Cleft lip and palate surgery

At Children's Wisconsin, our multidisciplinary team of specialists uses a comprehensive approach to treat cleft lip and cleft palate.

Cleft lip alone

For most infants who have cleft lip alone, we can repair the abnormality within the first several months of life (usually when your baby is between 10 and 12 pounds). Your child's surgeon will decide the best time for surgery. The goal of cleft lip repair surgery is to fix the separation of the lip. In some cases, we have to perform a second operation to fully repair the lip or address the changes that may occur with growth.

Cleft palate repairs

We usually repair cleft palates between the ages of 9 and 18 months (before the age of 2). Cleft palate repair is a more complicated surgery than cleft lip repair. Therefore, we do it when your baby is bigger and better able to tolerate the surgery.
Your child's physician will determine the best time for the surgery. The goal of cleft palate repair is to close the roof of the mouth to enable your child to eat and learn to speak normally. It is important to fix the roof of the mouth at a relatively young age before speech development progresses too far. Some children with clefts require revisions of the palate repair to maintain normal speech later in childhood.

What to expect before and after surgery

At Children's, your child's care begins at your very first appointment and continues well beyond surgery. Although every surgical procedure is different, there are some things you can expect to occur before and after each surgical procedure.

Before surgery

At your first visit, your child's plastic surgeon will discuss with you:

• The details of the surgery
• Risks, including possible complications
• Benefits, including the expected outcome

Recovery time

You will also have the opportunity to talk with your child's plastic surgeon to ask questions and address any concerns you have.

After surgery for cleft lip

Although most children do well after surgery, there are some things to know. For example:

• Your child may be irritable following surgery, and his or her physician may prescribe medications to help with this.
• Your child may also have to wear padded restraints on the elbows to prevent rubbing at the stitches and surgery site.
• You will have to bring your child in for stitch removal in about 3 to 5 days.
• After surgery, you will notice a scar. With time, it will fade, but it will not completely disappear.
• Some swelling, bruising and blood around the stitches is normal, but if you have concerns about them, it's ok to contact your child's physician.

After the surgery for cleft palate

Cleft palate surgery is usually more involved and can cause more discomfort and pain than cleft lip surgery. Your child's physician may order pain medicine to help with this.

The pain and the location of the surgery may keep your child from eating and drinking normally after surgery. To help keep your child hydrated, hospital staff will give your child fluids through an IV (intravenous catheter) until he or she can drink adequately.

Although each surgery is different, there are some things you can expect:

• Your child will have stitches on the palate where the surgeon repaired the cleft. The stitches will dissolve after several weeks, so your child's physician will not have to take them out. In some cases, the surgeon will place packing material on the palate. Do not remove the packing unless your child's physician tells you to.
• Many infants show signs of nasal congestion after surgery. These signs may include:
  • Nasal snorting
  • Mouth breathing
• Your child will be on antibiotics to prevent infection while in the hospital. Your child's physician may want you to continue these drugs at home.
• Your child may be in the hospital from 1 to 3 days, depending on what your child's physician's recommends.
• Offer a small amount of water 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 breast-feeding, bottle-feedings, or cup-feedings after surgery. Do not feed your child anything but soft food and liquid for 7 to 10 days after surgery, depending on physician recommendations.

For older infants and children, age-appropriate soft foods may include:

• Strained baby foods
• Popsicles
• Yogurt
• Mashed potatoes
• 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. Do not allow him or her to run or engage in rough play (i.e., wrestling, climbing) or to 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. Your child's physician will discuss the specifics with you after surgery. Remember, the care we provide for your child doesn't end when the surgery is over. We will be an important part of your child's overall health management after surgery, and we want you to feel like you’re a part of the care team as well.