Cleft Lip & Cleft Palate Surgery
What is cleft lip and cleft palate surgery?
Cleft lip and cleft palate are separations, or splits, in the lip and mouth of an infant. It’s a congenital disorder, which means it happens while a fetus is still in the uterus. A cleft occurs when tissues don’t join together properly during fetal development.
What is a cleft lip and cleft palate?
A cleft lip is a separation of the two sides of your child’s upper lip. It appears as a narrow or wide opening and can include gums and nostrils and extend to their palate (roof of their mouth).
A cleft palate is a split or opening in the top of your child’s mouth. It can involve the bony front portion or the soft back portion of their mouth.
Cleft lips and palates can occur together or separately, although having both a cleft lip and cleft palate is most common.
Cleft lip surgery
Cleft lip repair is surgery to fix a split (cleft) in your child’s lip. Their surgeon makes a cut (incision) along the edges of the cleft lip extending up into their nose. They use stitches to reapproximate the muscle of your child’s upper lip and bring the cut edges of the skin together to shape the upper lip and nostrils.
Cleft palate surgery
Cleft palate repair is surgery to fix a separation or opening in the roof of your child’s mouth. Their surgeon detaches and rearranges the tissues on the roof of their mouth. Stitches are used to bring the left and right sides of the cleft together.
What do cleft lip and palate surgery fix?
Cleft lip and cleft palate surgery help restore function to your child’s lips and mouth and correct their appearance. Cleft lips and palates are associated with health problems like hearing loss, dental problems and speech problems.
Surgery helps improve your child’s ability to:
- Eat and drink.
At what age is cleft lip surgery?
Surgery to fix cleft lip typically occurs when a child is 3 to 6 months old. This could include lip taping, a nasal elevator or nasoalveolar molding (NAM) shortly after birth. These procedures help prepare their lip and palate for surgery by getting the tissues better positioned. In some cases, your child may need a second surgery to fix their lip and surgeries to correct the shape and function of their nose.
At what age is cleft palate surgery?
Cleft palate surgery generally occurs when a child is around 12 months old (before your child learns to talk). If your child also has a cleft lip, surgery to treat the cleft lip happens first. Your child may need two or more surgeries to repair a cleft palate. Some treatments to fix cleft palate (like procedures to fix the gums or jaw) aren’t performed until your child is 10 or older.
What happens before cleft lip and cleft palate surgery?
Several healthcare providers are involved in your child’s care, including surgeons, speech therapists, otolaryngologists (head and neck surgeons) and dentists. Your child’s surgeon will meet with you to evaluate your child’s cleft palate or cleft lip and determine the best surgical treatment.
Your child's pediatrician will examine them the week before surgery to ensure they’re healthy enough for surgery and go over your child’s medical history and allergies. They may ask you to stop giving your child certain medications in the week leading up to surgery.
Your child’s surgeon will supply specific eating and drinking instructions based on your child’s age. They must have an empty stomach for anesthesia. Some typical instructions may include:
- No milk (formula or cow’s milk) for at least six hours before surgery.
- Breastfeeding (chestfeeding) may be allowed up until four hours before surgery.
- Clear liquids (water or apple juice) are allowed up until three hours before surgery.
- No solid foods or baby food beginning at midnight the day of the surgery.
Make sure you share your concerns with your healthcare provider and get all of your questions answered so you know what to expect on the morning of your child’s surgery.
What happens during surgery?
The goal of cleft lip surgery is to close the gap in your child’s lip and improve the shape and appearance of their upper lip and nose. Incisions are made on either side of the cleft to create ﬂaps of skin. Those pieces of skin are drawn together and stitched with absorbable (they dissolve) stitches.
Your baby is under general anesthesia (they’re asleep) for the procedure. Cleft lip surgery takes less than two hours. Your child will spend the night at the hospital to ensure they tolerated surgery well.
Cleft palate surgery aims to close the opening in the roof of your child’s mouth, create a palate that supports normal speech development and prevent food from coming out of their nose. Cleft palate surgery takes between two and three hours but can take longer depending on the type of palate repair.
Your child will be asleep (under general anesthesia) for the entire procedure and not feel pain.
The surgery involves rearranging and repairing several layers of tissue in the roof of their mouth and nasal cavity. Incisions are made on each side of their palate. Layers of tissue are loosened so they can be stretched. Once the tissue is in place and the separation is closed, their surgeon will use absorbable stitches to close the incision.
What should I expect after surgery?
Your child may be fussier than normal following surgery. Soft splints or cuffs are placed around your child’s arms to prevent them from touching their lip. Most children will find these uncomfortable and irritating.
Your child can start eating (breastmilk or formula) or drinking shortly after surgery, but they may have trouble. An intravenous (IV) catheter will be used to give your child fluids until they can drink on their own. Check with your healthcare provider for specific eating and drinking instructions once you’re back home.
Your child will stay in the hospital for at least one or two days. Some children may need to stay longer depending on their recovery. After surgery, they’re allowed to drink clear liquids from a cup only (no utensils or straws).
Swelling and small amounts of bleeding (like blood in their saliva) are normal. Your child will have stitches in their mouth for several weeks, but some dissolve sooner.
Your child may be given prescription pain medication and an antibiotic when they leave the hospital.
How many surgeries does it take to fix a cleft palate and cleft lip?
