Frequently Asked Questions (FAQ):
1. Risks
3. Surgery of the cleft lip(how is it done)
4. Recovery from cleft lip surgery
5. Surgery of the Cleft palate(how is it done)
6. Recovery from cleft palate surgery
All surgery carries some
uncertainty and risk
When surgery is done by a qualified plastic surgeon with experience in repairing
cleft lip or palate, the results can be quite positive. Nevertheless, as with
any operation, there are risks associated with surgery and specific
complications associated with this procedure.
In cleft lip surgery, the most common problem is asymmetry, when one side of the
mouth and nose does not match the other side. The goal of cleft lip surgery is
to close the separation in the first operation. Occasionally, a second operation
may be needed.
In cleft palate surgery, the goal is to close the opening in the roof of the
mouth so the child can eat and learn to speak properly. Occasionally, poor
healing in the palate or poor speech may require a second operation.
Planning for surgery
At your initial consultation, your doctor will discuss the
details of the procedure he or she will use, including where the surgery will be
performed, the type of anesthesia to be used, possible risks and complications,
recovery, costs, and the results you can expect. Your surgeon will also answer
any questions you may have about feeding your baby, by breast or by bottle, both
before and after the surgery.
In most cases, health insurance policies will cover most or all of the cost of
cleft lip or cleft palate surgery. Check your policy to make sure your child is
covered and to see if there are any limitations on what types of treatment are
covered.
Cleft
lip surgery
A cleft lip can range in severity from a slight notch
in the red part of the upper lip to a complete separation of the lip extending
into the nose. Clefts can occur on one or both sides of the upper lip. Surgery
is generally done when the child is about 10 weeks old. To repair a cleft lip, the surgeon will make an
incision on either side of the cleft from the mouth into the nostril. He or she
will then turn the dark pink outer portion of the cleft down and pull the muscle
and the skin of the lip together to close the separation. Muscle function and
the normal "cupid's bow" shape of the mouth are restored. The nostril
deformity often associated with cleft lip may also be improved at the time of
lip repair or in a later surgery.
Before surgery | Result after surgery |
Recovering from cleft lip
surgery
Your child may be restless for awhile after surgery, but your
doctor can prescribe medication to relieve any discomfort. Elbow restraints may
be necessary for a few weeks to prevent your baby from rubbing the stitched
area.
If dressings have been used, they'll be removed within a day or two, and the
stitches will either dissolve or be removed within five days. Your doctor will
advise you on how to feed your child during the first few weeks after surgery.
It's normal for the surgical scar to appear to get bigger and redder for a few
weeks after surgery. This will gradually fade, although the scar will never
totally disappear. In many children, however, it's barely noticeable because of
the shadows formed by the nose and upper lip.
Cleft
palate surgery
In
some children, a cleft palate may involve only a tiny portion at the back of the
roof of the mouth; for others, it can mean a complete separation that extends
from front to back. Just as in cleft lip, cleft palate may appear on one or both
sides of the upper mouth. However, repairing a cleft palate involves more
extensive surgery and is usually done when the child is nine to 18 months old,
so the baby is bigger and better able to tolerate surgery.
To repair a cleft palate, the surgeon will make an incision on both sides of the
separation, moving tissue from each side of the cleft to the center or midline
of the roof of the mouth. This rebuilds the palate, joining muscle together and
providing enough length in the palate so the child can eat and learn to speak
properly.
Before | After |
Recovering from
cleft palate surgery
For a day or two, your child will probably feel some soreness and
pain, which is easily controlled by medication. During this period, you child
will not eat or drink as much as usual -- so an intravenous line will be used to
maintain fluid levels. Elbow restraints may be used to prevent your baby from
rubbing the repaired area. Your doctor will advise you on how to feed your child
during the first few weeks after surgery. It's crucial that you follow your
doctor's advice on feeding to allow the palate to heal properly.
The
repaired lip or palate
Children with a cleft palate are particularly prone to
ear infections because the cleft can interfere with the function of the middle
ear. To permit proper drainage and air circulation, the
ear-nose-and-throat surgeon may recommend that a small plastic ventilation tube
be inserted in the eardrum. This relatively minor operation may be done later or
at the time of the cleft repair. In addition, surgery may be recommended by your
plastic surgeon when your child is older to refine the shape and function of the
lip, nose, gums, and palate.
Perhaps most important, keep in mind that surgery to repair a cleft lip or
palate is only the beginning of the process. Family support is critical for your
child. Love and understanding will help him or her grow up with a sense of
self-esteem that extends beyond the physical defect.