If your child has cleft lip, the gap—or split—in your child's lip extends upward towards their nose. The gap in a cleft lip also affects your child's:

  • skin,
  • mouth muscles,
  • and the mucosa on the inside of the lip.

During cleft lip surgery, surgeons repair all of these areas. This means your surgeon will repair your child's flattened nose and their cleft lip at same time.

Surgeons usually repair a cleft lip when your child is two to three months old. But the timing of your child's surgery will depend on their size and overall health.

How Do Surgeons Repair Cleft Lip?

There are many techniques for repairing cleft lip. Our surgeons choose a technique that is best for your child's cleft. The procedure is slightly different if your child has a bilateral cleft lip (a cleft that goes into both nostrils) or a unilateral cleft lip (a cleft that goes into only one nostril). 

Bilateral Cleft Lip Repair

In a bilateral cleft lip, the lip skin in the center of your child's face does not have muscle like normal lips do. With bilateral cleft lip, the muscle from the two sides of the lip stretches across and underneath the central skin.

During a cleft lip surgery, surgeons will move the skin on the central lip so it becomes the center of your child's new lip.

Children with cleft lip can also have bone problems. The bone behind the central lip (where your child's front teeth will come in later) is sometimes pushed out too far. NAM devices can help pull this bone back into place and make the lip repair more successful. 

During a cleft lip repair, our surgeons also reshape your child’s nose. This changes how your child's nose looks as well as how it works. 

Unilateral Cleft Lip Repair

A unilateral cleft lip is when the gap—or split—in your child’s lip goes into only one nostril instead of both nostrils. Children with unilateral cleft lip need surgery to rotate their central lip downward. Surgery also lengthens the short side of your child's lip on the same side of the cleft.

During surgery, surgeons will stretch the side of the lip (also called the lateral lip segment) across your child's gap. Surgeons then bring these muscles together to recreate a circle of muscle, just like how muscle looks in normal mouths.

Surgical Techniques

Many surgeons think the best way to repair a cleft lip is to follow the subtle muscle shape in your child's lip and nose on the non-cleft side of their face. For some children, these older techniques can cause scarring in the area where surgeons make incisions.

Many pediatric ENT surgeons use a new technique called anatomic subunit. This newer technique follows the mouth’s natural lines and hides scars in the contours (the natural curves and shapes) in your child’s face.

There is no standard technique for repairing cleft lip. However, you should choose a surgeon who is comfortable with several techniques so they can use a technique that is best for your child’s unique facial and muscle shape.

Repairing Lip Scars

Our surgeons also have expertise with repairing lip scars. This expertise allows your child to avoid having lip scars after their cleft lip surgery.

Primary Cleft Rhinoplasty: Will My Child Need a Nose Job?

Infants breathe through their nose—not their mouths. Because of how infants breathe, disorders that affect the nasal airway are serious in babies. This is because infants breathe through their noses and eat through their mouths at the same time.

Sometimes breathing disorders are not serious. But breathing disorders can still make it hard for a baby to feed normally. 

Other infants have growths inside their nose and sinuses that must be removed. Depending on the growth, some of these infants may need reconstructive surgery.

Infants with a cleft lip often have a range of how their nose looks. In many children with cleft lip, the cartilage that holds the nose open (also called springing open) is slightly smaller than normal. The nose is also often in an abnormal position and is usually flatter than normal. 

If surgeons only focus on your child’s cleft lip, your child will still have an asymmetrical nose. Your child will need surgery to fix the nose’s shape. This surgery is called primary cleft rhinoplasty.

During cleft lip surgery, your surgeon can reach your child’s nasal space and use minimally invasive lip incisions to reposition the nasal cartilage into a more normal position.

How much repair your child needs will depend on how abnormally your child’s nose is shaped.

Other Nose Problems  

Depending on the shape of your child's nose, surgeons may need to make small changes during rhinoplasty to improve how your child’s nose works.