It depends on the severity of the cleft and if other health conditions are present. Cleft lip repair usually requires just one surgery, while cleft palate surgery can take two. Your child’s healthcare provider can estimate how many surgeries your child needs to treat their cleft.
Are cleft palate and cleft lip surgery painful?
Your child is asleep (under general anesthesia) for the procedure, so they won’t feel pain. They’ll be uncomfortable after the pain medication wears off. Your child’s surgeon will provide instructions on pain management. Do your best to comfort your child as they recover. Talk to your child’s healthcare provider to make sure you understand what’s normal after cleft palate and cleft lip surgery.
Risks / Benefits
What are the benefits of cleft lip and cleft palate surgery?
Surgery to correct a cleft lip or palate helps your child’s lips and mouth function properly and lowers the risk of certain health conditions. A child with a cleft lip or cleft palate is at risk for:
- Frequent ear infections or fluid buildup behind their eardrum.
- Trouble feeding, sucking or swallowing.
- Hearing loss.
- Fluid coming out of their nose.
- Speech delays.
- Dental problems.
What are the risks or complications of cleft lip and palate repair?
Like most surgeries, treating a cleft palate or cleft lip comes with risks. Surgery to fix cleft lip and cleft palate is generally very safe.
The most common risks are:
- Reactions to anesthesia.
- Breathing problems.
- Surgery isn’t successful or more surgeries are needed.
Recovery and Outlook
What are the at-home care instructions after cleft lip surgery?
You can expect instructions from your surgeon on how to care for your child once they return home.
Eating and drinking
Your provider will give you a complete list of eating and drinking modifications. Baby food is generally OK to continue, but it must be watered down or eaten through a cup. Straws are generally not safe following cleft lip surgery. You may even need to use a special bottle or syringe for feeding your baby formula or breastmilk. Ask your child’s healthcare provider about spoon-feeding your child, as this may be permitted.
The area around your child’s mouth will be swollen and bruised for several days after surgery. Keeping the incision site clean (with warm water) and dry is important. Stitches should dissolve within one to two weeks of surgery.
After the stitches dissolve, a pink or red scar will remain. The scar may feel hard and first but should soften over time. Some healthcare providers will recommend an ointment be applied to the scar once the stitches are out. Scars sunburn easily, so be diligent about applying sunscreen every time before your child goes outside.
Your child may need pain medicine for the first few days after surgery. Follow the label instructions on over-the-counter infant pain relievers. If this doesn’t seem to be helping, contact your child’s provider.
Most children are back to their usual behavior about a week after surgery. Ask your child’s healthcare provider for specific recovery instructions as they could vary depending on your child’s medical history.
What are the at-home care instructions after cleft palate surgery?
Your child’s provider will send you home with a complete list of at-home care instructions.
Eating and drinking
In the weeks after surgery, your child will only be allowed to drink liquids from a cup only (no straws). Your child should only be given soft or mashed-up foods (nothing crunchy or hard). Spoon-feeding your child during their recovery is usually OK. Check with your child’s surgeon to make sure you understand the rules for eating and drinking.
Stitches may last up to a month. Exposed bone on the sides of their palate is normal and will fill in on its own. A small amount of bleeding (in saliva or mucus) is expected. You can expect your child’s mouth to be swollen for at least one week.
Your child may be sent home with pain medicine and an antibiotic to prevent infection. Over-the-counter ibuprofen or acetaminophen can treat sore throat, neck and jaw pain or earache. You can expect your child to feel some degree of pain for up to two weeks. The pain could affect their eating, drinking and sleeping.
There may be more drainage coming from their nose after surgery and it could appear pink or bloody. Your child may snore and sound congested for several weeks.
Talk to your child’s surgeon to understand how to best treat them at home as they recover from cleft palate surgery.
How long do cleft palate and cleft lip surgery take to heal?
It can take up to four weeks to recover from cleft lip or cleft palate surgery. Recovery from cleft palate surgery may take a little longer due to the complexity.
When to Call the Doctor
When should I see my healthcare provider?
Your child’s healthcare provider will schedule a postoperative appointment for one to two weeks after cleft lip or cleft palate surgery. However, if your child experiences any of the following, call their provider right away:
- Fever higher than 101.4 degrees Fahrenheit (38.55 degrees Celsius) or a fever that doesn’t respond to medication.
- Trouble breathing or blue/pale skin color.
- Bleeding from their nose or mouth (pink mucus and saliva are normal).
- Signs of infection like pus or bleeding from the incision.
- Signs of dehydration, like no tears when crying, sunken eyes, dry mouth or not urinating enough (at least one wet diaper every six hours).
- Any redness or severe swelling at the incision site.
- The incisions open or the stitches are loose.
A note from Cleveland Clinic
Cleft lips and cleft palates are common birth anomalies that affect a child’s upper lip or roof of the mouth. Your child may need a few surgeries to fix a cleft palate or cleft lip. Your child’s healthcare provider will give you specific at-home instructions for before and after cleft palate or cleft lip surgery. If you’re a parent or guardian of a child requiring surgery, the best things you can do are help relax and calm your child and make sure all of their surgeon’s post-op instructions are followed. Following their directions is important for successful treatment. Don’t be afraid to ask your surgeon questions and talk through your child’s treatment plan and needs for ongoing care. Most kids with cleft lip and palate are treated successfully with no long-term problems.
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