The cleft of the lip is repaired at around 4-6 months.
Before the operation
You will be asked to attend a pre-operative appointment a week or so prior to surgery. For patients at the Oxford Centre, this is usually held at the Oxford surgical clinic. For patients at the Salisbury centre, this may be at either the Salisbury Surgeon’s clinic or Salisbury Early Years clinic.
The operation
Coming into hospital
Your baby will be admitted the day before or the day of the operation. You will meet the nurse, doctor and anaesthetist who will all explain what will happen during your baby’s stay in hospital.
Your baby may need to have a routine blood test. Photographs are taken as a baseline for follow-up and audit records. A routine hearing test will also be performed prior to your baby’s cleft palate repair.
Day of operation
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. 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.
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.
Feeding after the operation
Once back on the ward, your baby will be allowed to feed as soon as they want. Breast pumps are available on the ward, if required. Bottle fed babies can resume feeding with the bottle and teat they are used to. Your baby may also have a drip, which usually continues until the nurses feel your baby is taking enough by mouth.
Initially your baby’s feeding routine will be slightly disrupted and you will find that they may want to take small, frequent, amounts. They will return to their normal feeding routine gradually over the next few days.
Will my baby be in pain?
Local anaesthetic and pain killers are given throughout the operation. Every effort is made to reduce any pain after the operation. Paracetamol and regular feeds will usually settle your baby comfortably. An occasional dose of a stronger analgesia may be needed, especially if the lip is very bruised and swollen.
Care of the lip following surgery
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 up to 2-3 weeks to dissolve.
On some occasions, your baby will need to have their stitches removed seven 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 helped 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. They will then continue to support you as required.
There will be a post-operative review six weeks after the operation at the early years clinic for your centre (see Oxford Surgical clinic or Salisbury Early Years clinic). Here, we review the surgery and healing process and discuss next steps. It is also a good opportunity to ask questions.
Before your child starts school, the lip repair will be checked to see it is satisfactory. Sometimes, additional surgery may be necessary, such as cleft lip re-repair (see below) or alveolar bone graft (for children with a cleft of the gum).
Cleft lip re-repair
Some children require a further operation on their lip after their initial repair. This can happen for a number of reasons and the team will discuss this with you as necessary.
Questions or concerns?
Please contact your clinical nurse specialist.