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Cleft Lip and Cleft Palate Surgery

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KEY POINTS

  • Cleft lip and cleft palate surgery is done to close an opening (cleft) in the upper lip or in the roof of the mouth, which is called the palate. The birth defect can affect one or both nostrils also.
  • This surgery can help treat or prevent problems with breathing, feeding, talking, and problems with teeth, as well as improve the way your baby looks.
  • Ask your child’s healthcare provider how long it will take for your child to recover and how to take care of your child at home.
  • Make sure you know what symptoms or problems you should watch for and what to do if your child has them.

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What is cleft lip or palate surgery?

Cleft lip and cleft palate surgery is done to close an opening (cleft) in the upper lip or in the roof of the mouth, which is called the palate, in children less than 18 years old. The opening is a birth defect that can happen when a baby’s lip or mouth does not form properly. It may affect muscles, bones, soft tissues, and cartilage. The birth defect can affect one or both nostrils also.

When is it used?

Children with a cleft lip or cleft palate often have problems with breathing, feeding, and talking. They also may have more ear infections, hearing loss, and problems with their teeth. Surgery can help treat or prevent these problems, as well as improve the way your baby looks.

Surgery to close the split in a cleft lip, palate, or nose is usually done when a baby is 3 to 6 months old. Sometimes a second surgery is done later to make sure that both sides of the mouth and nose match.

Closing the opening in the roof of the mouth usually helps the child eat and speak more normally.

Your child’s healthcare provider may provide certain special devices for your baby to wear on the mouth and lip before surgery. This depends on the type and location of the repair planned.

How do I prepare my child for this procedure?

  • This surgery may be done as an outpatient or inpatient procedure. This means that your child may be able to go home the same day as the surgery, or your child may be in the hospital for one or more days. Talk to your child’s healthcare provider about where your child will have surgery.
  • Your child may or may not need to take regular medicines the day of the procedure. Tell your healthcare provider about all medicines and supplements your child takes. Some products may increase the risk of side effects. Ask your healthcare provider if your child needs to avoid taking any medicine or supplements before the procedure.
  • Tell your healthcare provider if your child has any food, medicine, or other allergies such as latex.
  • Your child’s provider will tell you when your child needs to stop eating and drinking before the procedure. This helps to keep your child from vomiting during the procedure.
  • Tell your child’s provider if your child has an infection such as a cold.
  • Follow any other instructions your child’s healthcare provider may give you.
  • Ask any questions you have before the procedure. You should understand what your child’s healthcare provider is going to do. You have the right to make decisions about your child’s healthcare and to give permission for any tests or procedures.

What happens during the procedure?

Your child will be given a general anesthetic to prevent pain during the procedure. General anesthesia relaxes the muscles and puts your child into a deep sleep.

To repair a cleft lip, your child’s healthcare provider will make a cut on either side of the split in the lip. The cut will extend from the mouth into the nostril. Your provider will then pull the muscle and the skin of the lip together to close the separation.

To repair a cleft palate, your child’s healthcare provider will make a cut on both sides of the split in the roof of the mouth. Your provider will move tissue from each side of the cleft to the center of the roof of the mouth to close the separation.

If the cleft affects the nose as well as the lip or palate, the nose may be repaired at the same time or in a later surgery.

Your child may need a small plastic tube in each eardrum to help prevent problems from ear infections. This procedure may be done at same time as the cleft repair or at a later time.

More surgeries may be needed into adulthood.

What happens after the procedure?

For a day or 2, your child will feel some soreness. Your child’s healthcare provider may prescribe antibiotic medicine to prevent infection and will recommend a pain medicine for you to give to your child at home.

Your child may need IV fluids if your child is not able to eat or drink as much as usual. Your child’s healthcare provider will tell you the best way to feed your child during the first few weeks after surgery. For the first week, your child may need to be given only a liquid foods. It may help to give your child small, frequent feedings. Be sure to give your child plenty of liquids.

Your child may have a stuffy nose that may affect eating also. Ask your child’s healthcare provider how you can help treat your child’s nose stuffiness.

Follow your healthcare provider’s instructions for caring for the wound. It’s normal to have swelling, bruising, and blood around the stitches. After cleft palate surgery, there may be bloody fluid draining from the nose and mouth. This should decrease after the first day. Swelling should be almost gone in a week.

Children with a cleft palate are more likely to get ear infections. Your child may need a small plastic tube in each eardrum. This procedure may be done at same time as the cleft repair or at a later time. After the ear tubes are in place, try to keep water out of the ears. Protect your child's ears during bathing, shampooing, and swimming. Vaseline coated cotton balls, silicone ear putty, or specially made ear molds can be placed in the outer ears to keep the ears dry.

It’s normal for the surgical scar to seem to get bigger and redder for a few weeks after surgery. The scar will fade over time. The scar will never go away completely, but usually it becomes much less noticeable.

Follow your child’s healthcare provider's instructions. Ask your provider:

  • How long it will take for your child to recover
  • If there are activities your child should avoid and when your child can return to normal activities
  • How to take care of your child at home
  • What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup. Keep all appointments for provider visits or tests.

What are the risks of this procedure?

Every procedure or treatment has risks. Some possible risks of this procedure include:

  • Your child may have problems with anesthesia.
  • Your child may have an infection or bleeding.

Ask your child’s healthcare provider how these risks apply to your child. Be sure to discuss any other questions or concerns that you may have.

Developed by Change Healthcare.
Pediatric Advisor 2022.1 published by Change Healthcare.
Last modified: 2021-12-07
Last reviewed: 2020-04-08
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
© 2022 Change Healthcare LLC and/or one of its subsidiaries
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