Cleft Lip Repair

Bilateral cleft lip repair

A bilateral cleft lip is an inborn abnormality that involves a child being born with two holes or divides on either side of the upper lip. It can be accompanied by a cleft palate or not. There are feeding, speech development, dental alignment and facial appearance impairment of this condition.

Bilateral Cleft Lip Repair

Bilateral cleft lip repair is a reconstructive surgery that is done to seal both sides of the clefts and restore normal lip shape, symmetry and functionality. The nose is also reconstructed using the surgery and the appearance of the entire midface is also enhanced.

Bilateral cleft lip surgery

Bilateral cleft lip surgery is a form of reconstruction surgery aimed at repairing a cleft lip that comes out on both sides of the upper lip. The aim is to provide a realistic, functional lips and nose, and continuity of the muscles, and normal feeding, speech and facial development.

What is Bilateral Cleft Lip?

A bilateral cleft lip arises when there are no proper fusions of tissues of the upper lip on each side of the fetus. This results in:

• Two clefts on upper lip
• A central segment (prolabium) which sticks out or is weakly supported.
• Displays nose and nasal cartilage inconsistency.
• Nourishment and speech impairment.

Indications for Surgery

Bilateral cleft lip surgery is indicated in case:

• The baby is 3–6 months old
• Weight is normal and there are no health problems.
• Pre-surgical alignment (as NAM) has been done where necessary.

Pre-Operative Preparation

• In-depth health assessment.
• Feeding assessment
• To minimize cleft gap, nasoalveolar molding or lip taping.
• Photographic assessment
• Counselling for parents

Anaesthesia

• The child is anesthetized generally to make sure that it is safe and comfortable.

Marking the Lip

Accurate drawings are drawn to indicate:

• Central philtrum
• Cupid’s bow
• Symmetrical lip segments

Incisions

• Cuts are made on both sides of the lip along the intended lines and across the prolabium.

Muscle Reconstruction

• Orbicularis oris muscle (lip muscle) is pulled apart with care and is attached in the middle.
• Lip muscle alignment is important and essential to the shape of lips.

Prolabium and Philtrum Reconstruction

• The mid lip part is reformed to create an organic philtral column.
• The bow of Cupid is rebuilt to create conventional lips.

Nasal Correction

• Nares cartilages are re-positioned.
• Nose symmetry is enhanced, usually using internal nasal splints.

Layered Closure

The surgeon sutures the lip in divisions:

• Mucosa
• Muscle
• Skin
• This will guarantee strength, shape and limited scarring.

Post Bilateral Cleft Lip Surgery Recovery

• Hospital stay: 1–2 days
• Bruising and mild swelling 1-2 weeks.
• Medications to relieve pain are administered.
• The feeding can switch to the spoon, cup, or syringe.
• The arm restraints can be recommended to avoid touching the lip.
• Visits to check healing and scar.

Scar care includes:

• Ointments
• Silicone gels
• Gentle massage
• Healing timeline
• Early healing: 2–3 weeks
• Final appearance of scars: 6-12 months.

Bilateral cleft lip treatment

Bilateral cleft lip repair is a complex of interventions which include surgical and orthodontic intervention and supportive treatment, to repair the cleft on both sides of the upper lip. The aim is to normalize the appearance, enhance feeding, proper development of speech, and growth of the face. Bilateral Cleft Lip Treatment Preferences:

Pre-Operative Orthopedic Management

Nasoalveolar Molding

• Carried out in the initial weeks of birth.
• Progressively closes the cleft gap.
• Coordinates the gums (alveolar ridges).
• Reshapes nose and cleaves nose cartilage.
• Improves results of surgery

Lip Taping

• Helps reduce cleft width
• Enhances preoperative symmetry.

Feeding Support

• Special bottles or feeding methods.
• Helps keep body fed and gain weight.

Primary Bilateral Cleft lip repair surgery

• Timing: Usually 3–6 months of age
• This is the primary cleft closing surgery.

