examples of general questions to ask the doctor

  • What is the purpose of this surgery, and what results can be expected?
  • How are the timing and reasons for surgery determined? Is it safe to have surgery now?
  • What precautions should be taken before and after surgery, and what are the risks of complications?
  • How will pain be managed after surgery? Which medications should be taken, and for how long?
  • What schedule will be followed for additional care (speech therapy, dentistry, and otolaryngology)?
  • What is the expected long-term prognosis (speech, teeth, and appearance)?

• Examples of condition-specific questions

  • Does our child have only a cleft lip, or are examinations, including genetic testing, needed to determine whether cleft palate or other malformations (a syndrome) are also present?
  • When and how many times might correction of the nasal shape (rhinoplasty) be needed after surgery? How long should the nasal stent be worn?
  • When is orthodontic treatment in the future (correction of the teeth and facial skeleton) or alveolar bone grafting likely to be needed?

Brief prognosis summary: With appropriately timed multidisciplinary treatment (appropriately timed reconstructive surgery, speech therapy, and dental and otolaryngology care), functional and aesthetic outcomes are generally favorable. However, long-term follow-up is necessary because speech treatment, orthodontic treatment, and additional plastic surgery may be needed.