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Cleft Lip Repair

At Mobile Oral and Facial Surgery, we believe parents and guardians can contribute to the success of this surgery and invite you to participate. Please read the following information to learn about the surgery and how you can help. 

Fast Facts About Cleft Lip Repair 

  • Cleft lip repair is a surgery to fix a cleft lip. 
  • Your childs cleft lip surgery will be done under general anesthesia (an-es-THEEZ-ya), which means that he or she will be sound asleep during the surgery. 
  • When general anesthesia is needed, there are important rules for eating and drinking that must be followed in the hours before the surgery. 
  • This surgery usually takes between 2 to 6 hours, depending on the type of cleft lip repair your child needs. 
  • Your child will stay overnight for at least 1 day after the surgery. 
 

What Is Cleft Lip Repair? 

Cleft lip is a separation in one or both sides of the lip that is present at birth. Early in the development of the baby inside the mother, the left and right sides of the face and the roof of the mouth join together or fuse.” If the two sides do not come together correctly, an opening in the lip may occur. 

This opening can be on just one side of the face, called a unilateral (yoon-ill-lat-er-ool) cleft, or on both sides of the face, called a bilateral (by-lat-er-ool) cleft. A cleft lip that goes up to the nose is called a complete cleft lip; otherwise the cleft is called an incomplete cleft lip. 

Left untreated, a child born with a cleft lip may face problems with feeding, growth, development, ear infections, hearing, speech and facial appearance. The cleft lip usually is corrected early in a childs life, between 3 to 6 months of age, but sometimes later. 

Cleft lip surgery will correct the cleft and usually will leave minimal scarring. Virtually every child born with a cleft lip is able to lead a healthy, happy life once the cleft has been repaired. 

Home Preparation 

When general anesthesia is needed, there are important rules for eating and drinking that must be followed in the hours before the surgery. One business day before your childs surgery, you will receive a phone call from a nurse. (Nurses do not make these calls on weekends or holidays.) Please have paper and a pen ready to write down these important instructions. If these instructions are not followed exactly, it is likely your childs surgery will be cancelled. 

  • The nurse will give you specific eating and drinking instructions for your child based on your child’s age. Following are the usual instructions given for eating and drinking. No matter what age your child is, you should follow the specific instructions given to you on the phone by the nurse. 
 

For children older than 12 months: 

  • After midnight the night before the surgery, do not give any solid food or non-clear liquids. That includes milk, formula, juices with pulp, and chewing gum or candy. 
 

For infants under 12 months: 

  • Up to 6 hours before the scheduled arrival time, formulafed babies may be given formula.
  • Up to 4 hours before the scheduled arrival time, breastfed babies may nurse. 
 

For all children: 

  • Up to 2 hours before the scheduled arrival time, give only clear liquids. Clear liquids include water, Pedialyte®, Kool-Aid® and juices you can see through, such as apple or white grape juice. 
  • In the 2 hours before the scheduled arrival time, give nothing to eat or drink. 
  • You may bring along a comfortitem – such as a favorite stuffed animal or blankiefor your child to hold during the surgery. 
  • You should bring a long-sleeve T-shirt, slightly larger than your childs usual size, to the hospital on the day of surgery. It will help make your child more comfortable on the day you take your child home from the hospital. 
  • You may want to purchase a bottle of hydrogen peroxide, a tube of antibiotic ointment, such as bacitracin, and a box of QTips to have on hand so you can take care of your child’s lip and nose when you get home from the hospital. 
 

The Surgery 

Your childs cleft lip repair will be done in the Main Operating Room. When you have checked in, you and your child will be called to an examination room where your childs health history will be taken, and vital signs will be checked. You will meet with one of the doctors on your childs surgical team to go over the surgery. He or she will answer any last-minute questions you might have at this time. A member of the anesthesia staff also will meet with you and your child to review his or her medical information and decide which kind of sleep medication he or she should get. As the parent or legal guardian, you will be asked to sign a consent form before the anesthesia is given. 