Goals

• Produce a realistic lips feature.
• Repair the bow and philtrum of Cupid.
• Regain lip movement muscle continuity.
• Correct nasal deformity
• Enhance oral and feeding.

Components of the Surgery

• Lip muscles repositioning.
• Coherence of skin, mucosa and muscle layers.
• Remodelling the central prolabium.
• Primary nasal correction

Nasal Correction and Support

Done with or subsequent to lip repair:

• Repositioning nasal cartilages.
• Creating nasal symmetry
• Shaping with nasal stents or splints.

Alveolar Bone Grafting (Later Stage)

Timing: 7–9 years

• Insert bone in the upper gum.
• Supports permanent teeth
• Stabilizes the dental arch
• Establishes a solid future of orthodontics.

Speech Therapy

• Assistance with pronunciation and voice production.
• Treats speech disorders due to the involvement of cleft lips/palates.
• Typically necessary in case of cleft palate.

Treatment in orthodontics

Performed in stages:

• Corrects dental alignment
• Expands arches
• Places braces if needed
• Improves bite and occlusion

Secondary Surgeries (Where necessary)

Some children might need some extra operations:

• Alteration of lips to enhance the look or balance.
• Nose surgery to develop the shape of a nose.
• Scar revision
• They are typically performed when one is a child or an adolescent.

Social and Psychological Support

• Helps children develop trust.
• Helps to deal with appearance issues.
• Offers family counselling.

Factors Affecting Bilateral cleft lip surgery cost

The cost of surgery of bilateral cleft lip is determined by many factors:

Key Factors Affecting Cost

Moving the cleft Severity and Complexity

• The surgical repair of bilateral cleft lip (both sides) is more complex than that of a unilateral cleft lip( one side), that the surgery requires more time, more advanced equipment and sometimes another surgery is even necessary. 
• If associated with another craniofacial malformation (e.g. palate defect) the cleft the cost becomes higher. 
• Ethnic preparation (pre-surgical orthopedic preparation, such as nasal molding, lip taping) may be required, which is also an extra money.

Experience and Reputation of Surgeon

• Specialty surgeons who have high experience are more expensive. 
• The cleft team model (plastic/craniofacial surgeon and orthodontist and speech therapist) can be more expensive but more effective.

Hospital & Location

• Privacy vs government hospital: in most cases, the cost of a private facility is higher. 
• City: the metropolitan cities (Delhi, Mumbai, Bengaluru) are likely to have higher hospital/room/overhead costs as compared to smaller cities or towns. 
• Cost is also influenced by accreditation, infrastructure (availability of ICU, specialized pediatric plastics).

Type of Anaesthesia and Length of Hospital stay

• This surgery takes general anaesthesia on infants; that increases the cost. 
• The longer the duration of stay in the hospital (complications, monitoring) the greater the cost (room charges, nursing, meals). 

Investigations before the Surgery and after Surgery

• There is an increase in cost by blood tests, imaging, anaesthesia clearance, and other tests. 
• Post-operative: drugs, dressings, follow-ups, and scar management, potential secondary surgery is all factors. 

Additional/Secondary Procedures

• In case of nasal correction, alveolar bone grafting, speech/orthodontic work is required in the future, they will be additional cost to the overall treatment. A considerable number of packages can call out the main lip repair only. 
• Symmetry surgery or aesthetic surgery can be done later in childhood.

Room Type and other Facilities

• This will make it more expensive to have a nicer (instead of a typical) private room (or to have the private nursing). 
• Other facilities (transport, VIP service) in medical tourism can be more expensive.

Bilateral cleft lip repair recovery

The post-surgery recovery following bilateral cleft lip repair is mostly uneventful in case of appropriate post-operative management, nutritional support, and follow-up evaluation. Most of the infants turn normal in a few weeks and the scar disappears in months.

