Cleft Lip and Cleft Palate Repair
Definition
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 to 6 months. Cleft palate repairs occurs most often at age 9 to18 months.
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
Problems from the procedure are rare, but all procedures have some risk. Your child's doctor will review potential problems, like:
- Bleeding
- Infection
- Scars not healing correctly
- Reaction to the anesthesia
- Damage 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.
What to Expect
Prior to Procedures
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
Anesthesia
General anesthesia will be used. It will block any pain and keep your child asleep through the surgeries. It is given by IV.
Description of the Procedures
Cleft Lip Repair
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 2 parts of the lip. If your child has 2 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.
Cleft Palate Repair
During cleft palate repair, incisions will be made on the 2 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.
Immediately After Procedures
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.
How Long Will It Take?
- Cleft lip repair—about 2 hours
- Cleft palate repair—2 to 4 hours
How Much Will It Hurt?
Anesthesia prevents pain during surgery. Your child will be given medication to relieve pain or soreness during recovery.
Average Hospital Stay
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 to 3 days.
Post-procedure Care
At the Hospital
The hospital staff will:
- Give your child nutrition and fluids through an IV, then later by mouth.
- Give your child pain medicine.
- Use elbow splints to keep your child’s hands away from the incisions.
Preventing Infection
During your child's stay, the hospital staff will also take steps to reduce the chance of infection such as:
- Washing their hands
- Wearing gloves or masks
- Keeping 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 same
- Reminding your child's healthcare providers to wear gloves or masks
- Not allowing others to touch your child's incision
At Home
To help ensure a smooth recovery for your child at home:
- 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-aged 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.
Call Your Child’s Doctor
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:
- 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
- New or unexpected symptoms
Call for emergency medical services or go to the emergency room right away for:
- 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 your child has an emergency, call for emergency medical services right away.
RESOURCES:
Centers for Disease Control and Prevention
https://www.cdc.gov
National Institute of Dental and Craniofacial Research
https://www.nidcr.nih.gov
CANADIAN RESOURCES:
Birth Defect Research for Children
http://birthdefects.org
Health Canada
https://www.canada.ca
REFERENCES:
Cleft lip and cleft palate surgery. American Society of Plastic Surgeons website. Available at: https://www.plasticsurgery.org/reconstructive-procedures/cleft-lip-and-palate-repair. Accessed September 5, 2019.
Cleft lip and palate. Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/en/parents/cleft-lip-palate.html. Updated October 2014. Accessed September 5, 2019.
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: https://www.muhealth.org/conditions-treatments/pediatrics/pediatric-plastic-surgery/cleft-lip-and-palate. Accessed September 5, 2019.
Last reviewed September 2019 by EBSCO Medical Review Board Donald W. Buck II, MD Last Updated: 9/16/2020