Sometimes your surgeon must move or reposition your child’s septum. The septum is bone and cartilage that separates the nose into two nostrils. Sometimes your surgeon must use different techniques to stabilize your child's nasal cartilage so it stays in a normal position. 

Your surgeon will evaluate your child's cleft and review the surgical plan with you to answer any questions you have.

Our pediatric facial plastic & ENT surgeons have an in-depth understanding of nasal anatomy and how the nasal passages function. We also regularly diagnose and manage nose problems. We use this knowledge during cleft lip surgery, but also as children grow and develop problems with the inside or outside of their nose. 

Sutures

After surgery, our team will use sutures—or stitches—on the inside of your child’s nose to hold the skin and cartilage in their new position. Your child will usually need sutures on the side of their nose as well.

Most sutures dissolve on their own. Some sutures have a small piece of gauze called a bolster.

Why Should I Choose a Pediatric Facial Plastic & ENT Surgeon?

Our pediatric facial plastic & ENT surgeons have training and experience in cleft lip repair as well as removing masses from the lips. Our surgeons focus their work on children with unique conditions that affect the face, head, and neck.

What To Expect

  • When you meet your surgeon to discuss surgery, you will receive a handout that explains what to expect as well as home care your child will need. Please review this with your surgeon and our clinic nurses before your child’s surgery. This will make the time after surgery less stressful.
  • For a week or two after surgery, your child will probably need a little extra care and attention. You shouldn't be worried about spoiling your child while they are recovering. It is okay to help your child through their recovery by holding them and comforting them.
  • Your child will stay in the hospital one or two nights depending on how well they recover from surgery.
  • Your child will have an IV that will give them fluids. The IV will keep them hydrated. Your child will also receive pain medication through the IV if the pain medications they take by mouth aren't enough.
  • They may have small flexible stents in their nose to help the nose heal.
  • Your child's lip and nose will probably be swollen.
  • Most if not all of the sutures will dissolve on their own. In some cases, your surgeon may recommend sutures that need to be removed by hand. These sutures are usually removed in clinic.
  • Your child will receive pain medication and this will be adjusted to ensure their pain is well controlled.
  • Our team will closely monitor your child to make sure they are breathing correctly and aren't in pain. We will also monitor how much your child is eating/drinking.
  • Your child will usually wear arm straighteners. These will prevent your child from accidentally hurting themselves while they are healing.

Common Questions

How will I feel about how my child looks after surgery?

After surgery, your child will look different. This is often a very emotional time. Some parents miss the big smile their child had with a cleft, but parents are also excited to see their child's new face.

Our nurses and staff will help you through this exciting time.

Are there restrictions on how my child can eat?

We don't put restrictions on how you child eats or drinks. 

Your child can use whatever bottle or cup they used before surgery. Problems with healing are very uncommon.

Most children are able to drink and eat soon after surgery. However, some children refuse to eat. Your nurse will work with you to figure out what your child needs to help them eat.

Will my child be able to drink after their cleft lip surgery?

Most children can eat and drink normally after cleft lip surgery. While their lip and face are usually sore, most children do not have so much pain that it prevents them from drinking. 

Sometimes babies need stronger pain medications to make them comfortable. We will monitor your baby closely to ensure they have the pain medications they need.

If your child needs stronger pain medications, they might get constipated. If this happens, a couple ounces of apple or pear juice usually will help your child go to the bathroom. 

Check with your surgeon to make sure your child can eat certain foods.

Do I need to clean out my child’s nasal stent?

Infants must breathe through their noses. Infants also breathe faster than we do, so they must be able to breathe easily as they eat. If your child’s nose stents become clogged, your child may have trouble breathing and eating.

If your child is having trouble breathing, one of the first things we notice can be difficulties with feeding. Sometimes fixing breathing problems is as simple as putting saline (salt water) drops in your child’s nose.

If your child's stents are starting to get clogged, you can use saline to thin the mucous. Other times your child's stents will need to be replaced or cleaned out. We use newer nasal stents that stay in on their own and can be removed for cleaning at home. Your surgeon can discuss whether these are right for your child.