Immediate Recovery (First 24- to 48 hours) 

• Baby is kept a close guard under hospital care.
• They are given pain medicines and IV fluids where necessary.
• Pallor of the lips and nose is normal.
• Depending on the instructions of a surgeon, feeding can begin a few hours after surgery.
• Some babies may need oxygen or airway support on a temporary basis.

Recovery at Home (First 2 Weeks)

Swelling & Bruising

• The highest swelling is observed after 48 hours and recedes in 7-10 days.
• There is likely to be bruising around the lip, cheeks, and nose.

Feeding Care

The method of feeding can shift provisionally to:

• Spoon feeding
• Cup feeding
• Syringe feeding
• Use bottle nipple only when recommended (so that the lip is not pressured).
• Eat slowly to avoid discomfort.

Wound & Stitch Care

• Stitches can either dissolve or they can require removal (depending on technique).
• Maintain a clean and dry incision.
• Use prescribed ointments as ordered.
• Do not touch the lip or rub it.

Arm Restraints (No-No’s)

• Soft elbow ties are used to ensure that the baby does not touch the site of surgery.
• Usually used for 10–14 days.

Pain & Comfort

• The pain is not severe and can be managed using drugs.
• Babies can be colicky in their first few days, and also they settle very easily.

Follow-Up Visits

• First follow-up: within 1 week
• Second follow-up: 2 weeks, or dissolution of stitches.

Other visits to monitor:

• Healing
• Lip symmetry
• Scar formation
• Nasal shape

Scar Care (After 2–3 Weeks)

Having well healed the incision:

• Begin gentle scar massage.
• Silicone gel/silicone sheets are recommended.
• Shield the scar against the sun (necessary when the baby becomes older).
• Scar will appear red or hard after a few months and slowly become soft.

Expected Healing Timeline

Week 1–2

• The swelling is decreased.
• Incision starts to appear clean and smooth.

Week 3–4

• Lip motion improves.
• Baby feeds more comfortably.

2–3 Months

• Scar starts fading.
• Nares scoliosis increases.

6–12 Months

• Final scar appearance.
• Symmetry of face is enhanced when baby develops.

Best hospital for bilateral cleft lip repair India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Bilateral cleft lip is an intricate inborn disorder though with modern surgical practices and extensive multidisciplinary treatment children are capable of an impressive level of functional and aesthetic results. It can be used to uncover the natural appearance of the lip and nose by early intervention with pre-surgical molding, timely lip repair and nasal repair and enhance feeding, speech development and facial development. After-surgical care is typically uneventful and post-surgical scars only become better with time. The success in the long run is based on the coordinated care which involves surgery, orthodontic guidance; speech therapy and regular follow ups up to the childhood. Children who had bilateral cleft lip can have healthy, confident and rewarding lives with proper treatment plan and regular support.

Affordable bilateral cleft lip repair India GetWellGo

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• Support during and after treatment. 
• Language Support
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• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
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FAQ

Does it require pre-surgical molding (NAM)?

• Although not required, nasoalveolar molding may be very effective in enhancing outcomes of surgery through reduction in cleft gap and preoperative nasoalveolar shape.

Will my child be in pain after surgery? 

• Some pain can be expected, but it's usually mild to moderate and controlled with the pain medication that is prescribed.

Can Babies Be Normally Fed In The Postoperative Period? 

• There can be the necessity of temporary changes in feeding (spoon, cup, syringe), but after some healing babies can easily resume their usual way of feeding.

Will the scar be visible?

• The scar is less apparent with the passage of time and gets much better in a year particularly when scar-treatment methods such as silicone gel and massage are used.

Does bilateral cleft lip have an effect on speech?

• In case of involvement of the lip only, the speech is generally normal. If your baby has a cleft palate, he or she will need speech therapy. 

Can my son/daughter live a normal life after treatment? 

• Yes. When they undergo proper surgery and long term care, children also live totally normal, healthy and confident lives.