A cleft lip is usually repaired when the baby is between three to six months old. An orthodontic appliance may be used before and after the lip repair surgery to help align the lip and nose. A child with a very wide opening may need to have a temporary procedure that brings the parts of the lip closer together before the full lip repair is done.
The goal of the surgery is to bring together the separation in the lip so that the lips work and look normal. Incisions are made on both sides of the cleft to create ﬂaps of tissue that are then drawn together and stitched to close the opening. Surgery is performed in the hospital under general anesthesia.
What to Expect After Cleft Lip Surgery
Caregivers can expect that baby will recover well after cleft lip repair. Normally, there are no feeding modifications associated with a cleft lip repair. The baby may need to stay overnight if they are having trouble adjusting to feeding or are having difficulties with pain management, but these instances are not common.
Caregivers will learn how to care for the surgical site from the surgical team. They will also learn about post-operative care such as nasal stenting, scar massage or any other recommendations for best outcome.
Surgical Treatment for Cleft Palate
A cleft palate is usually repaired between 11 and 13 months of age. The plastic surgeon carefully puts the tissue and muscles in a better position so that the opening between the nose and mouth is closed and the roof of the mouth is rebuilt. Incisions are made on both sides of the opening, and specialized ﬂap techniques are used to reposition the muscles and the palate. The repair is then stitched closed, usually in the middle of the roof of the mouth, so that normal feeding and speech development can occur and growth can continue throughout the child’s life. Surgery for cleft palate is performed under general anesthesia. Children are observed overnight in the hospital and remain there until they are comfortable and can drink sufficient fluids. Most children are eating and drinking comfortably after the first night and are discharged home at that time.
The goal of surgery is to create a palate that works well for feeding and speech. Most children will have good speech after palate repair. If there is breakdown in the palate that does not heal in the first two months after surgery, this is called a fistula. If the fistula is felt to result in nasal leakage of air or fluids, then a fistula repair would be performed after at least six months following palate repair to be certain the tissues have adequately healed to withstand repair. Some children, however, may need further surgery on the muscles of the palate or the muscles of the throat to achieve normal speech.
What to Expect After Cleft Palate Surgery
In partnership with baby’s speech therapist, caregivers will be well prepared for cleft palate surgery. Since the baby will not be able to put any objects into their mouth after the surgery, a speech therapist will offer parents techniques and resources for feeding, such as open cup feeding, starting between six to eight months of age.
Parents can expect that baby will stay overnight after their surgery to monitor feeding and pain control after the procedure. Usually, patients are sent home with elbow immobilizers to keep baby from putting their hands or objects into their mouth for at least four weeks after the procedure.
Other Surgeries for Cleft Lip & Palate Repair
Additional surgeries are dependent on the severity of clefting at birth, dental needs and patient growth. Some children may require a few surgical procedures at various ages to achieve their best outcome. Timeline of these surgeries are dependent on many factors, which are discussed in detail during appointments with the providers of the cleft team.