Surgery to Fix Openings in the Upper Lip and Roof of the Mouth (Cleft Lip, Cleft Palate Surgery) in Children: What to Expect

A cleft lip is an opening in the lip, and a cleft palate is an opening in the roof of the mouth. Cleft lip and cleft palate surgeries are done to close these openings so a child can eat and speak normally. If a cleft can be seen, surgery can also help to improve how the child looks.

Children who have a large opening or have more than one opening may need to have more than one surgery for a full repair.

Tell your child's health care provider about:

• Any allergies your child has.
• All medicines your child takes. These include vitamins, herbs, eye drops, and creams.
• Any problems your child or family members have had with anesthesia.
• Any bleeding problems your child has.
• Any surgeries your child has had.
• Any medical problems your child has.

What are the risks?

Your child's health care provider will talk with you about risks.

• Infection.
• Bleeding.
• Pain.
• Pooling of blood under the wound.
• Numbness in the face, lips, gums, or roof of the mouth.
• Allergic reaction to medicines. This is rare.
• Trouble breathing. This is rare.

• Scarring.
• The roof of the mouth being uneven.
• Lasting numbness in the face, lips, gums, or roof of the mouth. This is rare.

What happens before?

Medicines

• Ask about changing or stopping:
  • Any medicines your child takes.
  • Any vitamins, herbs, or supplements your child takes.
• Do not give your child aspirin or ibuprofen unless you're told to.

When to stop eating and drinking

• 8 hours before
  • Your child must stop eating meat, fried foods, or fatty foods.
  • Your child may eat only light foods, such as toast and crackers.
  • Your child may drink most liquids. Do not give your child energy drinks.
• 6 hours before
  • Stop giving your child milk. Stop giving your baby formula.
  • Clear liquids, such as water, clear fruit juice, and sports drinks, are OK.
  • Your baby may still have breast milk.
• 4 hours before
  • Give only clear liquids to your child, such as water, clear fruit juice, and sports drinks.
  • Stop giving your baby breast milk.
• 2 hours before
  • Have your child stop drinking all liquids.

General instructions

• For your child's safety, they may:
  • Need to have their skin washed with a soap that kills germs.
  • Get antibiotics.
  • Have their surgery site marked, in the case of a cleft lip.
• Your child may need to stay in the hospital for a few days. Ask your child's provider what to expect.
  • Make plans to stay in the hospital with your child.
  • You might want to make a schedule so adults can take turns staying with your child.

What happens during cleft lip and cleft palate surgery?

• An IV will be put into a vein in your child's hand or arm.
• Your child may be given:
  • A sedative to help them relax.
  • Anesthesia to keep them from feeling pain.
• For a cleft lip:
  • The surgeon will make cuts on the sides of the cleft.
  • The skin and muscle layers on both sides of the cleft will be stitched together.
• For a cleft palate:
  • Tissue and muscles on the roof of the mouth will be repositioned.
  • Then the area will be stitched closed.
• Skin glue, antibiotic ointment, or tape strips may be applied to the cuts.
• A bandage may be placed on the cuts.

These steps may vary. Ask what you can expect.

What happens after?

• There may be small tubes in your child's nose, called nasal stents. These might be stitched in place. They help to hold the shape of the nostril and also help with breathing. Your child's provider will take them out when it's time.
• How long your child needs to stay in the hospital will depend on how quickly they recover. Right after surgery, your child may:
  • Be watched closely. This includes checking their pain level, blood pressure, heart rate, and breathing rate.
  • Receive fluids through the IV.
  • Be given pain medicine.
  • Have arm splints. The splints will help keep your child from touching the cuts and bandages.