Cleft Lip and Palate Surgery: What You Need to Know

Cleft lip and palate surgery is a procedure that can correct a common birth irregularity. It’s typically performed in infancy and can correct issues with feeding, speech, and appearance.

A cleft lip is a common developmental irregularity where there’s an opening in a baby’s upper lip. A cleft palate happens when there’s a split in the roof of the mouth (palate). This occurs during fetal development when the tissues of the upper lip and top of the mouth don’t join properly.

Some infants may have just a cleft lip or a cleft palate, while others may have both irregularities.

Babies born with a cleft lip and palate may have issues feeding and breastfeeding or chestfeeding, as it will be difficult to form a proper seal. Dental problems and frequent ear infections are also common issues for babies with a cleft lip and palate.

Cleft lip and palate surgery can repair most of these issues. Depending on the severity of the irregularity, more than one surgical procedure is often needed.

Learn more about preparing for the procedure and what to expect during and after surgery.

What is cleft lip and palate surgery?

Cleft lip and palate surgery is a surgical procedure to repair a cleft lip and palate. Usually, these are separate surgeries, with cleft lip surgery happening earlier.

Cleft lip surgery is typically performed between 2 and 6 months of age, and cleft palate repairs are usually done between 9 and 18 months of age. The exact timing will depend on the infant’s health, the specific irregularity, and any local protocols.

There are many different surgical techniques to address both cleft lip and cleft palate, depending on your infant’s specific condition and the surgeon’s preferences.

The primary goals of cleft lip surgery are to:

• restore full function to the muscles around the mouth and lips
• correct cosmetic irregularities

The general goals of cleft palate surgery are to:

• reorient the palate muscles so there’s a solid foundation for movement and clear speech
• separate the oral and nasal cavities
• repair the palate irregularity

Cleft lip and palate surgeries are regularly performed by plastic surgeons, though a team of specialists may be consulted to address specific issues before and after surgery.

How effective is cleft lip and palate surgery?

Most cleft lip and palate surgeries are successful and completed without complications. They’re normally done during infancy so that facial structures can more quickly normalize, which can ease the child’s social, emotional, and physical development.

Sometimes, only one surgery is needed to repair a cleft lip or cleft palate, especially if treated during infancy. Occasionally, more than one surgery is needed to make a full repair, but surgical procedures are continuing to advance and become more sophisticated and less invasive.

Preparing for cleft lip and palate surgery

Cleft lip and palate surgery is not usually an emergency procedure, which means that you’ll have time to prepare yourself and your infant for surgery.

Your child’s surgeon will give you specific eating and drinking directions appropriate for your child’s age. It’s important to have an empty stomach before anesthesia.

Your pre-operative instructions may include the following:

• 2 weeks before surgery: Do not give any ibuprofen or aspirin to your infant. They may cause bleeding complications.
• 1 week before surgery: Speak with a nurse about your child’s health history. You’ll need to know information such as recent vaccinations or exposure to contagious diseases.
• 1 day before surgery: Your child:
  • can have breast milk up to 4 hours pre-surgery
  • can have formula up to 6 hours pre-surgery
  • cannot have any other foods or liquids 8 hours pre-surgery
  • may have clear liquids up to 2 hours pre-surgery
  • may have nothing to eat or drink within 2 hours of surgery
  • may take any prescription medications needed, unless a doctor instructs otherwise

What happens during cleft lip and palate surgery?

There are many different surgical techniques to address cleft lip and cleft palate. The type of surgery will depend on the specific irregularity, your surgeon’s preference, and the technology available.

In general, you can expect the following for cleft lip surgery:

1. Your infant will be placed under general anesthesia.
2. Incisions will be made on either side of the cleft, creating flaps of skin.
3. Layers of tissue are loosened so they can be moved around.
4. These tissues in the roof of their mouth and nasal cavity will be rearranged and repaired.
5. Dissolvable stitches will be added to hold the incision in place.

The main goal is to close the gap in the lip and improve the shape and appearance of the upper lip and nose. The procedure for cleft lip surgery usually takes about 2 to 3 hours . Your infant will typically be kept overnight so that they can be closely monitored.

Cleft palate surgery is sometimes a little more extensive and can take up to 3 hours or more. The main goal of palate surgery is to close the palate opening and make a surface that supports healthy feeding and speech development.

What to know about recovery

Infants recovering from cleft lip and palate surgery are usually back to their usual behavior in about 1 week. Right after surgery, it’s common to find your infant fussy and irritated as they adjust and recover.

Here’s what to expect immediately after surgery and once you get home.

Cleft lip surgery

• Your infant will usually have bandages or splints on their face and lips to prevent them from touching the incision.
• Your infant should be allowed to eat or drink after surgery, but they may have difficulties. IV fluids are not uncommon while your infant adjusts.
• A doctor will give you specific at-home feeding instructions, but normally you’ll need to thin out your infant’s food. Sometimes, special devices are needed for feeding after surgery.
• You’ll need to keep their incision area clean and dry. The stitches will dissolve in about 2 weeks, and you can expect to see swelling and bruising in the area.
• Expect to see a scar at first, which can be treated with ointment. While the scar is healing, you’ll want to take extra care in the sun.
• A doctor may suggest pain management immediately following surgery. You should follow their instructions exactly or that of any over-the-counter medication you choose.

Cleft palate surgery

• Your child will have stitches in their mouth for several weeks.
• Swelling and minor bleeding from the mouth are common right after surgery.
• Your infant may be prescribed antibiotics and pain medication when leaving the hospital.
• The surgeon will give you specific feeding instructions after surgery, but usually, only soft foods and liquids from a cup (no straws) are permitted for several weeks.
• It’s typical to see some bone exposed in your infant’s palate area. This should fill in on its own.
• Expect the stitches to last about a month. Usually, they’ll dissolve on their own.
• Your infant may be in pain, which could impact their sleeping and feeding. A doctor can instruct you on any continued pain management needs.
• Expect some nasal drainage, snoring, and congestion from your infant in the early postsurgery days.

Most children heal fully about 1 month following either surgery, though it’s common for cleft palate surgery to take a little longer. Speak with a doctor or surgeon about the specific recovery process and expectations.

What are the risks?

All surgeries have risks, but cleft lip and palate surgeries are generally considered safe procedures. The standard surgical risks in either surgery include:

• allergic reactions to anesthesia
• bleeding
• infection
• breathing problems
• incomplete surgery, resulting in the need for additional surgeries
• possible damage to deeper structures
• irregular scar healing

Cleft palate surgery is associated with the following possible long-term complications:

• Palatal fistula: This happens when the repaired area of the palate fails to heal and makes an abnormal connection between the mouth and nose cavities, possibly causing speech and feeding issues.
• Velopharyngeal insufficiency (VPI): This happens when the soft palate doesn’t close tight enough in the back of the throat, causing speech issues.
• Midface hypoplasia: This is a complication in which the cheekbones, eye sockets, and upper jaw bones don’t develop as much as the rest of the face.

Takeaway

Cleft lip and cleft palate are birth irregularities that can be corrected with surgeries. These irregularities can cause:

• feeding issues
• speech delays
• breathing difficulties
• cosmetic abnormalities

While cleft lip and palate surgeries are most successful if performed during infancy, they can also be performed at later stages.

Your infant will need special care in the early days after surgery, but both procedures are usually performed with minimal risk of complications or long-term health issues.