Cleft Lip, Cleft Palate Surgery, Pediatric

A baby with a bilateral cleft lip, also showing a close-up of the cleft lip.

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 is visible, surgery can also help to improve the child's appearance.

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

Tell your child's health care provider about:

Any allergies your child has.
All medicines your child is taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
Any problems your child or family members have had with anesthetic medicines.
Any bleeding problems your child has.
Any surgeries your child has had.
Any medical conditions your child has.

What are the risks?

Generally, this is a safe procedure, but problems may occur.

Short-term problems may include:

Infection.
Bleeding.
Pain.
Pooling of blood under the wound (hematoma).
Numbness in the face, lips, gums, or roof of the mouth.
Allergic reaction to medicines or to surgical tape. This is rare.
Difficulty breathing. This is rare.

Long-term problems may include:

Scarring.
Unevenness to the roof of the mouth.
Numbness in the face, lips, gums, or roof of the mouth. This is rare.

What happens before the procedure?

Medicines

Ask your child's health care provider about:

Changing or stopping your child's regular medicines. This is especially important if your child is taking diabetes medicines or blood thinners.
Giving your child medicines such as ibuprofen. These medicines can thin your child's blood. Do not give these medicines to your child unless your child's health care provider tells you to.
Giving your child over-the-counter medicines, vitamins, herbs, and supplements.

When to stop eating and drinking

Follow instructions from your child's health care provider about what your child may eat or drink before the procedure. These may include:

8 hours before the procedure
- 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 the procedure
- Stop giving your child milk. Stop giving your baby formula.
- Clear liquids, such as water, clear fruit juice, and sports drinks, are okay.
- Your baby may continue to have breast milk.
4 hours before the procedure
- 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 the procedure
- Have your child stop drinking all liquids.

If you do not follow the health care provider's instructions, your child's procedure may be delayed or canceled.

General instructions

Ask your child's health care provider:
- How your child's surgery site will be marked, in the case of cleft lip.
- What steps will be taken to help prevent infection. These steps may include:
  - Washing skin with a germ-killing soap.
  - Giving your child antibiotic medicine.
Make plans to stay in the hospital with your child. Your child may need to stay in the hospital for a few days. Ask your child's health care provider what to expect. You might want to make a schedule so adults can take turns staying with your child.

What happens during the procedure?

An IV will be inserted into one of your child's veins. Your child will receive medicine through this line during the procedure.
Your child may be given a medicine to help him or her relax (sedative).
Your child will be given a medicine to make him or her fall asleep (general anesthetic).
The surgeon will make incisions on either side of the cleft.
For a cleft lip, 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.
- Tubes may be put in the ears to help prevent ear infections.
Skin glue, antibiotic ointment, or adhesive strips may be applied to the incisions.
A bandage (dressing) may be placed on the incisions.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

Your child's blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until he or she leaves the hospital.
There may be tubes in your child's nose (nasal stents). These might be stitched in place. They help to hold the shape of the nostril and improve breathing. A health care provider will take them out at the proper time.
Your child may receive fluids through the IV that was placed in your child's arm.
Your child will be given pain medicine.
A splint may be put on your child's arm. The splint will help to keep your child from touching the incisions and dressings.
Your child may need to stay in the hospital for up to 3 days, depending on how quickly your child recovers.
Your child will slowly start to take in fluids and nutrition. You will be given instructions on how to feed your child during the recovery period.

Summary

Cleft lip and cleft palate surgeries are done to close the cleft opening so a child can eat and speak normally.
For a cleft lip, 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.