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Cleft Lip and Cleft Palate Repair

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Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Child’s Doctor

Definition

Cleft lip and cleft palate repair are surgeries of the lip and the roof of the mouth. These repairs are two separate surgeries that are sometimes done together.

Surgery is usually done at a young age. Cleft lip repairs occurs most often at age 3-6 months. Cleft palate repairs occurs most often at age 9-18 months

Infant With Cleft Lip

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Reasons for Procedure

These surgeries are done to repair birth defects called cleft lip and cleft palate. A cleft lip is an open gap in the upper lip. A cleft palate is an open gap in the roof of the mouth. 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 such as 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.

The goals of cleft lip repair 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.
  • Allow the lips to close with a tight seal.

The goal of cleft palate repair 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
  • Reaction to the anesthesia
  • 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

Your child will need to have an empty stomach before surgery. Make sure you get specific instructions about when to stop feeding your child.

In the time leading up to the surgeries, the doctor may have your child wear a device called an obturator. The device fits inside the mouth. It may help your child during feedings and help to keep the arch in the lip.

Your child will be treated by a team of specialists. The doctors will:

  • Order tests such as blood tests, urine tests, and 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

General anesthesia will be used. It will block any pain and keep your child asleep through the surgeries. It is given by IV.

To repair a cleft lip, an incision will be made on either side of the cleft. The incision will be from the lip to the nostril. Sutures will be used to close the two parts of the lip. If your child has two openings on either side of the lip, an additional surgery will be needed in about a month. Bandages will be placed over the incision area.

During cleft palate repair, incisions will be made on the two sides of the cleft. A special flap technique will be used to move the hard palate in the front of the mouth and the soft palate in the back of the mouth. The muscle fibers in palate will also be moved. Removable or absorbable stitches will be used to close the area.

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 the nose.

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

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

The surgeries are usually done in a hospital. For a cleft lip repair, your child may have to stay overnight. A longer stay may be required if an additional cleft repair is planned. If your child is having cleft palate repair, the hospital stay is usually 2-3 days.

The hospital staff will:

  • Give your child nutrition and fluids through a vein in the arm, then later by mouth.
  • Give oxygen through the nose, if needed.
  • Give your child pain medication.
  • Use elbow splints to keep your child’s hands away from his incisions.

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 medication as needed. If your child had a 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 breastmilk or formula feedings. If your child had cleft lip repair and is old enough, you will be able to feed them a soft diet using a spoon. If your child had cleft palate repair, 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.
  • 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.
  • If your school-age child had surgery, they may struggle with teasing from their classmates. Encourage your child to talk to you. Be there to listen to their concerns. Your child may also benefit from working with a therapist. This can help them cope with their condition and surgeries.
  • Apply sunscreen to your child’s face, especially on the healed incision area.
  • 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. After the repairs are done, your child will be able to develop and function normally. In some cases, your child may need more surgeries to improve 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

Call for medical help or go to the emergency room right away if any of the following occurs in your child:

  • Signs of dehydration: little or no urination, sunken soft spot on head (in babies), no tears when crying, dry and cracked lips
  • Fast breathing or trouble breathing
  • Blue or gray skin color
  • Not waking up or not interacting

If you think you have an emergency, call for medical help right away.

RESOURCES:

Birth Defects

Centers for Disease Control and Prevention

http://www.cdc.gov/ncbddd/bd

National Institute of Dental and Craniofacial Research

http://www.nidcr.nih.gov

CANADIAN RESOURCES:

Birth Defect Research for Children

http://www.birthdefects.org

References:

Cleft lip and cleft palate repair. American Society of Plastic Surgeons website. Available at: http://www.plasticsurgery.org/x7352.xml. Accessed August 21, 2013.

Cleft lip and palate. Kids Health website. Available at: http://kidshealth.org/parent/medical/ears/cleft_lip_palate.html. Updated January 2011. Accessed August 21, 2013.

Cleft lip and palate. Pediatric Plastic Surgery website. Available at: http://smilesforkids.missouri.edu/common_conditions/clp.php. Accessed August 21, 2013.

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

What to expect: cleft lip surgery. University of Missouri Children’s Hospital, Pediatric Plastic Surgery website. Available at: http://smilesforkids.missouri.edu/for_parents/cl_expectations.php. Accessed August 21, 2013.

Last reviewed September 2013 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.