Cleft Lip and Cleft Palate: What You Need to Know
Cleft lip and cleft palate are among the most common congenital facial differences (or birth defects) in children.
These birth differences arise when the tissues and bone inside the mouth do not fuse properly, resulting in a space in the upper lip and/or palate.
Both cleft lip and cleft palate surgeries are performed in the hospital under general anesthesia and usually require a stay of at least one night.
Cleft Lip and Cleft Palate Causes
The exact cause(s) of cleft lip and cleft palate are not completely understood. Some evidence suggests the conditions may be genetic. Additional research suggests a combination of genetic and environmental factors affecting the mother during pregnancy — including smoking, diabetes or the use of certain medications — could be connected. Genetic consultation may be suggested.
However, some cleft lip and palate cases may not be related to genetic or environmental factors. The cause of those cases is still unknown and often, the conditions cannot be prevented.
Cleft Lip and Palate Symptoms
Beyond the cosmetic abnormality, other possible complications that may be associated with cleft lip and cleft palate include:
Feeding difficulties. Feeding difficulties occur more with cleft palate abnormalities. The infant may be unable to suck properly because the roof of the mouth is not fully formed.
Ear infections and hearing loss. Ear infections are often due to a dysfunction of the tube that connects the middle ear and the throat. Recurrent infections can then lead to hearing loss.
Speech and language delay. Due to the opening of the roof of the mouth and the lip, muscle function may be decreased, which can lead to a delay in speech or abnormal speech. Ask your doctor if consultation with a speech therapist would be right for your child.
Dental problems. As a result of the abnormalities, teeth may not develop normally and orthodontic treatment may be required.
Cleft Lip and Palate Diagnosis and Treatment
For most infants with cleft lip alone, your child’s surgeon can repair the abnormality within the first several months of life. To repair a cleft lip, the plastic surgeon uses a special technique to suture the two sides of the lip together, leaving a scar that blends into the lip. The goal of this surgery is to fix the separation of the lip. Sometimes, a second operation is needed.
Cleft palate repairs are usually done between the ages of 6 to 18 months. This is a more complicated surgery, and it is done when the baby is bigger and better able to tolerate the surgery. Your child’s doctor will advise about the exact timing of the surgery. To repair a cleft palate, the plastic surgeon uses tissue from either side of the mouth to fill in the gap. A second operation may be required.
At your first visit with the plastic surgeon, he or she will explain the details of the surgery, risks, complications, costs, recovery time and outcomes.
More About Cleft Lip and Cleft Palate from Johns Hopkins Medicine
Cleft Lip and Palate from the Parents
When Guy was born with a bilateral cleft lip and palate, Felicia and Gavin didn’t know what to expect. Read their testimonial of Guy’s experience with the cleft clinic at Johns Hopkins.
Recovery After Surgery for Cleft Lip and Cleft Palate
Recovering After Surgery for Cleft Lip
Your child may be irritable following surgery. Your child’s doctor may prescribe medications to help with this. Your child may also have to wear padded restraints on his or her elbows to prevent him or her from rubbing at the stitches and surgery site.
Stitches will either dissolve on their own or be removed in approximately five to seven days. Specific instructions will be given to you regarding how to feed your child after the surgery. The scar will gradually fade, but it will never completely disappear.
During the surgery, and for a short time after surgery, your child will have an intravenous (IV) catheter to provide fluids until he or she is able to drink by mouth. For a day or two, your child will feel mild pain, which can be relieved with a nonaspirin pain medication. A prescription medication may also be given for use at home.
Your child’s upper lip and nose will have stitches where the cleft lip was repaired. It is normal to have swelling, bruising and blood around these stitches.
Recovering After Surgery for Cleft Palate
This surgery is usually more involved and can cause more discomfort and pain for the child than cleft lip surgery. Your child’s doctor may order pain medicine to help with this. As a result of the pain and the location of the surgery, your child may not eat and drink as usual. An IV catheter will be used to help give your child fluids until he or she can drink adequately.
Your child will have stitches on the palate where the cleft was repaired. The stitches will dissolve after several days, and they do not have to be taken out by the doctor. In some cases, your child’s doctor may place packing on the palate. Do not take the packing out unless you are told to do so by your child’s doctor.
There may be some bloody drainage coming from the nose and mouth that will lessen over the first day.
There will be some swelling at the surgery site, which will diminish substantially within a week.
For two to three days, your child will feel mild pain that can be relieved by a nonaspirin pain medication. A prescription medication may also be given for use at home.
Many infants show signs of nasal congestion after surgery. These signs may include nasal snorting, mouth breathing and decreased appetite. Your child’s doctor may prescribe medication to relieve the nasal congestion.
Your child will be on antibiotics to prevent infection while in the hospital. Your child’s doctor may want you to continue this at home.
Your child may be in the hospital for one to three days, depending on the doctor’s recommendation.
A small amount of water should be offered after every bottle or meal to cleanse the incision. You can continue to rinse this area gently with water several times a day, if necessary.
Diet After Surgery
Your child’s doctor may allow breast-feeding, bottle feedings or cup feedings after surgery. Your child should be placed on a soft diet for seven to 10 days after surgery. For older infants and children, age-appropriate soft foods may include strained baby foods, popsicles, yogurt, mashed potatoes and gelatin.
Your child should not use a straw or pacifier, as both could damage the surgical repair.
Activity After Surgery
Your child can walk or play calmly after surgery. He or she should not run or engage in rough play (i.e., wrestling or climbing) or play with “mouth toys” for one to two weeks after surgery. Your child’s doctor will advise you when your child can safely return to regular play.
Following up with your child’s surgeon and the cleft team is very important. Your child’s doctor will also be an important part of your child’s overall health management after the surgery.