Cleft Lip & Palate Guide

Surgery for Cleft Lip & Palate

All babies with cleft lip and palate can have cleft lip and palate surgery to restore function and a more normal appearance. Cleft lip and palate surgical repair is most often done in stages. Some of the surgeries will be done when your child is very young and some when your child is older and more developed. Some surgeries may not be done until he is a teenager. Surgeries are planned to occur with your child’s facial growth.

Your child’s craniofacial surgeon at Children’s will explain what types of surgery your child may need and when they may occur.

  • First Surgery

      The first surgery your child will have is to repair the cleft lip and rebuild muscles and tissues around his mouth and nose. This will be done while your child is still a baby.

      - Cleft lip repair is most often done when your child is 2 to 3 months old.

      - Cleft palate repair is most often done when your child is about 6 months old.

      Each surgery takes about an hour and a half, and your child may need to stay in the hospital overnight. Your child’s doctor will tell you whether your child needs one or both types of surgery. 

      Unilateral cleft lip repair

  • After Surgery

      You may stay in your baby’s room after cleft lip and palate surgery and help care for him. We will show how to care for your baby at home.

      Here are some tips to help you prepare for caring for your baby right after cleft lip and palate surgery.

      In the hospital

      Your child will have a few tubes and wires attached to him. These may include:

      - A pulse oximeter. This is a monitor that measures the oxygen in your child’s blood. A soft, plastic wire leads from the monitor and is attached to your child’s finger with a bandage. The wire will not hurt or shock your child.

      - An I.V. (intravenous) line. This is a thin, soft, plastic tube that goes into your child’s veins. It lets us give your child food, fluids and medicines that can’t be taken by mouth.

      Your child may have some discomfort from the cleft area after surgery. We can give him pain medicine through the I.V. or by mouth. To help prevent falls, be sure to keep your child’s side rails up and watch him carefully if he tries to stand or walk. Pain medicines can make him unsteady on his feet. (Falls after medication have been identified as a problem by our patient safety team)

      We may also give your child other medicines (antibiotics) to help prevent infection.

      You may notice some bloody drainage from the surgical site. Do not be alarmed; this is normal for a day or so.

      Your child may be extra fussy for a while after surgery. This is also quite normal for three to five days.

      Your child may need arm immobilizers (welcome sleeves) to help prevent him from touching his mouth area. If so, the restraints must be loosened a few times each day to check for skin problems. Loosen only one at a time, and do not let your child’s hand near his mouth. Arm immobilizers can make your child clumsy, so if your child is walking, watch for falls. Make sure his shoe strings are tied and pant cuffs are turned up.

      You will be able to begin oral feeding soon after cleft lip and palate surgery. You may need to use a special method for a few days. If so, we will teach you how to feed your child with a syringe or special bottle.

      After you go home

      Your child will return to the doctor’s office in a week or so for a checkup. Any sutures that won’t dissolve will be removed at this time. (Most sutures used for cleft lip and palate repairs dissolve in three to six weeks.) At this visit, you may be taught how to help reduce the scar on the lip.

      Your child’s next visit will be four to six weeks later to make sure everything is healing well. If your child had a cleft palate repair, your doctor will see if any openings have formed in the new palate. If so, they will need to be repaired at a later date.

      Every six months or so at first, your child will be checked by the Children’s Craniofacial team. They will see how your child’s facial growth, hearing, speech, and mental and motor development are doing and provide treatment as needed. You will need to make clinic visits less often with time.

  • Future Surgeries

      As your child grows, he may need more cleft lip and palate surgeries at different ages. It depends on if problems arise and on the treatment plan that the Children’s Craniofacial team has made for your child.

      - Your child will be screened regularly by a speech/language pathologist to monitor his speech development. If air is escaping from your child’s nose, this may need to be repaired in surgery.

      - Before your child reaches school age, he may have a nasal tip reconstruction (repair of the end of the nose) and a revision of the lip scar.

      - When your child is 6 to 11 years old, the cleft in his upper gum will be repaired using a bone graft.

      - During your child’s mid-teens, he will have the final repairs to the cleft lip and/or palate and a last repair of scar tissue. He may also need surgery to advance the upper jaw.

      - Regular hearing evaluations can indicate if a visit to an ear, nose and throat doctor is needed. Children with chronic ear infections may need ear tubes.

  • Hospital Visits

      Most of your child’s cleft lip and palate surgeries at Children’s will be done as an outpatient. This means he may be sent home on the same day. At other times, he may need to stay in the hospital overnight. Your child’s doctor will tell you as soon as possible if your child needs to spend the night. Just in case, we suggest that you always pack a bag.

      If your child stays overnight, you are welcome to stay also. Having a parent or family member nearby is important for your child. He will be less fearful and more secure with you nearby. Each of our hospital rooms at Children’s at Scottish Rite is private and includes a hide-a-bed sofa, full bathroom, television and telephone.

      When you stay overnight at the hospital, you may not get a lot of sleep. We must check your child often during the night, and you may wake up during our nurses' visits.

      We have a cafeteria for you to eat in or you may order meals to be delivered to your child’s room. You may also bring food and snacks from home. A refrigerator, microwave and coffee maker for parent use are provided on each floor of the hospital.

  • Visitation Guidelines

      We want to provide you with quality family-centered care. Please follow these guidelines to help us keep your child safe and provide the best possible care and service.

      - Visiting hours are from 8:30 a.m. to 8:30 p.m. We may need to limit the number of visitors in your child's room to two at a time. Your nurse will let you know if a limit is needed.

      - It is best for your child if one parent spends the night. Other family members may use the Ronald McDonald House, located at 5420 Peachtree-Dunwoody Road, Atlanta, GA30342. The number of rooms available may be limited. Getting a room depends on such factors as how far away your home is from the hospital and family need. Call for information about reservations and house rules (office: 404-847-0760; weekends: 404-250-4994; night (emergencies only): 404-250-4993). A shuttle can take you to and from the Ronald McDonald House and the hospital at all hours.

      - All visitors less than 12 years of age must stop at the nurses’ station for screening before entering your child’s room. The nurse will ask questions about any possible illness. This includes brothers and sisters and is done with each visit. The visiting child will receive a special sticker to wear during the visit.

      - Brothers, sisters and other visitors less than 12 years of age must be with a parent and remain in the room at all times, unless they are taking part in activity center or family activities.

      - Because of the risk of illness to our patients, we ask that infants, toddlers and young school-aged children keep visits brief.

      - Siblings are not allowed in the playroom until after 3:30 p.m., unless approved by the child life specialist.

      - Children less than 12 years of age must be with a parent, volunteer or child life specialist while in the playroom or on the playground.

      At times, it may be necessary to alter these guidelines for the patients’ safety and health.