Cleft Lip, Cleft Palate Surgery

ExitCare ImageIf a child has a cleft lip or a cleft palate or both, there is a gap (called a cleft) in the upper lip or roof of the mouth (the palate). This problem forms before birth. It develops sometime between the 5th and 8th week of pregnancy. It can be a small notch or a wide opening. A cleft lip will affect the child's looks. A cleft palate might be visible or it might not be. Both can make it hard for the child to eat or speak normally. Children with a cleft palate often have frequent ear infections.

Surgery usually can fix these conditions.

The goal of surgery is to close the cleft with minimal scarring and so that the lip and palate can function normally during feeding and speech.

  • The first surgery is to close the cleft lip. Often, more than 1 surgery is needed. This may be the case if your child has more than 1 gap or if the condition is severe.

  • Then, as your child grows up and develops, other operations may be needed.

  • For example, surgery might be done to improve your child's speech. Or, it could help your child's breathing. Sometimes the jaw needs to be straightened.

  • Also, additional surgery can improve your child's appearance.

LET YOUR CAREGIVER KNOW ABOUT:

  • Any allergies.

  • Any recent colds or infections.

  • All medications your child is taking.

  • Previous problems with medicine that makes your child sleep (anesthetics).

  • Any history of bleeding or other blood problems.

  • Previous surgery.

  • Other health problems.

RISK AND COMPLICATIONS

Short-term possibilities include:

  • Bleeding.

  • Infection.

  • Pain.

  • Bruises or swelling where the IV was placed in the hand or arm.

  • Infection near the incision.

  • Pooling of blood under the wound (hematoma).

  • Allergic reaction to medications or to surgical tape. This does not happen often.

  • Difficulty breathing. This is almost always temporary. It also is very rare.

Longer-term possibilities include:

  • Scarring.

  • Skin damage.

  • Damage to blood vessels in the area.

  • The roof of the mouth might be uneven.

  • Loss of feeling (numbness) in the face, lips, gums, or roof of the mouth. This is caused by nerve damage. It is usually temporary. Sometimes it is permanent, but that is rare.

  • Additional care. This could include:

  • Future surgery. Operations will probably be needed as the child grows and develops. They can improve the child's ability to eat, breathe, or talk. They also can improve the child's appearance.

  • Speech therapy. Children usually learn to speak normally after surgery. Sometimes, a specialist can help.

  • Dental care. A cleft can cause teeth to come into the mouth in unusual ways. They might be an odd shape. They could be in the wrong place. Or some teeth might be missing. A dentist should be able to fix these problems. Some children may need braces when they are older.

BEFORE THE PROCEDURE

  • Your child cannot eat or drink for 6 to 8 hours before the surgery.

  • If your child is taking any non-steroidal anti-inflammatory drugs (NSAIDs) before the surgery, your surgeon may want you to stop these a week before the surgery.

  • Arrive at least an hour before the surgery, or whenever your child's surgeon recommends. This will give you time to check in and fill out any needed paperwork.

  • Most children will not need a blood transfusion. Discuss this with the surgeon who will be doing the operation.

  • You should make plans to stay in the hospital with your child. The hospital stay is usually overnight, but your child may stay 2 or 3 days. Ask your child's healthcare provider what to expect. You might want to make a schedule so adults can take turns staying with your child.

PROCEDURE

The preparation:

  • You can stay with your child until a member of the surgical team takes your child to the operating room.

  • Your child will be changed into a hospital gown.

  • A medication to help your child relax (sedative) might be given.

  • Your child will have an intravenous (IV) access tube, although this may be done after your child is asleep. A needle will be put in your child's arm. Medication will be able to flow directly into the body through this needle.

  • Your child will be given a drug that makes sure the child is asleep during the surgery (general anesthetic).

The procedure differs for a cleft lip and a cleft palate. It also may vary depending on how severe the condition is. In general:

  • The surgeon will make cuts (incisions) on either side of the cleft.

  • For a cleft lip, the skin and muscle layers on both sides of the cleft will be stitched together. This will close the gap.

  • For a cleft palate, tissue and muscles on the roof of the mouth will be moved (repositioned). Then the area is stitched closed .

  • Dressing such as steri-strips may be placed on the incision. Sometimes skin glue or antibiotic ointment is used.

  • If the child has a cleft palate, tubes might be put in the ears at the time of the cleft palate surgery. The tubes will help the ears drain. The child should have fewer ear infections as a result.

AFTER THE PROCEDURE

  • Your child will stay in a recovery area until the anesthesia has worn off. Blood pressure and heart rate will be checked every so often.

  • You may be able to sit with your child during this recovery time. Expect your child to be sleepy and groggy for most of the day.

  • Once the body functions are back to normal, your child will be moved to a hospital room. Your child will probably stay in the hospital overnight but may require 2 or 3 days in the hospital. This will depend on how quickly your child recovers.

  • Your child's mouth and face may have some swelling or bruising. This will go away. But, it might take a week.

  • The IV may stay in your child's arm after surgery. This will make sure your child gets needed fluids.

  • Eating may be difficult after this surgery. Ask your child's healthcare team for instructions and advice.

  • Your child will continue to be given pain medication. This will help keep your child comfortable.

  • Arm splints keep the child from touching the incision and dressings. They are sometimes used after surgery. They also do not let the child suck their thumb. The splints usually may be taken off for bathing and changing. When they are off, your child must be watched closely.

  • Your child might have tubes in the nose (nasal stents). These help hold the shape of the nostril and improve the breathing through the nose. A healthcare worker will take them out when it is time. Do not remove them on your own unless instructed to do so for cleaning purposes. Some surgeons may stitch them in place.

  • Before your child goes home, be sure to ask if the incision area needs medication or special care.

  • Your child will have stitches. Sometimes the stitches go away (dissolve) on their own. Other times, they must be taken out by your child's healthcare provider. Ask which type your child has so you know what to expect.

  • Be sure to take your child to all follow-up appointments.

PROGNOSIS

Surgery can correct a cleft lip or cleft palate in most children. As the child grows and develops, more surgery may be needed. Some children also need dental surgery. With proper care, though, the child should be able to lead a much more normal life.