The Treatment

Surgical Repair Of The Lip

Surgery is the only way to correct a cleft lip. Part of the operation involves stitching the skin of the lip together (no skin is taken from anywhere else). The operation may also involve improving the shape of your baby's nose. It the baby also has a cleft palate, some surgeons close the front part of the palate during the same operation. The surgeon will need to know if your baby is fit enough to have the operation. This is decided by taking a blood sample and other tests.

On the day of operation your baby will be given no food for a few hours before hand to reduce the chance of being sick. A sedative drug ('pre-med') is given by injection or as a drink. Dental impressions may be taken before or during the operation to give an accurate record of the extent of the cleft to compare with the future development of the mouth. Some bleeding from the mouth afterwards is to be expected. You will see some stitches, swelling and crusting on the lip. A small piece of foam may be used to hold the nose in its new shape. You may find that splints have been placed on your baby's arms to prevent the child from touching the stitches. It is common to find that the baby's scars become red and swollen afterwards, but this will clear up.

The cleft surgeon will carry out the above-mentioned procedure, and usually it is done in the first few months. Surgeons do not agree on the best time to operate or the order of the operations (e.g., some prefer to repair the palate before the lip). You may want to ask the surgeon why he / she carries out lip repair at a particular time.

You may have strong feelings about when your baby should have its operation. The surgeon should take account of your feelings in this decision. Ask how long your baby will have to stay in hospital. Ask a member of the cleft team about this. You might also ask to accompany your baby to the operating theater and recovery room. You should be prepared that your baby may look very different after the operation. Dummies (comforters) should be given to pacify your baby only when really necessary, as some surgeons are concerned about their effect on the healing wound following the operation. If so in your case, you may be requested to practice spoon feeding prior to the operation. Other surgeons are happy for the baby to feed by bottle or breast immediately after surgery.


Surgical Repair Of The Palate

The surgeon aims to repair the palate in layers, with as little surgery to the upper jaw and hard palate as possible. He / she reconstructs the muscle of the soft palate so it can work properly during speech and swallowing. Some surgeons don't attempt to close the gap in the upper gum area completely at this stage. On the day of the operation your baby will be given no food for a few hours before hand to reduce the chance of being sick. A sedative drug ('pre-med') is given by injection or as a drink. Some bleeding from the mouth afterwards is to be expected. Your child's mouth may also be sore at the corners, where the lip has been stretched a little during the operation. Dental impressions may be taken before or during the operation to give an accurate record of the extent of the cleft to compare with the future development of the mouth. You may find that splints have been placed on your baby's arms to prevent him / her touching the stitches. A cleft surgeon conducts this operation.

Surgeons still do not agree on the best time to operate or which operations produces the bets results. Most surgeons in the UK repair the palate at some time from about 4 months to 12 months. Repairing the palate before the child learns to speak is thought to help normal speech development. Unfortunately, some parts of the palate surgery may restrict future growth of the palate and upper jaw. Surgeons are actively working on ways to reduce this. Everyone agrees that, despite these potential problems palate repair in infancy is vital for good speech development.

The cleft surgeon will be able to tell you at what age the left will be repaired. Do not be surprised if the operation is postponed if your child is not felt to be strong enough for the operation, or if there is another medical problem. Ask how long your baby will have to stay in the hospital. You as the parent can expect to stay in the hospital. Ask a member of the cleft team about this. You might also ask to accompany your baby to the operating theatre and recovery room. Dummies (Comforters) should be given to pacify your baby only when really necessary, as some surgeons are concerned about they effect on the healing wound following the operation. Some surgeons prefer babies to feed by spoon after the operation. If so in your case you may be requested to practice spoon-feeding prior to the operation. Other surgeons are happy for the baby to feed by bottle or breast immediately after the surgery. In some cases, the repair is unable to hold and separates. Most of these holes are small and close completely on their own. Others contract and become very small.