Cleft lip and cleft palate
repair are surgeries of the lip and the roof of the mouth. These repairs are 2 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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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 earHearing impairmentSpeech problemsDental problems such as missing or malformed teethFeeding 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.
Problems from the procedure are rare, but all procedures have some risk. Your child's doctor will review potential problems, like: BleedingInfectionScars not healing correctlyReaction to the anesthesiaDamage to nerves, blood vessels, muscles, or lungs
Additional birth defects may put your child at a higher risk for complications.
Be sure to discuss these risks with the doctor before the surgeries.
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-raysAsk about your child’s medical history and do a physical examGive you a chance to ask questions about the surgeries and recovery process
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 the 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 2 hoursCleft 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 an IV, 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 the incisions.
During your child's stay, the hospital staff will also take steps to reduce the chance of infection, such as:
Washing their handsWearing gloves or masksKeeping your child's incisions covered
There are also steps you can take to reduce your child's chance of infection, such as:
Washing both you and your child's hands often, and reminding visitors and healthcare providers to do the sameReminding your child's healthcare providers to wear gloves or masksNot allowing others to touch your child's incision
When you return home, do the following to help ensure a smooth recovery for your child: 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.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.
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.
It is important to monitor your child's recovery. Alert your child's doctor to any problems. If any of the following occur, call your child's doctor: BleedingSigns of infection, including fever and chillsIrritabilityRefusal to drinkRedness, swelling, increasing pain, or bleeding or discharge from the incision siteCough or shortness of breathNausea or vomitingAny new symptoms
Call for emergency medical services or go to the emergency room right away if any of the following occurs in your child:
—little or no urination, sunken soft spot on head in babies, no tears when crying, dry and cracked lips
Fast breathing or trouble breathingBlue or gray skin colorNot waking up or not interacting
If you think you have an emergency, call for emergency medical services right away.
Cleft lip and cleft palate surgery. American Society of Plastic Surgeons website. Available at:
http://www.plasticsurgery.org/reconstructive-procedures/cleft-lip-and-palate.html. Accessed September 12, 2014.
Cleft lip and palate. Nemours Kids Health website. Available at:
http://kidshealth.org/parent/medical/ears/cleft_lip_palate.html. Updated January 2011. Accessed September 12, 2014.
Rosen H, Barrios LM, Reinisch JF, Macgill K, Meara JG. Outpatient cleft lip repair.
Plast Reconstr Surg.
What to expect: cleft lip surgery. University of Missouri Children’s Hospital, Pediatric Plastic Surgery website. Available at:
http://smilesforkids.missouri.edu/common-conditions/cleft-lip-palate/what-to-expect-cleft-lip-surgery. Accessed September 12, 2014.
Last reviewed September 2015 by Donald Buck, 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.
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