Cleft Lip RepairBy
Hedy Marks, MPH
What is cleft lip repair?
Cleft lip repair, also called cheiloplasty, is surgery to correct a cleft lip. Cleft lip is a birth defect that occurs when the upper lip doesn't fuse together properly during development. It can look like a small notch in the edge of the lip or it can extend into the nose and gums. Cleft lip can affect one side of the mouth, called a unilateral cleft, or both sides of the mouth, called a bilateral cleft.
Cleft lip repair involves joining the sides of the lip together to close the opening or space in the lip. The surgery improves the function, structure and appearance of the lip.
Cleft lip repair is a common but major surgery with serious risks and potential complications. Most children with cleft lip have the surgery between three to six months of age.
Other procedures that may be performed
Cleft lip may occur alone or with cleft palate. Cleft palate is a birth defect that occurs when the roof of the mouth, or palate, does not develop properly. Cleft palate results in a split or opening in the roof of the mouth. Cleft lip and cleft palate may require correction in separate surgeries.
Your child’s doctor may recommend other procedures before or after cleft lip repair including:
Cleft palate repair to correct cleft palate
Dental and orthodontic procedures to repair dental problems, such as gum problems, bone defects, and small, missing, abnormal, displaced or extra teeth
Lip adhesion procedure or molding plate to bring the sides of a very wide cleft lip closer together before cleft lip repair surgery
Plastic surgery including scar revision surgery to minimize the appearance of scars and nose surgery to improve the appearance of the nose
Why is cleft lip repair surgery performed?
Cleft lip repair treats a cleft lip. Left untreated, cleft lip can cause problems with feeding, growth and development, ear infections, hearing, speech, and self-esteem. Dental problems are also associated with cleft lip.
Who performs cleft lip repair?
The following specialists repair cleft lips:
Plastic surgeons specialize in aesthetic and reconstructive surgery.
Facial plastic and reconstructive surgeons specialize in plastic and reconstructive surgery of the face. They initially train as plastic surgeons or otolaryngologists (ear, nose and throat doctors/surgeons).
Head and neck plastic surgeons specialize in plastic and reconstructive surgery of the head and neck. They also train as plastic surgeons or otolaryngologists (ear, nose and throat doctors/surgeons) before further specialization.
How is cleft lip repair performed?
You child’s cleft lip repair will be performed in a hospital. Cleft lip repair surgery takes from two to six hours, depending on the extent of surgery.
The goal of cleft lip repair is to close the separation in the lip. The surgeon will make incisions on either side of the cleft to create flaps of tissue. The surgeon will draw the flaps of tissue together and stitch them to close the cleft.
Types of anesthesia that may be used
Your child's doctor will perform cleft lip repair using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put your child in a deep sleep. Your child is unaware of the procedure and will not feel any pain.
The doctor may use a sedative medication to relax your child before surgery. It is usually given by mouth. Your child’s care team will then start general anesthesia through a breathing mask. After your child is asleep, the team will insert an IV to give fluids and medications.
What to expect the day of your child's cleft lip repair surgery
The day of your child's surgery, you can expect to:
Talk with a preoperative nurse. The nurse will examine your child and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all of your child’s clothing and dress your child in a hospital gown. Your child’s care team will give your child blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your child's medical history and the type of anesthesia your child will have
Remain with your child in the pre-op area until before surgery.
The anesthesiologist or nurse anesthetist will start your child's anesthesia through a breathing mask.
Once your child is asleep, a surgical team member will start an IV to maintain anesthesia.
The surgical team will monitor your child's vital signs and other critical body functions. This occurs throughout the procedure and your child's recovery until your child is alert, breathing effectively, and vital signs are stable.
Wait in the waiting room during your child's cleft lip repair. The team will call you to the recovery room once your child arrives from surgery. Parents are often present when their child wakes up from surgery.
What are the risks and potential complications of cleft lip repair?
As with all surgeries, a cleft lip repair involves risks and possible complications. Most cleft lip repairs are successful, but complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Potential complications of cleft lip repair
Complications of a cleft lip repair include:
Damage to nerves, blood vessels and muscles
Lip asymmetry, possibly requiring more surgery
Poor and irregular wound healing
Reducing your child's risk of complications
You can reduce the risk of some complications by following your child's treatment plan and:
Giving your child’s medications exactly as directed
Making sure your child follows activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. For example, make sure your child drinks only liquids or semi-liquids as directed. Use a bottle or cup. Do not use straws or utensils until your child's doctor recommends it.
Notifying your child's doctor immediately of any concerns, such as bleeding, fever, or increase in pain
Telling all members of the care team if your child has any allergies
Understanding and following instructions on how to care for your child's lip after surgery
Using sun protection as directed during healing
How do I prepare my child for cleft lip repair surgery?
