Recovery Series: Cleft Lip and Cleft Palate Procedures

Dr. Sacha Obaid, Board-Certified Plastic Surgeon Serving Dallas, Plano, Southlake, and Nearby Fort Worth, Texas

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Recovering from a surgical procedure is never easy, but because cleft lip and cleft palate repairs are performed on your child when they are as young as three months old, there are many special considerations to be aware of during the recovery phase.

Cleft lip and cleft palate repairs are done as two separate procedures. Cleft lip repair is usually performed on children at 3 months of age, while cleft palate repair is performed at 9 to 12 months.

On the Day of Surgery

Your child will have cleft lip or cleft palate repairs performed under general anesthetic. After the surgery is over, your child will stay overnight in the hospital. Pain medication is administered over the course of the evening to ensure they don’t experience any distress as they wake up.

Most children will be awake and alert enough to be hungry by the evening on the day of surgery, and you can feed your child that night. At this stage they’ll be experiencing some discomfort when they swallow, so there’s no cause for alarm if your child doesn’t want to drink or eat much. They will still receive IV fluids and won’t be at risk of dehydration.

After a cleft lip repair, infants will have some visible stitches, as well as swelling, bruising, and perhaps some blood in the area around the stitches. This can be upsetting to see, but the child will receive pain medication and won’t feel any significant discomfort.

The results of cleft palate repair are inside the mouth, so there are fewer visual changes. Most children experience some facial swelling and bloody discharge from the mouth and nose. There will be stitches inside the mouth, and the surgeon may also place some packing inside the mouth, which shouldn’t be removed.

The Day After Surgery

As long as your child is able to drink plenty of fluids the next morning, your family can return home. If your child is unable or unwilling to drink much, they may stay in the hospital for a few more hours or for a second night. This isn’t necessarily a cause for alarm; some children just need a little more time to start drinking normally again.

To prevent a baby from touching their face once they go home, you’ll be given “no-no guards,” which are a kind of mild restraint fitted onto the arms. They provide almost complete freedom of movement of the shoulders, wrists, and hands, but the baby is unable to bend their elbow enough to touch their mouth or put things in their mouth.

cleft lip and cleft palate recovery picIt’s often hard for parents to feel good about using restraints on their child, but it’s important to use them, even if the baby cries and appears distressed at wearing them. The no-no guards are provided for your child’s safety, and they’re not painful or discomforting; they’re just different from what baby is used to. Your child may feel some frustration at not being able to touch their mouth, but wearing these guards will ensure that the stitches remain in place and greatly reduces the risk of infection.

Problem Signs

The main risks with these procedures are damage to the incision and infection.

If your child has any of the following warning signs at any point during their recovery, contact their doctor immediately:

  • Pain that isn’t relieved by prescribed or recommended medication
  • Temperature over 100.4 degrees
  • Diarrhea or vomiting
  • Drainage fluids that smell bad or look like pus
  • Bleeding from incisions or from the nose or mouth in the case of cleft palate repair
  • Any injury sustained to the child’s repaired lip or palate
  • Failure of the child to drink adequate fluids
  • Difficulty waking the child or excessive sleepiness

Week One Follow-Up Visit

The follow-up visit usually takes place five to seven days after the procedure. The surgeon checks the incisions to make sure everything is healing properly and removes the stitches.

For cleft palate repair, self-dissolving stitches may be used. These don’t need to be removed by the surgeon, but a follow-up visit is still necessary to make sure cleft palate recovery is proceeding normally.

The First Few Weeks after Surgery

After the surgery is complete and your child moves into the recovery phase, the goal is to protect their face as much as possible. Wearing the no-no guards is an important part of this, as is taking steps toward pain and health management and making some small changes in feeding and bedtime habits.

Keeping Your Child Healthy

  • There will be some visible swelling and bruising on the face after a cleft lip repair and some facial swelling after a cleft palate repair. Most swelling will reduce significantly over the course of the first week after surgery.
  • Mild pain medication may be prescribed for use at home, particularly with cleft palate repair, which usually causes more discomfort and pain than cleft lip repair.
  • Antibiotics may also be prescribed. The doctor of a child who undergoes cleft palate repair may also prescribe decongestant medication, as nasal congestion is common after the procedure.
  • No-no guards are typically worn for 10 days after surgery. They can be removed for short periods during the day, as long as the child is watched closely to make sure they don’t touch their mouth.
  • You will be given instructions, so you can keep cleft lip repair stitches clean and free from crusting. This helps with healing and also ensures that the stitches are easy to remove when the time comes.
  • Older children should be limited to calm and quiet play for the first couple of weeks after surgery. They can resume a normal activity level after this time.

Feeding Habits

  • If your child is able to drink clear liquids after waking up after the procedure, they can resume their usual diet the day after surgery.
  • After a cleft lip repair at three months old, infants are unable to suck effectively on a bottle or pacifier. This continues for about three weeks. In the meantime, feeding is carried out using a syringe attached to a short length of soft rubber tubing.
  • For the cleft palate repair, a full liquid diet is recommended for three weeks post-op. This can be given to your child with a syringe or a sippy cup with a very short spout.

Bedtime Habits

  • For the first week or two, your child will be fussier than normal and may have a disturbed sleep schedule.

Four to Six Weeks after Surgery

By this time, most children are well on the way to being fully healed and will be eating or drinking normally.

After cleft lip repair, visible swelling and redness is mostly gone by two to three weeks, but some residual redness lingers for up to six weeks after the procedure. You can massage your child’s lip area gently to help reduce scar contraction. Sunlight should be avoided until the scar is completely healed.

One Year Later

After a year, scars have fully healed. In the case of cleft lip scars, they have reduced considerably in appearance.

For some children, additional surgeries may be necessary as they grow up. For example, if your child has both a cleft lip and a cleft palate, these must be repaired in two separate procedures.

Even after cleft lip repair, some abnormal facial development will still occur. Because of this, most children require some revisionary surgery at five years old. This is typically performed shortly before a child starts school.

Do you still have questions about the process of correcting your child’s cleft lip or palate? North Texas Plastic Surgery’s compassionate, expert care will ensure your little one has the best experience possible. Call today to make a consultation!