Cleft Lip and Cleft Palate Surgery

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KEY POINTS

• Cleft lip and cleft palate surgery is done to close an opening (cleft) in the upper lip or in the roof of the mouth, which is called the palate.
• This surgery can help treat or prevent problems with breathing, feeding, talking, and problems with teeth, as well as improve the way your baby looks.
• Ask your provider how long it will take for your child to recover and how to take care of your child at home.
• Make sure you know what symptoms or problems you should watch for and what to do if your child has them.

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What is cleft lip or palate surgery?

Cleft lip and cleft palate surgery is done to close an opening (cleft) in the upper lip or in the roof of the mouth, which is called the palate. The opening is a birth defect that can happen when a baby’s lip or mouth does not form properly.

When is it used?

Children with a cleft lip or cleft palate often have problems with breathing, feeding, and talking. They also may have more ear infections, hearing loss, and problems with their teeth. Surgery can help treat or prevent these problems, as well as improve the way your baby looks.

Surgery to close the split in a cleft lip is usually done when a baby is 2 to 3 months old. Sometimes a second surgery is done later to make sure that both sides of the mouth and nose match.

Surgery for cleft palate is usually done when the baby is 9 to 18 months old. Closing the opening in the roof of the mouth usually helps the child eat and speak more normally.

How do I prepare my child for this procedure?

• Your child may or may not need to take his regular medicines the day of the procedure. Tell your healthcare provider about all medicines and supplements that your child takes. Some products may increase the risk of side effects. Ask your healthcare provider if your child needs to avoid taking any medicine or supplements before the procedure.
• Tell your healthcare provider if your child has any food, medicine, or other allergies such as latex.
• Your child’s provider will tell you when your child needs to stop eating and drinking before the procedure. This helps to keep your child from vomiting during the procedure.
• Tell your child’s provider if your child has an infection, like a cold.
• Follow any other instructions your child’s healthcare provider may give you.
• Ask any questions you have before the procedure. You should understand what your child’s healthcare provider is going to do. You have the right to make decisions about your child’s healthcare and to give permission for any tests or procedures.

What happens during the procedure?

The surgery is done at the hospital.

Your child will be given a general anesthetic to prevent pain during the procedure. General anesthesia relaxes the muscles and puts your child into a deep sleep.

To repair a cleft lip, your child’s healthcare provider will make a cut on either side of the split in the lip. The cut will extend from the mouth into the nostril. Your provider will then pull the muscle and the skin of the lip together to close the separation. If the cleft affects the nose as well as the lip, the nose may be repaired at the same time or in a later surgery.

To repair a cleft palate, your child’s healthcare provider will make a cut on both sides of the split in the roof of the mouth. Your provider will move tissue from each side of the cleft to the center of the roof of the mouth to close the separation.

Your child may need a small plastic tube in each eardrum to help prevent problems from ear infections. This procedure may be done at same time as the cleft repair or at a later time.

What happens after the procedure?

Your child will stay in the hospital for 2 to 3 days or longer, depending on your child’s condition.

For a day or two, your child will feel some soreness. Your child will have an IV for a day or two because he or she will not eat or drink as much as usual. Your child’s healthcare provider may prescribe antibiotics to prevent infection and will recommend a pain medicine for you to give your child at home.

Your child’s healthcare provider will tell you the best way to feed your child during the first few weeks after surgery. For the first week, your child may need to be given only a liquid diet. Your child may have mild pain and a stuffy nose and may not eat as much as usual. It may help to give your child small, frequent feedings. Be sure to give your child plenty of liquids. Ask your child’s healthcare provider how you can help treat your child’s nose stuffiness.

Follow your healthcare provider’s instructions for caring for the wound. It’s normal to have swelling, bruising, and blood around the stitches. After cleft palate surgery, there may be bloody fluid draining from the nose and mouth. This should decrease after the first day. Swelling should be almost gone in a week.

Children with a cleft palate are more likely to get ear infections. Your child may need a small plastic tube in each eardrum. This procedure may be done at same time as the cleft repair or at a later time. After the ear tubes are in place, try to keep water out of the ears. Protect your child's ears during bathing, shampooing, and swimming. Vaseline coated cotton balls, silicone ear putty, or specially made ear molds can be placed in the outer ears to keep the ears dry.

It’s normal for the surgical scar to seem to get bigger and redder for a few weeks after surgery. The scar will fade over time. The scar will never go away completely, but usually it’s barely noticeable.

Follow your child’s healthcare provider's instructions. Ask your provider:

• How long it will take for your child to recover
• If there are activities your child should avoid and when your child can return to normal activities
• How to take care of your child at home
• What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup. Keep all appointments for provider visits or tests.

What are the risks of this procedure?

Every procedure or treatment has risks. Some possible risks of this procedure include:

• Your child may have problems with anesthesia.
• Your child may have an infection or bleeding.

Ask your healthcare provider how these risks apply to your child. Be sure to discuss any other questions or concerns that you may have.