You are an important member of your child's healthcare team. The steps you take before surgery can improve your child's comfort and outcome.
You can prepare your child for cleft lip repair surgery by:
Answering all questions about your child's medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your child's medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your child's age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Giving or stopping medications exactly as directed. This may include not giving your child ibuprofen (Advil, Motrin). Your child's doctor will give you instructions on what medications are safe for your child to take.
Making sure your child does not eat or drink before surgery as directed. Surgery may be cancelled if your child eats or drinks too close to the start of surgery because he or she can choke on stomach contents during anesthesia.
Making sure your child wears an obturator before surgery, as directed. An obturator is a device worn inside the mouth. It helps with feeding and maintaining the arch of the lip before repair.
On the day of surgery, consider bringing your child's "lovey"—a stuffed animal, blanket, or other familiar item—to provide comfort. Also, pack a large long-sleeved shirt for your child to wear home from the hospital.
Questions to ask your doctor
Facing your child’s surgery can be stressful. It is common for parents to forget some of their questions during a doctor’s office visit. You may also think of other questions after your child's appointment. Contact your child’s doctor with concerns and questions before cleft lip repair and between appointments.
It is also a good idea to bring a list of questions to your child's preoperative appointments. Questions can include:
Why does my child need a cleft lip repair? Are there any other options for treating my child's condition?
What type of procedure does my child need? How many surgeries will my child need?
If you find a problem or another condition during surgery, will you treat it right away or will my child need more surgery later?
How long will the surgery take? When can my child go home?
How long can I remain with my child before surgery? How soon after surgery can I see my child?
Can my child bring a comfort item?
What kind of restrictions will my child have after surgery?
What medications are needed before and after the surgery?
How will you treat my child's pain?
How do I care for my child after a cleft lip repair? How will my child eat and drink during recovery?
When should my child follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my child's cleft lip repair surgery?
Knowing what to expect can help make your child's road to recovery after cleft lip repair as smooth as possible.
How long will it take to recover?
Your child will stay in the recovery room after surgery until he or she is alert, breathing normally, and vital signs are stable. You can be with your child during recovery. Your child may cry, look confused, or vomit when waking up from anesthesia. These are normal reactions to anesthesia. Vomiting can be treated. Other symptoms will go away as the anesthesia wears off.
Your child will have a bandage covering the incision. Your child may be wearing soft padded arm restraints to prevent touching the wound, sucking a thumb, or putting objects in the mouth. The restraints are necessary for about two weeks, while the incision heals. Your child may also wear a nasal retainer to reshape the nose during healing. This can take up to three months.
If the doctor uses dissolvable stitches, they will go away on their own as the skin heals. Your child’s doctor will need to remove non-dissolvable stitches at a follow-up appointment, usually four to five days after surgery. Swelling and bruising of the mouth, lips and eyes is normal following cleft lip repair. Swelling should go down within a few weeks.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, and your child’s general health, age, and other factors. Healing will continue for a few weeks as swelling goes down.
Will my child feel pain?
Pain control is important for healing and a smooth recovery. There will be pain and discomfort after surgery. Your child's doctor will treat any pain so your child stays comfortable. Call your doctor if your child’s pain gets worse or changes in any way because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your child's follow-up appointments after cleft lip repair. Contact your child’s doctor for questions and concerns between appointments. Call the doctor right away or seek immediate medical care if your child has:
Bleeding or foul smelling drainage from the scar or nose
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of an infection, but you should follow your doctor's instructions about when to call for a fever.
Pain that is not controlled by pain medication
Problems with the nasal retainer
Signs of dehydration including low energy, sunken eyes, and fewer wet diapers
Skin color changes, such as pale, blue or gray skin
How might cleft lip repair surgery affect my child's everyday life?
Cleft lip repair surgery will greatly improve your child's ability to grow and develop normally. It prevents complications associated with a cleft lip, including poor growth, hearing and speech problems, breathing difficulties, and potential self-esteem issues.
Additional surgeries are sometimes needed to refine lip function or correct cosmetic irregularities. Sun protection is essential to minimize irregular or discolored scarring. This includes wearing hats, staying in the shade, and using an age-appropriate sunscreen product. Cleft lip repair scars will fade with time, but will always be slightly visible.
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- Cleft Lip and Palate. KidsHealth. http://kidshealth.org/parent/medical/ears/cleft_lip_palate.html.
- Cleft Lip and Palate Repair. American Society of Plastic Surgeons. http://www.plasticsurgery.org/Reconstructive-Procedures/Cleft-Lip-and-Palate.html.
- Cleft Lip Repair. Children's Hospital of Pittsburgh of UPMC. http://www.chp.edu/CHP/Cleft+Lip+Repair.
- A Guide to Understanding Cleft Lip and Palate. Children's Craniofacial Association. http://www.ccakids.com/assets/syndromebk_clp.pdf.