What is cleft lip repair?

Cleft lip repair, also called cheiloplasty, is surgery to correct a cleft lip. Cleft lip is a birth defect that occurs when the upper lip doesn't fuse together properly during development. It can look like a small notch in the edge of the lip or it can extend into the nose and gums. Cleft lip can affect one side of the mouth, called a unilateral cleft, or both sides of the mouth, called a bilateral cleft. 

Cleft lip repair involves joining the sides of the lip together to close the opening or space in the lip. The surgery improves the function, structure and appearance of the lip. 

Cleft lip repair is a common but major surgery with serious risks and potential complications. Most children with cleft lip have the surgery between three to six months of age. 

Other procedures that may be performed 

Cleft lip may occur alone or with cleft palate. Cleft palate is a birth defect that occurs when the roof of the mouth, or palate, does not develop properly. Cleft palate results in a split or opening in the roof of the mouth. Cleft lip and cleft palate may require correction in separate surgeries. 

Your child’s doctor may recommend other procedures before or after cleft lip repair including:

  • Cleft palate repair to correct cleft palate
  • Dental and orthodontic procedures to repair dental problems, such as gum problems, bone defects, and small, missing, abnormal, displaced or extra teeth
  • Lip adhesion procedure or molding plate to bring the sides of a very wide cleft lip closer together before cleft lip repair surgery
  • Plastic surgery including scar revision surgery to minimize the appearance of scars and nose surgery to improve the appearance of the nose

Why is cleft lip repair surgery performed?

Cleft lip repair treats a cleft lip. Left untreated, cleft lip can cause problems with feeding, growth and development, ear infections, hearing, speech, and self-esteem. Dental problems are also associated with cleft lip. 

Who performs cleft lip repair?

The following specialists repair cleft lips:

  • Plastic surgeons specialize in aesthetic and reconstructive surgery. 
  • Facial plastic and reconstructive surgeons specialize in plastic and reconstructive surgery of the face. They initially train as plastic surgeons or otolaryngologists (ear, nose and throat doctors/surgeons).
  • Head and neck plastic surgeons specialize in plastic and reconstructive surgery of the head and neck. They also train as plastic surgeons or otolaryngologists (ear, nose and throat doctors/surgeons) before further specialization.

How is cleft lip repair performed?

You child’s cleft lip repair will be performed in a hospital. Cleft lip repair surgery takes from two to six hours, depending on the extent of surgery.

The goal of cleft lip repair is to close the separation in the lip. The surgeon will make incisions on either side of the cleft to create flaps of tissue. The surgeon will draw the flaps of tissue together and stitch them to close the cleft. 

Types of anesthesia that may be used

Your child's doctor will perform cleft lip repair using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put your child in a deep sleep. Your child is unaware of the procedure and will not feel any pain. 

The doctor may use a sedative medication to relax your child before surgery. It is usually given by mouth. Your child’s care team will then start general anesthesia through a breathing mask. After your child is asleep, the team will insert an IV to give fluids and medications.

What to expect the day of your child's cleft lip repair surgery

The day of your child's surgery, you can expect to:

  • Talk with a preoperative nurse. The nurse will examine your child and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
  • Remove all of your child’s clothing and dress your child in a hospital gown. Your child’s care team will give your child blankets for modesty and warmth.
  • Talk with the anesthesiologist or nurse anesthetist about your child's medical history and the type of anesthesia your child will have
  • Remain with your child in the pre-op area until before surgery. 
  • The anesthesiologist or nurse anesthetist will start your child's anesthesia through a breathing mask.
  • Once your child is asleep, a surgical team member will start an IV to maintain anesthesia. 
  • The surgical team will monitor your child's vital signs and other critical body functions. This occurs throughout the procedure and your child's recovery until your child is alert, breathing effectively, and vital signs are stable.
  • Wait in the waiting room during your child's cleft lip repair. The team will call you to the recovery room once your child arrives from surgery. Parents are often present when their child wakes up from surgery.