When it is time for your child to go the operating room, you will be asked to wait in the surgical family waiting area. 

  • If your child is very scared or upset, the doctor may give a special medication to help him or her relax. This medication is flavored and takes effect in 10 to 15 minutes. 
  • If relaxation medicine is needed, you may stay with your child as he or she becomes drowsy; you will be asked to wait in the surgical waiting area when your child is ready to move to the operating room. 
  • Young children get their sleep medication through a space maskthat will carry air mixed with medication. Your child may choose a favorite scent to flavor the air flowing through the mask. There are no shots or needles used while your child is still awake. 
  • Once your child is asleep, an intravenous (in-tra-VEE-nuss) or IV line will be inserted into a vein in your childs arm or leg so that medication can be given to keep him or her sleeping throughout the surgery. Your child will have no pain during the surgery and no memory of it afterward. 
 

A Parent’s/Guardian’s Role 

The most important role of a parent or guardian is to help your child stay calm and relaxed before the surgery. The best way to help your child stay calm is for you to stay calm. 

During the surgery, at least one parent or guardian should remain in the surgical family waiting area at all times, in case the family needs to be reached. 

While Asleep 

While your child is asleep, his or her heart rate, blood pressure, temperature and blood oxygen level will be checked continuously. To keep your child asleep during the surgery, he or she may be given anesthetic medication by mask, through the IV or both. When the surgery is over, the medications will be stopped and your child will begin to wake up. 

Waking Up 

When your child is moved to the recovery room, you will be called so that you can be there as he or she wakes up. 

  • Your child will need to stay in the recovery room to be watched until he or she is alert and vital signs are stable. The length of time your child will spend in the recovery room will vary because some children take longer than others to wake up after anesthesia. 
  • Your child will still have the IV in. A nurse will remove it before your child leaves the hospital, when he or she is drinking well. 
  • Your child will have set of padded arm restraints called “no-no’s” placed on his or her arms to prevent them from bending at the elbow. These no-nos will need to stay in place for about 2 weeks as the surgical scar heals. 
  • Children coming out of anesthesia may react in different ways. Your child may cry, be fussy or confused, feel sick to his or her stomach, or vomit. These reactions are normal and will go away as the anesthesia wears off. 
  • You may notice some swelling around your childs mouth, lips and eyes, as well as some dried blood or oozing where the cleft lip was repaired. The swelling may look worse on the day after the surgery, but it will go down over the next weeks. 
  • You may see sutures (SOO-chers) or stitches underneath steri strips, only dissolvablesutures will be used, and these sutures do not need to be removed. As the skin heals, the parts of the sutures on the inside of the lip and mouth will dissolve on their own, and the parts you can see on the outside of the skin will dry up and fall off. If non­ dissolvable sutures were used, they will be removed by the doctor at your childs first follow-up visit. 
  • Your child may have a nasal retainer in place to help reshape the nose during healing. The retainer, which acts as a splint inside the nose, may stay in place for up to 3 months. 
  • When your child is alert, he or she will be moved to a hospital room so the nursing staff can continue his or her care. If you need help, the nurse will show you how to feed your child and clean his or her scar so that you will become comfortable caring for your child at home. 
 

Going Home 

After the surgery, and for the weeks afterward at home, your child will only be allowed to drink liquids or semi-liquids from a bottle or cup. No utensils or straws should be used until your childs surgeon says it is OK. 

  • Within the first 24 hours after the surgery, while your child is still in the hospital, he or she will be allowed to drink clear liquids from a bottle or cup. 
  • Your child will stay in the hospital until he or she is drinking well and urinating normally. 
  • When your child is drinking well, the IV will be removed by a nurse before you leave the hospital. 
  • Some children will need to stay for more than 1 day if they are not drinking and urinating normally, or if their parents need extra time to learn how to care for them.