Which postoperative goal is most important following surgical repair of cleft lip and palate?

Parents generally request the specific “care path” for their child so that expectations for cleft lip and cleft palate repair plastic surgery can be defined. These treatment protocols vary between centers and among surgeons; there is no absolute right or wrong. Nevertheless, we believe that any protocol should deliver a clear vision of care from infancy to adulthood.

For information specific to your child, request a consultation online or call us at (469) 375-3838.

Our usual sequence of care is as follows:

Many parents are very concerned about the presence of scars. Unfortunately, all cleft lip repairs leave visible scars. Every effort is made to keep scars to a minimum and to place scars so that they are easily concealed.

Secondary (or “redo”) surgeries at any stage may be necessary. Our occurrence of secondary surgery is less than 5%.

After Surgery Care

The goal after surgery is to protect the new repair and stitches. For this reason there will be some changes in the child’s feeding, positioning, and activity for a short time. Remember, these are only temporary!

Infants will not be able to suck on a nipple/bottle or pacifier for 10 days after surgery. A syringe with a short piece of soft rubber tubing will be used for feeding. Older children may drink from a cup. It is helpful if the child has practiced drinking from the syringe before surgery. As soon as the infant awakes from anesthesia and acts hungry they may be offered a feeding of clear liquid (Pedialyte, sugar water, apple juice). When this is tolerated, they may resume their regular formula. Infants who have already begun cereal or baby foods may be offered diluted feedings with the syringe. Older children will be on a blenderized diet that pours easily from a cup.

There may be some discomfort as the child swallows so they may not drink much the first evening. This is why IV fluids are continued until their drinking improves. Pain medicine will also be given to relieve distress.

A child who has had a cleft lip repair should be positioned on their side or back to keep them from rubbing their face in the bed. A child with only a cleft palate repair may sleep on their stomach.

It is important to keep the stitches clean and without crusting. Parents are shown how to clean the suture line and apply ointment while in the hospital. This will continue until the stitches are removed about a week later.

It is important to keep the child from hurting the incision or putting hands or toys in their mouth. For this reason they will wear arm restraints (NoNo’s) which keep them from bending their elbows. These are also used for 10 days after surgery.

Children usually spend one night in the hospital and are discharged when they begin to drink an adequate amount of fluids. Parents are encouraged to stay with their child and participate in their care. Chair beds are available in the rooms for overnight sleeping.

For most infants with cleft lip alone, the abnormality can be repaired within the first several months of life (usually when the baby is 10 to 12 pounds). This will be decided by your child's surgeon. The goal of this surgery is to fix the separation of the lip. Sometimes, a second operation is needed.

Cleft palate repairs are usually done between the ages of 9 to 18 months, but before the age of 2. This is a more complicated surgery and is done when the baby is bigger and better able to tolerate the surgery. The exact timing of the surgery will be decided by your child's physician. The goal of this surgery is to fix the roof of the mouth so that your child can eat and learn to talk normally. Sometimes, a second operation is needed.

Initial visit

At your first visit with the plastic surgeon, he/she will discuss with you the details of the surgery, risks, complications, costs, recovery time, and outcome. At this time, your child's surgeon will answer any questions you may have.

After the surgery for cleft lip

Your child may be irritable following surgery. Your child's physician may prescribe medications to help with this. Your child may also have to wear padded restraints on his/her elbows to prevent him/her from rubbing at the stitches and surgery site.

Stitches will either dissolve on their own or will be removed in approximately five to seven days. Specific instructions will be given to you regarding how to feed your child after the surgery. The scar will gradually fade, but it will never completely disappear.

During the surgery, and for a short time after surgery, your child will have an intravenous catheter (IV) to provide fluids until he/she is able to drink by mouth. For a day or two, your child will feel mild pain, which can be relieved with a non-aspirin pain medication. A prescription medication may also be given for use at home.

Your child's upper lip and nose will have stitches where the cleft lip was repaired. It is normal to have swelling, bruising, and blood around these stitches.

After the surgery for cleft palate

This surgery is usually more involved and can cause more discomfort and pain for the child than cleft lip surgery. Your child's physician may order pain medicine to help with this. As a result of the pain and the location of the surgery, your child may not eat and drink as usual. An intravenous (IV) catheter will be used to help give your child fluids until he/she can drink adequately.

Your child will have stitches on the palate where the cleft was repaired. The stitches will dissolve after several days and they do not have to be taken out by the physician. In some cases, packing will be placed on the palate. Do not take the packing out unless you are told to do so by your child's physician.

There may be some bloody drainage coming from the nose and mouth that will lessen over the first day.

There will be some swelling at the surgery site, which will diminish substantially in a week.

For two to three days, your child will feel mild pain that can be relieved by a non-aspirin pain medication. A prescription medication may also be given for use at home.

Many infants show signs of nasal congestion after surgery. These signs may include nasal snorting, mouth breathing, and decreased appetite. Your child's physician may prescribe medication to relieve the nasal congestion.

Your child will be on antibiotics to prevent infection while in the hospital. Your child's physician may want you to continue this at home.

Your child may be in the hospital for one to three days, depending on your child's physician's recommendation.

A small amount of water should be offered after every bottle or meal to cleanse the incision. You can continue to rinse this area gently with water several times a day, if necessary.

Diet after surgery

Your child's physician may allow breastfeeding, bottle-feedings, or cup-feedings after surgery. Your child should be placed on a soft diet for seven to 10 days after surgery. For older infants and children, age-appropriate soft foods may include strained baby foods, popsicles, yogurt, mashed potatoes, and gelatin. Note: your child should not use a straw or pacifier, as both could damage the surgical repair.

Activity after surgery

Your child can walk or play calmly after surgery. He/she should not run or engage in rough play (i.e., wrestling, climbing) or play with "mouth toys" for one to two weeks after surgery. Your child's physician will advise you when your child can safely return to regular play.

Follow-up with your child's surgeon and the cleft team is very important. This will be discussed with you. Your child's physician will also be an important part of the child's overall health management after the surgery.

Which goal is priority after surgical repair of cleft lip?

What is the immediate post operative care for an infant with cleft lip repair?

When providing postoperative care for the cleft lip The nurse should position the child in?

What happens after cleft lip and palate surgery?