What happens during surgery and recovery?
If your child has a cleft lip, it is generally repaired at about 3 months of age. Incomplete and complete cleft lips are repaired in a similar manner. Treatment of a microform cleft lip is usually more minor, and can sometimes be done by only making incisions on the inside of the mouth.
During surgery, we make cuts in the skin, inside the mouth and nose, and sometimes in the nostrils. If your child has a cleft palate, we will often lift a flap of tissue in the roof of the mouth (called a vomer flap), and close the front part of the hole in the palate that is connected with the nose. This helps narrow the gap in the bones, and helps make sure that there is a complete closure of tissue in the floor of the nose. Your child will still need the rest of the palate repaired at 9-12 months of age. We then carefully repair the inside lining of the mouth and lips, the muscles of the lips, and the skin of the lip and nose. It is important to remember that many of the structures have not formed correctly (especially the cartilages of the nose), so it will not be possible to make everything appear perfectly symmetrical. Most children will need further surgery on their nose, and sometimes their lip, by the time they are an adult. We us absorbable sutures, that do not need to be removed, and cover the incisions with skin glue. Parents should be aware that they may initially have a mixed reaction to seeing their child after surgery. You have grown to love and bond with your baby the way that they are, and it is often a shock to see them look differently. Know that these feelings are normal, and you will gradually get used to the new appearance of your child.
After surgery, you will usually spend one night in the hospital to make sure that your child is drinking well before you go home. As soon as your child wakes up, you may feed them. You do not need to do anything differently, and may use the same diet and same bottles that you did before surgery. The surgery itself is not particularly painful, but your child may be irritable or not want to feed at first because things feel different, and they need to get used to their new mouth. It is normal for there to be some bloody drainage from the mouth and nose for the first few days/week after surgery. You may clean the outside of the nose gently with a warm washcloth or q-tips with peroxide, but do not stick any objects in the nose (including suction bulbs). We will also ask you to apply ointment to the nose and lip twice a day. After surgery, we will often use nasal stents. These are soft plastic hollow tubes that are taped into your child’s nostrils. The stents are generally worn for 3 months after surgery, and are gradually increased in size over this time. The stents help shape the nostrils and obtain a better overall result. They must be removed and cleaned daily, and replaced. The process is fairly easy, especially for families that have already been doing NAM.
As part of the normal course of healing after surgery there is usually some lip “contracture”. As the tissues heal, they become firm and tight. This will cause the lip to pull up and appear shorter, the scar to seem thick, and the lip may even look notched. This will go away as the tissues soften and relax, but sometimes this entire process can take 1-2 years before it is complete. Once the incisions are healed, we will let you know when you may begin scar care. This usually consists of daily scar massage with your favorite lotion to break up and soften the scar. You may also begin silicone treatments or use scar creams. You should also use sunscreen any time your child is going outside. Exposure to sunlight will darken the scar while it is in the process of healing.
If your child has a cleft lip, it is generally repaired at about 3 months of age. Incomplete and complete cleft lips are repaired in a similar manner. Treatment of a microform cleft lip is usually more minor, and can sometimes be done by only making incisions on the inside of the mouth.
During surgery, we make cuts in the skin, inside the mouth and nose, and sometimes in the nostrils. If your child has a cleft palate, we will often lift a flap of tissue in the roof of the mouth (called a vomer flap), and close the front part of the hole in the palate that is connected with the nose. This helps narrow the gap in the bones, and helps make sure that there is a complete closure of tissue in the floor of the nose. Your child will still need the rest of the palate repaired at 9-12 months of age. We then carefully repair the inside lining of the mouth and lips, the muscles of the lips, and the skin of the lip and nose. It is important to remember that many of the structures have not formed correctly (especially the cartilages of the nose), so it will not be possible to make everything appear perfectly symmetrical. Most children will need further surgery on their nose, and sometimes their lip, by the time they are an adult. We us absorbable sutures, that do not need to be removed, and cover the incisions with skin glue. Parents should be aware that they may initially have a mixed reaction to seeing their child after surgery. You have grown to love and bond with your baby the way that they are, and it is often a shock to see them look differently. Know that these feelings are normal, and you will gradually get used to the new appearance of your child.
After surgery, you will usually spend one night in the hospital to make sure that your child is drinking well before you go home. As soon as your child wakes up, you may feed them. You do not need to do anything differently, and may use the same diet and same bottles that you did before surgery. The surgery itself is not particularly painful, but your child may be irritable or not want to feed at first because things feel different, and they need to get used to their new mouth. It is normal for there to be some bloody drainage from the mouth and nose for the first few days/week after surgery. You may clean the outside of the nose gently with a warm washcloth or q-tips with peroxide, but do not stick any objects in the nose (including suction bulbs). We will also ask you to apply ointment to the nose and lip twice a day. After surgery, we will often use nasal stents. These are soft plastic hollow tubes that are taped into your child’s nostrils. The stents are generally worn for 3 months after surgery, and are gradually increased in size over this time. The stents help shape the nostrils and obtain a better overall result. They must be removed and cleaned daily, and replaced. The process is fairly easy, especially for families that have already been doing NAM.
As part of the normal course of healing after surgery there is usually some lip “contracture”. As the tissues heal, they become firm and tight. This will cause the lip to pull up and appear shorter, the scar to seem thick, and the lip may even look notched. This will go away as the tissues soften and relax, but sometimes this entire process can take 1-2 years before it is complete. Once the incisions are healed, we will let you know when you may begin scar care. This usually consists of daily scar massage with your favorite lotion to break up and soften the scar. You may also begin silicone treatments or use scar creams. You should also use sunscreen any time your child is going outside. Exposure to sunlight will darken the scar while it is in the process of healing.
