• Cleft Lip and Cleft Palate Repair

    Definition

    Cleft lip and cleft palate repair are surgeries to:
    • Close the opening in the upper lip (cleft lip)
    • Close the opening in the roof of the mouth or the soft tissue at the back of the mouth (cleft palate)
    These repairs are two separate surgeries that are sometimes done together, since a child born with a cleft lip may also have a cleft palate.
    Infant With Cleft Lip
    Nucleus factsheet image
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    Cleft lip and cleft palate are birth defects. The surgeries are done to fix these defects. If left untreated, the child can have many complications, such as:
    • Ear infections—Fluid is not able to drain properly from the ear.
    • Hearing impairment
    • Speech problems
    • Dental problems (eg, missing or malformed teeth)
    • Feeding difficulties—A baby with a cleft lip may have a hard time sucking. A cleft palate can cause milk or formula to enter the nasal cavity.
    Surgery is usually done at a young age:
    • Cleft lip—at age 3-6 months
    • Cleft palate—at age 9-18 months

    Cleft Lip Repair

    During the cleft lip repair, the goals are to:
    • Close the separation in the lip.
    • Create a curve in the middle part of the upper lip.
    • Create the right amount of distance between the upper lip and the nose.

    Cleft Palate Repair

    During the cleft palate repair, the goal is to have the palate area function normally. This includes proper development of the teeth and jaw, as well as speech.

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If your child is planning to have cleft lip and cleft palate repair, the doctor will review a list of possible complications, which may include:
    • Bleeding
    • Infection
    • Scars not healing correctly (eg, puckering of the skin)
    • Reaction to the anesthesia (eg, light-headedness, low blood pressure, wheezing, nausea and vomiting)
    • Damage to nerves, blood vessels, muscles, or lungs
    If your child has other birth defects, this may put him at a higher risk for complications.
    Be sure to discuss these risks with the doctor before the surgeries.

    What to Expect

    Prior to Procedures

    Your child will need to have an empty stomach before surgery. Make sure you get specific instructions about when to stop feeding your baby.
    In the time leading up to the surgeries, the doctor may have your child wear a device called an obturator. This device, which fits inside the mouth, may help your child during feedings and help to keep the arch in his lip.
    Your child will be treated by a team of specialists. The doctors will:
    • Order tests (eg, blood tests, urine tests, x-rays)
    • Ask about your child’s medical history and do a physical exam
    • Give you a chance to ask questions about the surgeries and recovery process

    Anesthesia

    General anesthesia will be used. It will block any pain and keep your child asleep through the surgeries. It is given through an IV in the hand or arm.

    Description of the Procedures

    Cleft Lip Repair
    To repair a cleft lip, the doctor will make an incision on either side of the cleft. The incision will be from the lip to the nostril. The doctor will then use sutures to close the two parts of the lip. If your child has a bilateral cleft lip (two openings on either side of the lip), he will need another surgery in a month. Bandages will be placed over the incision area.
    Cleft Palate Repair
    During cleft palate repair, incisions will be made on the two sides of the cleft. The doctor will use special “flap” techniques to move the hard palate (located toward the front of the mouth) and the soft palate (located toward the back of the mouth). The doctor will also move the muscle fibers in the palate. Removable or absorbable stitches will be used to close the area.

    Immediately After Procedures

    Your child will be brought into the recovery room. The hospital staff will monitor your child’s vital signs. In some cases, oxygen may be given through a tube in the nose.

    How Long Will It Take?

    • Cleft lip repair—about two hours
    • Cleft palate repair—2-4 hours

    How Much Will It Hurt?

    Anesthesia prevents pain during surgery. Your child will be given pain medicine to relieve pain or soreness during recovery.

    Average Hospital Stay

    The surgeries are usually done in a hospital. For a cleft lip repair, your child may have to stay overnight. He will need to stay longer if bilateral cleft repair is needed. If your child is having cleft palate repair, the hospital stay is usually 2-3 days.

