What Is Cleft Lip Surgery?Process, Preparation and Follow-up

Cleft lip surgery is the surgical repair of a congenital cleft lip, which occurs when the tissues of the lip do not fully join during development in the womb. The aim is to restore the continuity and muscle structure of the lip, to support feeding and speech, and to bring the appearance of the face into as natural a harmony as possible.

What is a cleft lip and why does it occur?

A cleft lip is an opening or notch in the upper lip that is present from birth. This opening may involve only a small part of the lip or may extend up to the base of the nose; it may be on one side (unilateral) or on both sides (bilateral).

In some children a cleft lip occurs on its own, while in others it is present together with a cleft palate. It is thought that genetic predisposition and environmental factors play a combined role in its development; however, in most families no clear cause can be identified. For this reason, it is important that parents do not hold themselves responsible.

The opening in the lip may affect the baby's sucking, the production of certain sounds later on, the development of the teeth and jaw, and the shape of the nose. All of these areas are considered together when planning the repair.

Who is cleft lip surgery performed on?

Cleft lip surgery is performed on babies and children with a congenital cleft lip in order to repair the structure of the lip. When the surgery will be carried out is decided by the doctor after assessing the child's general health, development and the type of cleft.

Additional procedures may also be considered in children, adolescents or adults who have previously had a repair but who, during the growth period, develop a need for further revision of the lip, nose or scar tissue. Whether these secondary procedures are needed, and their timing, varies from person to person.

What is nasoalveolar molding before surgery?

Nasoalveolar molding (pre-surgical shaping of the nose and palate) is a preparatory procedure carried out by an orthodontist (a specialist in correcting the teeth and jaw) in the period before surgery. Its aim is to guide the nasal structure affected by the cleft and the arch of the palate where the gums are located into a position more suitable for surgery.

This preparation is based on gently shaping the tissues with the help of a special appliance made to fit the baby's mouth and nose. As the tissues move closer together, it may become easier for the surgeon to plan the repair, and it may contribute to the symmetry of the nose.

Nasoalveolar molding may not be necessary for every child. Whether it will be used, when it will start, how long it will last and what the family needs to pay attention to at home are determined through a joint assessment by the surgeon and the orthodontist.

How does the cleft lip treatment process progress?

Cleft lip treatment usually begins with an initial consultation and examination; after the necessary tests, the procedure takes place on the planned day, and it then continues with follow-up examinations. Each stage is shaped according to the child's needs.

• Initial consultation and examination: The type and extent of the cleft, feeding status and the child's general health are assessed; the family's questions are answered and the treatment plan is discussed.
• Tests considered necessary: Depending on the child's general condition, blood tests or assessments by the relevant specialists may be requested.
• Preparation before surgery: If considered necessary, nasoalveolar molding is carried out by the orthodontist; information about feeding and preparation before the day of surgery is provided.
• Planned procedure day: The repair is carried out according to the plan made in advance. Details such as the type of anaesthesia and the hospital stay are explained separately by the doctor.
• Follow-up examinations: Wound healing and the shape of the lip and nose are monitored at regular intervals; follow-up continues throughout the growth period.

What should be considered after surgery?

After surgery, the most important points are protecting the wound area and carefully following the care and feeding recommendations given by the doctor. Families are given information about wound cleaning, the method of feeding and how to prevent the child from touching the lip.

Swelling and tenderness of the lip are expected in the early period. The scar tissue matures over time and its appearance may change over the course of months. The speed of healing and the final appearance of the scar vary from child to child.

As with any surgical procedure, this surgery also has risks. These may include infection, delayed wound healing, a noticeable scar, and asymmetry of the lip or nose. During the growth period, a need for further revision of the lip and nose may arise. If unusual redness, discharge, fever or feeding difficulties are noticed, a doctor should be contacted without delay.

Why is teamwork important in cleft lip treatment?

Teamwork is important because cleft lip treatment does not consist of a single operation alone and often requires follow-up spread over many years. A plastic surgeon, orthodontist, ear, nose and throat (ENT) specialist, paediatrician and speech and language therapist may work together at different stages of the process.

In children who have a cleft palate together with a cleft lip, palate repair and monitoring of speech development are an integral part of treatment. In addition to cleft lip repair, the areas of reconstructive surgery covered by our doctor include cleft palate repair, correction of speech disorders, craniosynostosis and microtia (a congenital ear development disorder).

The information in this article is general in nature; a personalised assessment of the appropriate timing, preparation and treatment plan for your child is carried out during a consultation with Prof. Dr. İbrahim Canter in Istanbul. You can discuss any questions you may have in detail at this appointment.