If your baby is having trouble breathing, you should call your doctor.

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Jeremy Meier, MD

Patient Rating:

4.7

4.7 out of 5

Dr. Jeremy Meier is an Assistant Professor of Surgery in the Division of Otolaryngology - Head and Neck Surgery at the University of Utah School of Medicine. His clinical practice encompasses all areas of complicated ENT problems in children.  Dr. Meier thrives on managing children with complex airway and breathing problems and craniofacial disorde... Read More

Specialties:

Otolaryngology, Head & Neck Surgery, Pediatric Otolaryngology, Cleft Lip & Cleft Palate Surgery

Locations:

PCH Outpatient Services at Riverton 801-662-1740
Primary Children's Hospital
Pediatric Otolaryngology/ENT
801-662-1740
University Hospital
Otolaryngology/ENT, Clinic 9
801-662-1740

Harlan R. Muntz, MD, FACS

Patient Rating:

4.4

4.4 out of 5

Dr. Harlan Muntz is a professor at the University of Utah where he teaches residents in pediatrics and ENT as well as doing research and patient care. His past research has mostly focused on children’s sinus problems and cleft palate speech problems, but has influenced many other areas of pediatric ENT including pediatric sleep apnea. He is current... Read More

Specialties:

Otolaryngology, Head & Neck Surgery, Pediatric Otolaryngology, Cleft Lip & Cleft Palate Surgery

Locations:

PCH Outpatient Services at Riverton 801-662-1740
Primary Children's Hospital
Pediatric ENT Clinic
801-662-1740
University Hospital
Otolaryngology/ENT, Clinic 9
801-662-1740

Jonathan R. Skirko, MD, MHPA, MPH

Dr. Skirko is an assistant professor in the Division of Pediatric Otolaryngology with clinical research and clinical practice based at Primary Children's Medical Center. He has a passion for the care of children with cleft lip or cleft palate. He has created a quality of life instrument to better measure and understand how difficulties with speec... Read More

Specialties:

Pediatric Otolaryngology, Pediatric Sleep Medicine, Alveolar Bone Graft, Cleft Lip & Cleft Palate Surgery, Midface (Jaw) Surgery, Rhinoplasty, Skull Base Surgery, Velopharyngeal Insufficiency (VPI)

Locations:

PCH Outpatient Services at Riverton 801-662-1740
Primary Children's Hospital 801-662-1740
Riverton Hospital
PCH Inpatient Services at Riverton
801-662-5338
Utah Valley Regional Medical Center 801-662-1740

Marshall E. Smith, MD, FACS

Patient Rating:

4.8

4.8 out of 5

Dr. Marshall Smith is a professor of Otolaryngology-Head and Neck Surgery. He is a board certified otolaryngologist and the medical director of the Voice Disorders Center. He completed his residency in Otolaryngology at UCLA and a fellowship in Pediatric Otolaryngology in Cincinnati. He is an NIH funded investigator and participates in research on ... Read More

Specialties:

Otolaryngology, Head & Neck Surgery, Pediatric Otolaryngology, Airway Disorders, Laryngeal Laser Surgery, Vasculitis, Voice Disorders

Locations:

LDS Hospital 801-408-4972
PCH Outpatient Services at Riverton 801-662-1740
Primary Children's Hospital
Pediatric ENT Clinic
801-662-1740
Surgical Specialty Center 801-587-8368
University Hospital
Otolaryngology/ENT, Clinic 9
801-587-8368
University of Utah Hospital
Clinic 9
50 N Medical Drive
Salt Lake City, UT 84132
Map
801-662-1740
Primary Children's Hospital 100 N. Mario Capecchi Drive
Salt Lake City, UT 84108
Map
801-662-1740
Primary Children's Outpatient Services at Riverton 3773 W. 12600 S.
Riverton, UT 84065
Map
801-662-1740