Cleft lip and cleft palate surgery

Overview

Cleft lip and cleft palate are congenital conditions characterized by separations or gaps in an infant’s lip and the roof of the mouth. These abnormalities result from improper tissue fusion during fetal development, occurring while the fetus is in the womb.

A cleft lip is a condition in which there is a separation between the two sides of your child’s upper lip. This separation can extend to various parts of their mouth, including their nostrils, gums, and  palate (the roof of their mouth), and it can appear as either a wide or narrow gap.

On the other hand, a cleft palate refers to a split or opening on the top of your child’s mouth. This cleft can affect both the soft posterior portion and the bony front portion of their mouth.

Less frequently, a cleft merely affects the submucous cleft palate, which affects the muscles of the soft palate at the rear of the mouth that are covered by the lining of the mouth. This kind of cleft is frequently undetected at birth and may not be identified until later on when symptoms appear. 

While it is more common to have both a cleft lip and a cleft palate simultaneously, these conditions can also occur independently of each other or coexist separately.

Cleft lip surgery

The surgical procedure performed to close a cleft or split in your child’s lip is called cleft lip repair. During this procedure, the edges of the cleft lip are carefully incised, extending into the nasal area. To reconstruct and shape your child’s upper lip and nostrils, the surgeon uses stitches to reapproximate the muscle of the upper lip and brings together the cut edges of the skin.

Cleft palate surgery

The operation known as cleft palate repair is performed to close an opening or split in your child’s palate. The tissues on the roof of their mouth are separated and rearranged by their surgeon. The left and right sides of the cleft are joined together using stitches.

When to undergo the procedure

A child with a cleft lip usually has surgery between the ages of three and six months. This could involve nasoalveolar molding (NAM) soon after birth, lip taping, or a nasal elevator. By better positioning the tissues, these procedures assist patients get ready for surgery on their lip and palate. Your child can occasionally require additional surgery to restore the form and function of their nose in addition to a second procedure to fix their lip.

Usually, cleft palate surgery is performed before a kid learns to speak, at approximately the age of 12 months. If your child also has a cleft lip, the cleft lip is treated surgically initially. For the repair of a cleft palate, your kid can require two or more procedures. Certain cleft palate treatments (such as gum or jaw surgery) are not done on a child until they are 10 years old or older.

Reasons for undergoing the procedure

Surgery for cleft lip and cleft palate aims to restore normal function to your child’s lips and mouth while enhancing their appearance. These procedures can address health issues such as speech difficulties, dental problems, and hearing impairments that are associated with cleft lips and palates.

Surgery enhances your child’s capacity to:

• Speak
• Hear
• Eat and drink
• Breathe

Risks

There are dangers associated with treating cleft lip and palate, much like with most procedures. Cleft lip and palate correction surgery is typically fairly safe.

The most typical risks are:

• Anesthesia side effects
• Infection
• Breathing problems 
• Bleeding
• The operation fails, or additional procedures are required

Before the procedure

Your child is receiving care from a number of medical professionals, such as dentists, speech therapists, otolaryngologists (head and neck surgeons), and surgeons. The surgeon for your child will consult with you to assess the best surgical course of action for your child’s cleft lip or palate.

The week prior to surgery, your child’s pediatrician will check up on them to make sure they are healthy enough for the procedure and review their medical history and allergies. The week before surgery, they might ask you to cease giving your some medications.

Depending on your child’s age, the surgeon will provide precise feeding and drinking guidelines. For anesthetic to work, their stomachs must be empty. Typical guidelines could be as follows:

• Breastfeeding is permitted up until four hours prior to surgery.
• No milk (formula or cow’s milk) for at least six hours prior to surgery.
• There can be three hours prior to surgery for clear liquids (water or apple juice). 
• No solid meals or baby food after midnight on the day of the procedure.

To ensure that you are prepared for what to expect on the morning of your child’s operation, make sure you discuss any of your worries and questions with your doctor.

During the procedure

Cleft lip

Closing the lip gap and improving the appearance of your child’s upper lip and nose are the two main objectives of cleft lip surgery. To form skin flaps, incisions are performed on both sides of the cleft. The skin sections are sewn together using absorbable stitches, which disintegrate over time.

For the procedure, your infant is under general anesthesia, which puts them to sleep. Less than two hours are needed for cleft lip surgery. Your child will stay overnight in the hospital to make sure they underwent surgery successfully without complications.

Cleft palate

The goals of cleft palate surgery are to stop food from escaping your child’s nose, close the aperture in the roof of their mouth, and create a palate that supports proper speech development. The duration of cleft palate surgery typically falls within the range of two to three hours, although it may extend beyond this timeframe based on the specific type of palate repair required.

Under general anesthesia, your child will be unconscious throughout the entire process and won’t experience any pain.

The procedure includes moving and fixing many tissue layers in the nasal cavity and roof of the mouth. They make incisions on both sides of their palate. Tissue layers are released to allow for stretching. The incision will be closed by their surgeon using absorbable stitches after the tissue is in place and the separation is sealed.

After the procedure

Cleft lip

After surgery, your child can be fussier than usual. To stop your child from touching their lip, gentle splints or handcuffs are wrapped around their arms. These will irritate and discomfort the majority of kids.

Soon after surgery, your child can begin to feed (breastmilk or formula) and drink, however they might have difficulties. Your youngster will receive fluids via an Intravenous (IV) catheter until they are able to drink on their own. When you return home, ask your doctor for specific recommendations on what to eat and drink.

Cleft palate

Your youngster will require a minimum of one or two days of hospitalization. Depending on how well they heal, some kids might need to stay longer. They can only have clear beverages from a cup after surgery; no straws or cutlery are permitted.

It’s common for them to swell and bleed a little bit (like have blood in their saliva). Although some will fall out sooner, your child’s mouth stitches will last for several weeks.

When your child leaves the hospital, they can be prescribed an antibiotic and painkillers.

While cleft palate surgery may require two procedures, cleft lip repair often only requires one. Your child’s doctor can make an estimate of the number of surgeries required to treat their cleft.

Outcome

Your surgeon will further provide you with information on how to take care of your child when they go back home.

Eating and drinking

Your doctor will provide you with a detailed list of dietary and beverage modifications. Typically, you can continue to feed your baby with solid food, but you may need to dilute it or use a cup. It’s generally advisable to avoid using straws after cleft lip surgery. There might be a need to use a special bottle or syringe to feed your infant formula or breast milk. Spoon–feeding your child may also be an option, and it’s best to discuss this with their doctor.

Incision care

Following the surgery, your child’s mouth area may experience bruising and swelling for a few days. It’s essential to maintain cleanliness and dryness in the incision area by gently cleaning it with warm water. Stitches typically dissolve or fall out within one to two weeks post–surgery.

Once the stitches are gone, a pink or red scar may remain. Initially, the scar may feel rough, but it should gradually become smoother. Some doctors recommend applying an ointment to the scar after the stitches are removed. It’s important to note that scars are sensitive to sunlight, so ensure your child always wears sunscreen when they are outdoors.

Pain

In the initial days following surgery, your child may need pain medication. When using over–the–counter infant pain medications, please follow the instructions on the label. If it appears that the medication is not providing sufficient relief, it’s advisable to consult your child’s doctor.

Most children typically return to their usual routines within about a week after surgery. However, it’s important to note that specific recovery instructions may vary depending on your child’s medical history, so it’s best to seek guidance from your child’s doctor.