A cleft lip is a hole in the lip that results from a disturbance in lip growth during the first trimester of development. The parts of the lip that are separated vary from child to child. Some children can simply have a notching or cleft in the lip vermilion or philtral column. This notching can vary in degree and is called an incomplete cleft. Other children have a complete separation of the lip that extends all the way up into the nose. This is called a complete cleft lip. This type of cleft often distorts the nose as well. Clefts of the lip can be on one side (unilateral) or on both sides of the lip (bilateral).  The cleft does not hurt, and parents should not be afraid to touch it.

Children with a cleft lip often have a hole in the gum below the lip as well. This is called an alveolar cleft. There can also be a separation in the roof of the mouth called a cleft palate. However, because the lip and palate develop separately, not all children with cleft lip have a cleft palate and visa versa.

Children with an isolated cleft lip (no cleft palate), typically have no problem eating. They can be fed with normal nipples, although a cross cut nipple is usually helpful. Feeding of a child with a cleft palate is more challenging and way to feed these babies is covered under the cleft palate segment of this website.

There are many causes of a cleft lip, most of which have nothing to do with the parents. Therefore parents should not blame themselves for "causing" the cleft. One child out of every 600 children born has a cleft lip. Therefore it is very common. Dr. Stelnicki is actively doing research to discover the cause of clefts and to improve the treatment of the condition. They are actively involved in research to decrease scar formation and is working toward safely repairing cleft lips in the womb, before the patient is born. Our team has scientists from Stanford working full time at improving care to patients with cleft lip and other craniofacial conditions.

Treatment of cleft lip at our center begins before birth when possible. Today, in utero diagnosis of cleft lip and palate is possible at 16 weeks gestation by ultrasound. Families found to have a child with cleft lip and palate by ultrasound are seen by our clinic and counseled as to what to expect when the child is born. The families are taught how to feed the child by our nurse practitioner so that they can be prepared to meet the needs of their special child even before the infant arrives. Genetic counseling and testing is also made available. Dr. Stelnicki then shows to family what to expect when the child is born, and familiarizes the family with what surgeries will need to be done to correct the problem. In this way, our program helps to relieve some of the fear and anxiety that accompanies this problem.

Once the child is born, feeding and airway issues are again addressed by the team. Our nurse specialist works with the family to make sure the baby is receiving optimal nutrition. This often requires special feeding devices such as the Haberman or Mead Johnson nipples and bottles, all of which are important parts of allowing the child to grow. Family support is also important at this time. Most families, who have a child born with a cleft or other craniofacial condition, do not know anyone else who has lived with this condition. This can lead to feelings of isolation and despair. To help fight this, Dr. Stelnicki has founded a family support organization called Facing It Together Foundation.  This foundation links families with similar problems together in a large support network. Experiences and ideas can be shared through this group, which are very helpful in learning how to cope with a child who has a facial difference. Contact Dr. Stelnicki's office directly for more information about Facing It Together Foundation. Our office will help to link up with proper family support group.

When talking with friends and family about your child, you should be direct. It is important to emphasize that in most cases, your child is completely normal, and simply needs a few surgeries, dental care, and speech therapy to treat the "hole" that is present in your child. It is important to emphasize that this hole does not hurt, and that your child should be held, touched, loved, and cared for just like any other baby. It is important to take pictures in order to record and remember the transformation that is about to occur in your child. These pictures will help you focus on your baby's condition and talk to others about what is happening with your child. When kids get older, they often enjoy looking back at themselves as infants, and seeing how far they have progressed. It will also help children explain to other kids what happened to them as a baby.

