Helping you to find out more…

Cleft Lip and Palate Surgery

The cleft of the lip is repaired at around 3-4 months.

The cleft of the palate is repaired around 6-9 months. The aim is to repair the muscles of the soft palate to help in feeding and speech development and to repair the cleft in the hard palate. Sometimes the soft palate is repaired along with the lip at three months.

Coming into Hospital

Your baby will be admitted the day before or the day of the operation and may need to attend a pre-admission clinic. Both admissions enable you to meet the nurse, doctor and anaesthetist who will all explain what will happen during your stay in hospital.

Your baby may also need to have a routine blood test. Photographs are taken as a baseline for follow-up and audit records. A routine hearing test will be performed prior to your baby's cleft palate repair.

Day of Operation

Your baby will not be without food and drink for more than 4-6 hours. More detailed instructions will be explained to you at the time.

Parents are welcome to accompany their baby into the anaesthetic room. You will be prepared and supported throughout this by your nurse. Your baby can be away from the ward for up to 4 hours. If you wish, you can accompany the nurse to the recovery room to collect your baby when he or she is ready to return to the ward.

Following repair of the lip, your baby may look different. This is not something to be frightened about the facial shape is still going to develop and look as you would expect. Your baby may sound different after a palate repair due to the closure of the cleft. You will quickly get used to this but it will seem strange at first.

Feeding After the Operation

He/ she will return to the ward with a drip and this will be continued until taking adequate drinks and diet. A milk feed using your baby's normal bottle and teat can be offered as soon as wanted. Occasionally, after cleft palate surgery, a nasogastric tube is used for the first 24 hours to complement bottle feeding.

Some babies may be reluctant to drink after cleft palate surgery and prefer solids. A soft puree diet will be introduced up to 24 hours following surgery. To help keep the mouth clean you will need to rinse with water following feeds and medication. Your ward nurse and clinical nurse specialist will help support you in feeding your baby.

Your baby's feeding routine will be slightly disrupted initially and you will find that it can take between 2 - 3 weeks to return to normal.

Will my baby be in pain?

Local anaesthetic and pain killers are given throughout the operation and every effort is made to reduce any pain or discomfort afterwards. Your nurse and anaesthetist will discuss and decide upon appropriate pain killers for your baby.

On discharge you will be given pain killers to give at home which may be needed for up to 2 weeks. Your clinical nurse specialist will be on hand to advise you.

Care of your Baby's Mouth following Cleft Palate Repair

It is important to prevent your baby from putting any objects, including fingers into his/her mouth. Puree/ soft diet (if applicable) needs to be continued for 4 weeks. Continue to give water after feeds for 2 weeks. Dummies may be discouraged, depending on your surgeon's preference, but if your baby has been used to one they can be re-introduced 2 weeks after surgery.

The stitches in the palate are dissolvable and can take a month or more to disappear.

Care of the Lip

There will be a scar on the lip extending down from the nostril. Sometimes special skin glue is used over the wound for extra protection and stability. Stitches are dissolvable and can take at least 2-3 weeks to dissolve. On some occasions your baby will need to have their stitches removed 7 days after surgery. Care of the wound and removal of the stitches will be discussed with you by your nurse.

Your baby may also require nasal splints, which are used for 3-4 months following surgery to help maintain and improve the shape of the nose. Once again you will be shown how to change and clean these prior to discharge.

In the initial stages after a lip repair the normal process of healing involves some contraction of the wound. This often lifts the lip scar into a slightly different position, which then drops without further surgery. During this time the scar can also be firm and red and rather raised. This is a normal healing process and can be hastened to settle by massaging the scar line commencing about 4 - 6 weeks after surgery. The scar line should always be protected from the sun using a sun block.

Follow Up

Your clinical nurse specialist will arrange to make a home visit 1-2 weeks after surgery. She will then continue to support you through your child's care. A follow-up clinic appointment will be arranged for 4-12 weeks following surgery.

Before your child starts school the lip repair will be checked to see it is satisfactory. Further surgery will be offered, if necessary.

Will any more operations be required after this?

Yes it is likely that he/she will require several more operations over the next 18 years.

Before starting school, any problems with the lip scar can be corrected. There is a possibility that an operation may be required on the back of the throat to help speech (usually performed between the ages of 5 and 8 years).

Between 8 and 10 years of age an operation will be required to place some bone into the gap in the gum, to enable normal teeth development.

At 16 to 18 years of age, surgery may be required to correct any disturbance in the shape of the nose. Around this time, (in a few cases) an operation may be needed on the upper jaw to correct any mal-alignment of teeth.

Arriving at the ward
Baby being weighed
Baby having name tag put on
Speaking with the Anaesthetist
Parents & baby in Anaesthetic Room
View of Anaesthetic Room & Theatre
Waiting to go in for the operation