    Post-procedure Care

    At the Hospital
    The hospital staff will:
    • Give your child nutrition and fluids through a vein in the arm, then later by mouth.
    • Give oxygen (if needed) through a tube in the nose.
    • Give your child pain medicine.
    • Use elbow splints to keep your child’s hands away from his incisions.
    At Home
    When you return home, do the following to help ensure a smooth recovery for your child:
    • If your child had cleft lip repair, clean the incision areas throughout the day, especially after feedings.
    • Give your child pain medicine as needed. If your child had cleft lip repair, you may need to put ointment on your child’s lip. Your child may also need antibiotics.
    • Use elbow splints to keep your child’s hands away from the incision area. You will be able to remove the splints throughout the day while you watch your child closely.
    • At first, your baby will be given fluids using a special bottle with a rubber-tip syringe or a spoutless cup. You will then be instructed to resume your baby’s normal feedings (breastmilk or formula). If your child had cleft lip repair, you will be able to feed him a soft diet using a spoon. If your child had cleft palate repair, he will have to start with a liquid diet, because food and utensils could interfere with the healing process.
    • Your child will be uncomfortable and irritable. Comfort your child by holding him.
    • Ask the doctor about how to wash your child's face and when it is safe for your child to bathe or soak in water.
    • Be sure to follow the doctor’s instructions.
    After the surgeries, you will see scars at the upper lip and nose. These scars will fade with time. Once the repairs are done, your child will be able to develop and function normally. In some cases, he may need more surgeries to improve his appearance. Surgeries may also be needed to improve breathing problems, jaw alignment, or speech development.

    Call Your Child’s Doctor

    After leaving the hospital, contact the doctor if any of the following occurs:
    • Signs of dehydration : little or no urination, sunken soft spot on head (in babies), no tears when crying, dry and cracked lips
    • Bleeding
    • Signs of infection, including fever and chills
    • Irritability
    • Refusal to drink
    • Redness, swelling, increasing pain, or bleeding or discharge from the incision site
    • Cough or shortness of breath
    • Nausea or vomiting
    • Any new symptoms
    In case of an emergency, call for medical help right away.

    RESOURCES

    Birth DefectsCenters for Disease Control and Prevention http://www.cdc.gov/ncbddd/bd/

    National Library of Medicine http://www.nlm.nih.gov/

    CANADIAN RESOURCES

    Birth Defect Research for Children http://www.birthdefects.org/

    Health Canada http://www.hc-sc.gc.ca/index-eng.php/

    References

    American Society of Plastic Surgeons. Important facts about the safety and risks of cleft repair surgery. American Society of Plastic Surgeons website. Available at: http://www.plasticsurgery.org/x7352.xml . Accessed April 27, 2010.

    American Society of Plastic Surgeons. More than a cosmetic repair. American Society of Plastic Surgeons website. Available at: http://www.plasticsurgery.org/x7352.xml . Accessed April 27, 2010.

    American Society of Plastic Surgeons. Preparing for surgery. American Society of Plastic Surgeons website. Available at: http://www.plasticsurgery.org/x7352.xml . Accessed April 27, 2010.

    American Society of Plastic Surgeons. What happens during cleft lip and palate surgery? American Society of Plastic Surgeons website. Available at: http://www.plasticsurgery.org/x7352.xml . Accessed April 27, 2010.

    American Society of Plastic Surgeons. Your child’s cleft lip and palate repair. American Society of Plastic Surgeons website. Available at: http://www.plasticsurgery.org/x7352.xml . Accessed April 27, 2010.

    American Society of Plastic Surgeons. Your child’s recovery and results. American Society of Plastic Surgeons website. Available at: http://www.plasticsurgery.org/x7352.xml . Accessed April 27, 2010.

    Children’s Mercy Hospitals and Clinics. Care card: care of nasal stents. Children’s Mercy Hospitals and Clinics website. Available at: http://www.cmh.edu/Content/view.aspx?id=4895 . Accessed April 28, 2010.

    Children’s Mercy Hospitals and Clinics. Care card: cleft palate (before surgery information). Children’s Mercy Hospitals and Clinics website. Available at: http://www.cmh.edu/Content/view.aspx?id=4914 . Accessed April 27, 2010.

    Drugs.com. Cleft lip repair. Drugs.com website. Available at: http://www.drugs.com/cg/cleft-lip-repair-inpatient-care.html . Updated April 2010. Accessed April 27, 2010.

    Kids Health. Cleft lip and palate. Kids Health website. Available at: http://kidshealth.org/parent/medical/ears/cleft%5Flip%5Fpalate.html# . Accessed April 27, 2010.

    Pediatric Plastic Surgery. Cleft lip and palate. Pediatric Plastic Surgery website. Available at: http://smilesforkids.missouri.edu/common%5Fconditions/clp.php . Accessed April 27, 2010.

    Rosen H, Barrios LM, Reinisch JF, Macgill K, Meara JG. Outpatient cleft lip repair. Plast Reconstr Surg. 2003;112(2):381-387.

    University of Missouri Children’s Hospital. What to expect: cleft lip surgery. University of Missouri Children’s Hospital, Pediatric Plastic Surgery website. Available at: http://smilesforkids.missouri.edu/for%5Fparents/cl%5Fexpectations.php . Accessed April 27, 2010.

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