Depending on the type of cleft lip, surgical treatment will begin anywhere from 2-6 months of age. The goal of surgery is to close the lip hole in a way that scarring is minimized and the lip appears as natural as possible. In some patients, orthodontic treatment will be initiated to properly align the alveolar ridges prior to surgery. This important step allows the surgeon to close the lip cleft without tension, thereby reducing the amount of scar post operatively. Precise alveolar (gum) alignment also allows the surgeon to perform a primary gingivoperiosteoplasty at the time of lip repair. If successful, the procedure permits closure of the cleft that is usually present in the dental alveolus at an early age. This prevents the need for bone grafting in the future and does not seem to interfere with facial growth if this is done in a gradual and well-orchestrated manner. Dr's Stelnicki is one of the few surgeons in the state who is trained in the technique of nasoalveolar molding. Nasoalveolar molding is a non-surgical, passive method of bringing the gum and lip together by re-directing the forces of natural growth. It is non-painful, and easy to use. It also allows for correction of the flattened nose prior to surgery, and facilitates nose repair at the time of lip repair. This technique is becoming the "gold standard" for cleft lip repair in many internationally know cleft and craniofacial centers, and we are proud to be able to bring this technique to the families associated with the Joe DiMaggio cleft and craniofacial center. 

Pre-Op	Nasoaleolar Molding
Post-Op

In patients who cannot undergo active orthodontic molding of the alveolus, a passive molding plate is made to hold the alveolar edges in place and then a preliminary lip adhesion is performed at age 1-2 months. A lip adhesion is a temporary closure of the lip that simply pulls the lip edges together, but in no way corrects the deformity. The goal of this surgery is to push the alveolar segments (gum ridges) together slowly, by using pressure from the lip adhesion to push the premaxilla backward. Then, at 7-8 months of age, a complete primary lip repair in performed.

When the lip is repaired, our own modification of the Millard type rotation advancement flap is used. This technique which was described by Dr. Ralph Millard Jr. allows for tension free cleft closure and adequate lengthening of the deficient lip. We have made some slight modifications to this technique, based on our experience, which seem to decrease the amount of external scaring and create a more normal philtral complex (upper lip crease). 

Lip repair is not performed until the child is steadily gaining weight, is in good overall health, and the lip and gum segments are properly aligned with Nasoalveolar molding or lip adhesion.

In addition to primary lip repair, primary clef lip nose repair is also performed at an early age. All patients with a cleft lip have some degree of deformity to their nose. We feel the best results in terms of nasal appearance are obtained if the nose is initially repaired at the time of the lip closure. However, in selected patients, we begin treating the nose prior to lip repair with a technique developed at New York University called nasoalveolar molding (NAM). NAM is performed at the time of orthodontic molding of the cleft alveolus. This technique allows the surgeon and orthodontist to mold the abnormally formed nasal cartilage into better shape prior to surgery. It also allows of the lengthening of the middle part of the nostrils called the columella. This structure is occasionally deficient in patients with unilateral cleft lip and is frequently deficient in individuals with a bilateral cleft lip. The slow and careful expansion of this region by NAM allows for the creation of a more normal appearing nose at the time of lip closure, without the need for creating abnormal scars across the base of the nose. 

In patients who are not candidates for NAM, Millard type forked flaps are used to elongate the columella and recreate a nostril sill.

After 2 weeks of healing, you will begin lip massage 5 times a day. This is essential because it decreases scar and helps prevent lip "notching" which always occurs after surgery. Massage helps you get the best result for your child and our nursing staff will instruct you in the proper method. This massage will continue for up to 6 months after surgery. Palate surgery is done between 12-18 months of age. This surgery is covered in the section on cleft palate.

Following the lip and palate repair, many children are done with their lip and palate surgery. It is simply important to watch dental and speech development as well as the maturation of the lip scar and the growth of the upper jaw. Occasionally however, some additional surgeries are required to optimize the final result. As your child grows, he or she may need some "touch up" lip surgery. This can be done about age 4, prior to going to preschool. Then, the lip is usually left alone. The cleft nasal deformity can also be addressed at this time. However, definitive nasal surgery should be delayed until after alveolar bone grafting or final maxillary growth is achieved. The need for additional surgeries such as speech surgery, bone grafting, and jaw advancements are covered in the other sections of this website.