A cleft lip occurs when there is a failure of normal structures to join together during embryological formation of the lip, resulting in a gap in the lip. A cleft lip often occurs together with a cleft palate which is the result of the failure of the two sides of the roof of the mouth to join together. A cleft palate can affect a child’s ability to feed, rate of weight gain, middle ear function, speech and facial growth.

Cleft lip is usually repaired at 3-6 months and the palate is usually repaired at 9-12 months of age. In some cases, the lip is strapped with tape for some time before surgery to reduce the gap to help prepare for the procedure. Further surgery is usually carried out at about 9-10 years of age to bone graft the bony gap in the top jaw (if present) called an alveolar bone graft. During childhood the child’s hearing and speech development will be monitored at annual clinic attendance. Sometimes speech therapy and/or grommets (drainage tubes inserted into the ear drums) may be necessary. Occasionally extra operations may be needed such as repair of a palatal fistula (small area of incomplete healing in the roof of the mouth), or a pharyngoplasty, an operation to tighten the space behind the soft palate if there is excess air escaping up the nose during speech. There are many different causes for this happening. Later, in teenage years starting at about 12 years, orthodontic bands may be needed to straighten any crooked teeth followed by possible upper and or lower jaw surgery to correct any disproportion between the top and bottom jaws. Finally, once this is done, it is usual to offer a rhinoplasty to correct any nasal deformity, which is common in children with cleft lip.