The term "cleft" refers to an opening. An opening in the lip is called cleft lip. An opening in the roof of the mouth (palate) is called cleft palate. There may be a cleft on one side of the upper lip or on both sides. In the case of a cleft palate, the soft part of the palate at the back of the mouth may have an opening, or the cleft may extend forward to the bony part of the palate called the hard palate. A baby may have a cleft lip, a cleft palate, or both.
Cleft lip surgery is usually done when a baby is 2 to 3 months old. The purpose of this surgery is to close the separation. Sometimes a second operation is done later to make sure that both sides of the mouth and nose match.
Surgery for cleft palate is usually done when the baby is 9 to 18 months old. Closing the palatal cleft usually helps the child eat and speak more normally.
In most cases, health insurance will cover most or all of the cost of cleft lip or cleft palate surgery. Check your policy to see what types of treatment are covered.
To repair a cleft lip, the surgeon will make a cut on either side of the cleft from the mouth into the nostril. He or she will then turn the dark pink outer part of the cleft down and pull the muscle and the skin of the lip together to close the separation. This corrects both the way the muscles work and the normal "cupid's bow" shape of the mouth. If there is a problem with the nostrils, it may be corrected at the same time as the lip repair or in a later surgery.
To repair a cleft palate, the surgeon will first make a cut on both sides of the separation. The surgeon will move tissue from each side of the cleft to the center of the roof of the mouth. This joins muscles together and provides enough length in the palate so the child can eat and speak properly.
For a day or two, your child will probably be restless and feel some soreness, which is easily controlled by medicine. Your child will have an IV for a day or two, because he or she will not eat or drink as much as usual. Elbow restraints may be used to keep your baby from rubbing the repaired 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 5 days. Your healthcare provider may prescribe antibiotics to prevent infection, and will recommend a pain medicine for you to give your child at home.
It is normal to have swelling, bruising, and blood around these stitches. After cleft palate surgery, there may be bloody drainage coming from the nose and mouth. This should decrease after the first day. Swelling should be almost gone in a week. Your child may also have a stuffy nose, mouth breathing, and not want to eat as much as usual.
Your healthcare provider will advise you on how to feed your child during the first few weeks after surgery. For the first week, usually a liquid diet is best. You may need to feed your child with a syringe with a rubber tip. When your child can eat soft foods, be careful using spoons or forks so that you do not damage the suture. You also need to clean your child's mouth after each feeding in order to help prevent infection.
It is normal for the surgical scar to appear to get bigger and redder for a few weeks after surgery. This will fade over time. The scar will never totally disappear, but in most children, it is barely noticeable.
During the first week or two after surgery your child can play calmly, but should not play roughly or put toys in her mouth.
Children with a cleft palate are more likely to get ear infections. Your child may need a small plastic ventilation tube in the eardrum. This procedure may be done at same time as the cleft repair or at a later time. After the ear tubes are in place, try to keep water out of the ears. Protect your child's ears during bathing, shampooing, and swimming. Vaseline coated cotton balls, silicone ear putty, or specially made ear molds can be placed in the outer ear to block the ear canal.