Treatments

A cleft, or separation of the upper lip and/or the roof of the mouth, occurs very early in the development of the unborn child. During fetal development, certain components of the upper lip and roof of the mouth fail to form normally. Cleft lip and cleft palate repair is a type of plastic surgery to correct this abnormal development both to restore function and to restore a more normal appearance.

Most clefts can be repaired through specialized plastic surgery techniques, improving child’s ability to eat, speak, hear and breathe, and to restore a more normal appearance and function.

Risks of repair
Problems these surgeries may cause are:

• The bones in the middle of the face may not grow correctly.
• The connection between the mouth and nose may not be normal.

Before the Procedure

You will meet with a speech therapist or feeding therapist soon after your child is born. The therapist will help you find the best way to feed your child before the surgery. Your child must gain weight and be healthy before surgery.

The child’s surgeon may ask for:

• Blood investigations
• Take a complete medical history of the child
• Do a complete physical examination of the child

Always tell child’s doctor or nurse:

• What drugs are being given to the child
• Include drugs, herbs, and vitamins you bought without a prescription

During the days before the surgery:

• About 10 days before the surgery, you will be asked to stop giving your child aspirin, ibuprofen, warfarin and any other drugs that make it hard for your child’s blood to clot.
• Ask your child’s doctor which drugs the child should still take on the day of the surgery.

On the day of the surgery:

Most times, your child will not be able to drink or eat anything for several hours before the surgery.

• Give your child a small sip of water with any drugs your doctor told you to give your child.
• Your child’s doctor or nurse will tell you when to arrive for the surgery.
• The doctor will make sure your child is healthy before the surgery. If your child is ill, surgery may be delayed.

Surgery:

• For cleft lip surgery, the child will have general anesthesia. The surgeon will trim the tissues and sew the lip together. The stitches will be very small so that the scar is as small as possible. Most of the stitches will absorb into the tissue as the scar heals, so they will not have to be removed later.
• Most times, cleft palate repair is done when the child is older, between 9 months and 1 year old. This allows the palate to change as the baby grows. Doing the repair when the child is this age will help prevent further speech problems as the child develops.
• In cleft palate repair also the child will have general anesthesia. Tissue from the roof of the mouth may be moved over to cover the soft palate. Sometimes a child will need more than one surgery / staged procedures to close the palate completely.
• During these procedures, the surgeon may also need to repair the tip of child’s nose, called rhinoplasty.

After the Procedure

Your child will probably be in the hospital for 5 to 7 days right after surgery. Complete recovery can take up to 4 weeks.

The surgery wound must be kept very clean as it heals. It must not be stretched or have any pressure put on it for 3 to 4 weeks. You will be taught how to take care of the wound. You will need to clean it with soap and water or a special cleaning liquid, and keep it moist with ointment.

Until the wound heals, your child will be on a liquid diet. Your child will probably have to wear arm cuffs or splints to prevent picking at the wound. It is important for your child not to put hands or toys in the mouth.

Outlook

Most babies heal without problems. How your child will look after healing often depends on how serious the defect was. Your child might need another surgery to fix the scar from the surgery wound.

A child who had a cleft palate repair may need to see a dentist or orthodontist. The teeth may need correcting as they come in.

Hearing problems are common in children with cleft lip or cleft palate. Your child should have a hearing test early on, and it should be repeated over time.

Your child may still have problems with speech after the surgery. This is caused by muscle problems in the palate. Speech therapy will help your child.