Michael D. Manuel, M.D.
Jana K. Cole, M.D.

CLEFT LIP

The operation performed will attempt to correct a birth defect caused by lack of fusion in development in the lip and/or palate. If this is an isolated lip deformity it may take one to two operations to totally correct this. If this is a lip and roof of the mouth abnormality, several operations may be required for best appearance and function to be obtained. The operation is usually performed at the three to four months of age however surgery may be delayed depending on your baby's health.

The cleft deformity is a lack of fusion of the two sides of the lip that caused distortion not only in the skin of the lip but also of the underlying muscles. The nose is also deformed to some extent in most cleft lip abnormalities. All tissues that are required for repair are present, they are just in an abnormal location. For this reason the operation is a realignment of the tissues following appropriately placed incisions. This operation will attempt to restore the lining of the lip but not address the correction of the split in the gum-line if it is present during the initial operation. The muscles will also be reattached which will hopefully bring better function and appearance to the lip. The nose may be corrected to some extent at the initial operation however will most likely require additional surgery if there is a significant deformity still present. The lack of fusion of the skin will result in a permanent scar in the lip. The scar will be aligned as so to create hopefully minimum affect in the child's appearance however this will be a permanent and irreversible scar. There may be some widening or thickening of the scar, reddening or irregularities which may need correction at a later date. In general this scar is very hyperactive and may take up to 12 to 18 months to flatten. It may initially cause some tightening with elevation of the cleft side of the lip. This will usually relax and return to a normal position within two years.

Complications directly associated with this operation include bleeding or infection at the operative site. Other abnormalities as mentioned are primarily related to the scar, healing and abnormalities in the nose position. Most of these can be corrected at a later date however there will always be some fell-tail sign of the original deformity present.

The operation takes approximately 1 1/2 to 2 hours and is performed under general anesthesia due to the child's age. There are several risks inherent with the general anesthesia and these can be discussed with the anesthesiologist prior to the operation. This operation can be performed as day surgery but in some children may require a 1 to 2 day hospital stay. The postoperative course will include local wound care which will be discussed. Also important are arm restraints which will need to be kept in place for approximately three weeks after surgery.