Cleft Lip Repair

What you should know

  • Cleft lip repair is surgery to fix the the opening in your child's lip. Cleft lip is a common birth defect (problem). With cleft lip, the skin on your child's upper lip has not grown together normally. Clefts may look different from one child to another. Some clefts may only be a small notch in the red part of the lip. Other clefts may have an opening into the floor (bottom) of the inside of the nose.

  • The cleft may be on one or both sides of your child's lip. If it is on one side, it is called a unilateral (u-nih-LAH-ter-al) cleft. If it is on both sides, it is called a bilateral (bi-LAH-ter-al) cleft. In many cases, caregivers do not know why clefts happen. Your child may be more likely to have a cleft if a family member had one. Medications, infections, smoking or alcohol taken during pregnancy may cause clefts.
    Pictures of an infant with a cleft lip and a repair of a cleft lip

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

Risks

  • There are always risks with surgery. Your child may bleed more than usual, or get an infection after surgery. Your child may have trouble breathing, or get blood clots. Caregivers will watch your child closely for these problems. If your child is allowed to put his hands to his mouth, or a toy in his mouth, he may hurt the surgery area. If your child's skin separates away from the stitches, surgery may have to be done again. This may also cause more scarring.

  • The most common problem with cleft lip repair is asymmetry. This is when the one side of the repaired lip does not line up with the other side. It is common for children with clefts to need repair surgery more than once.

  • If the cleft lip is not fixed, your child could have problems sucking, swallowing, and gaining weight. Feeding problems may allow liquids to back up into your child's ear canals. This increases the chance of ear infections, which may cause long-term hearing problems. He may also have problems talking because of his cleft.

  • Your child may have emotional problems, even with surgery to repair the cleft. This may be because he looks or talks differently than other children. It can also happen if your child feels different because of having to see caregivers. Call your child's caregiver if you have any questions or concerns about your child's care.

Getting Ready

Medicine before surgery:

  • Do not give any medicines to your child without first asking your child's caregiver. This includes prescriptions, over-the-counter drugs, vitamins, herbs, or food supplements.

  • Your child may need to take antibiotics (an-ti-bi-AH-tiks) before surgery to help prevent infections (in-FECK-shuns). Give them as instructed by your child's caregiver.

  • Never give aspirin to your child without first asking your child's caregiver. Giving aspirin to your child when he is ill may cause a very serious illness called Reye's syndrome. Read medicine labels to see if your child's medicine has aspirin.

Preparing your child for surgery:

  • If your child is older, show him the padded arm boards that will be used after surgery. Explain to him that they are to keep him from touching his mouth by accident. Put the padded arm boards on your child and let him play with them for a short time. This will help your child be less afraid when the boards are put on after surgery.

  • Teach your child to drink from a cup, the side of a spoon, or from a rubber-tipped syringe. It is better for your child if he does not have to learn this new way to drink after surgery.

  • Practice cleaning your child's mouth. Sit your child up with his head forward. Gently spray water or salt water on the roof of his mouth using a spray bottle. Let your child hold the spray bottle so he will not be afraid.

The night before surgery:

  • Ask caregivers about directions for eating and drinking.

The day of surgery:

  • Dress your child in loose, comfortable clothing. Put your child in a shirt that buttons or snaps in the front. Do not dress your child in a shirt that has to be pulled over his head to be put on or removed.

  • Write down the date, time, and location of your child's surgery.

  • Ask your child's caregiver before giving your child any medicine on the day of surgery. These medicines include insulin, antibiotics, over-the-counter medicines, vitamins, or prescription medicines.

  • An anesthesiologist (an-iss-thee-z-ALL-o-jist) may talk to you before your child's surgery. This is the caregiver who gives your child sleeping medicine before and during surgery.

Bring with you to the hospital:

  • A list of what medicines your child takes, or his pill bottles. Also write down why your child is taking the medicine, how much is taken, and how often.

  • Lightweight shirts with long sleeves that do not have to be put on over your child's head. After surgery, your child may need to wear padded arm boards to keep him from touching his mouth. Long sleeves worn under the arm boards may help keep the boards from rubbing on your child's skin.

  • Bring a few of your child's personal belongings with you to the hospital. These may include pajamas, a hairbrush, and slippers. Bring a blanket or favorite toy to keep with your child while he is in the hospital. This may help him feel less afraid. Remove all of your child's jewelry, such as earrings.

  • Bring any special bottles, nipples, or equipment you have been using to feed your child at home.

What is informed consent?

  • You may be asked to sign a consent form. A consent form is a legal paper that gives caregivers permission to do certain tests, treatments, or procedures. This form should tell you exactly what will be done to your child. Be sure all your questions have been answered before you sign the consent form.

  • You have the right to understand your child's health problem. You should understand what tests, treatments, or procedures may be done to treat your child's cleft lip. Your child's caregiver should also tell you about the risks and benefits of each treatment. This should be done before you sign a consent form.

Treatment

What Will Happen:

  • You will be asked to help your child change into a hospital gown. Medicine may be given in your child's IV to help him relax or make him drowsy. Your child will be taken to the operating room in a wheeled bed or crib. Your child will get general anesthesia (an-iss-THEE-zuh) during the surgery. This will keep him completely asleep during surgery.

  • To repair your child's lip, the doctor will cut along each side of the cleft. The skin and muscle of the lip will be moved together. This will help with the muscle function and shape of your child's lip. The edges are then sewn together with special thread. These stitches will help the edges stay together as they heal. If your child's cleft involves his nose, the nostril may be re-shaped at this time or in a later surgery.

  • The surgery may last 2 to 4 hours. Ask your child's doctor how long the surgery may take. Sometimes the surgery may take longer than expected. This is normal and is no reason to worry.

Waiting room:

This is a room where you and your family can wait until your child is ready for visitors after surgery. Your child's caregivers will look for you in the waiting room to let you know how the surgery is going. If you leave the hospital, be sure that caregivers have a phone number where you can be reached.

After surgery:

  • Your child will be taken to a recovery room and will stay there until he wakes up. You may be able to visit your child in the recovery room after caregivers get your child settled. The amount of time your child will spend in the recovery room depends on how fast he wakes from anesthesia.

  • Your child will then be taken back to a regular hospital room. Do not let your child get out of bed until a caregiver says it's OK.

Contact a caregiver if

  • You have questions or concerns about your child's surgery.

  • Your child has a fever.

Copyright © 2012. Thomson Reuters. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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