When does an infant with cleft lip usually undergo surgical repair of the cleft lip?

March 4, 2014
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DEAR MAYO CLINIC: I am 30 weeks pregnant with our first baby. After an ultrasound last week, our doctor informed us our baby will likely have a cleft lip. How soon after he is born do you recommend surgery? Will I still be able to breastfeed him?

ANSWER: Learning that your baby may have a cleft lip or a cleft palate can be upsetting. But fortunately, in most cases these conditions can be successfully repaired with surgery. The specific timing of surgery depends on how extensive the cleft is, and that cannot be definitely determined until your baby is born.

A cleft lip is an opening, or split, in a newborn’s upper lip, and a cleft palate is an opening in the roof of the mouth. Cleft lip and cleft palate may occur separately, or they can happen together. These birth conditions result when the developing facial structures in a growing baby don’t close completely during the first trimester of pregnancy.

As in your situation, a cleft lip may be identified on an ultrasound before a baby is born. But the exact nature of a cleft is often hard to accurately determine using prenatal testing. That means the cleft may be more or less severe than indicated by the ultrasound. This is especially true for a cleft palate, which is very difficult to assess before a baby is born.

When your baby is born, his doctor likely will do a thorough head-to-toe physical exam to make sure your baby is healthy. This evaluation also will help the doctor decide if any additional testing or evaluations may be needed. The vast majority of cleft lips and cleft palates are isolated birth conditions. Rarely, however, they can be a symptom of an underlying genetic disorder.

Once the specific nature of your baby’s cleft is known, a surgical schedule can be set. The goal of surgery is to ensure that a child can breathe, eat, speak and hear properly, as well as to achieve a symmetrical appearance of the child’s face.

When an otherwise healthy baby has only a cleft lip, the surgery to repair it typically is done between 10 and 12 weeks of age. If the child has other health problems, surgery may have to wait longer than that.

Cleft palate surgery often is performed between 10 and 18 months of age, again depending on the baby’s health and other medical concerns. Follow-up surgeries to improve nasal function, enhance speech or repair scarring may be needed as the child grows.

Until they have surgery, many babies with only a cleft lip can breastfeed, although it may take some experimentation to find a method that works best. Working with a lactation consultant often can help. If the palate is involved, then the baby may not be able to create the suction needed for breastfeeding. A bottle designed for babies with a cleft palate may be necessary, or you may need to explore other special feeding strategies to ensure your baby gets the nutrition he needs.

When your baby is born, early referral to a surgeon who specializes in cleft lip and cleft palate repair is key. That specialist can work with you to determine the best treatment plan for your child and help him get the comprehensive care his situation requires. With that plan in place, you will be able to focus on caring for and enjoying your new baby. — Shelagh Cofer, M.D., Otorhinolaryngology, Mayo Clinic Children’s Center, Mayo Clinic, Rochester, Minn.

For most infants with cleft lip alone, the abnormality can be repaired within the first several months of life (usually when the baby is 10 to 12 pounds). This will be decided by your child's surgeon. 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 9 to 18 months, but before the age of 2. This is a more complicated surgery and is done when the baby is bigger and better able to tolerate the surgery. The exact timing of the surgery will be decided by your child's physician. The goal of this surgery is to fix the roof of the mouth so that your child can eat and learn to talk normally. Sometimes, a second operation is needed.

Initial visit

At your first visit with the plastic surgeon, he/she will discuss with you the details of the surgery, risks, complications, costs, recovery time, and outcome. At this time, your child's surgeon will answer any questions you may have.

After the surgery for cleft lip

Your child may be irritable following surgery. Your child's physician may prescribe medications to help with this. Your child may also have to wear padded restraints on his/her elbows to prevent him/her from rubbing at the stitches and surgery site.

Stitches will either dissolve on their own or will 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 catheter (IV) to provide fluids until he/she is able to drink by mouth. For a day or two, your child will feel mild pain, which can be relieved with a non-aspirin 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.

After the 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 physician 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 intravenous (IV) catheter will be used to help give your child fluids until he/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 physician. In some cases, packing will be placed on the palate. Do not take the packing out unless you are told to do so by your child's physician.

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 in a week.

For two to three days, your child will feel mild pain that can be relieved by a non-aspirin 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 physician may prescribe medication to relieve the nasal congestion.

Your child will be on antibiotics to prevent infection while in the hospital. Your child's physician may want you to continue this at home.

Your child may be in the hospital for one to three days, depending on your child's physician'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 physician may allow breastfeeding, 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. Note: 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/she should not run or engage in rough play (i.e., wrestling, climbing) or play with "mouth toys" for one to two weeks after surgery. Your child's physician will advise you when your child can safely return to regular play.

Follow-up with your child's surgeon and the cleft team is very important. This will be discussed with you. Your child's physician will also be an important part of the child's overall health management after the surgery.

Which is the best time to surgical repair of cleft palate?

Cleft palates are typically repaired between 8 and 12 months of age. Clefts of the soft palate can usually be repaired early (8 to 10 months of age). Clefts of the hard and soft palate are best repaired later (10 to 12 months of age).

Why cleft lip is repaired early?

Given these developments, we question whether a delay in repair until 3–6 months of age is still necessary. Early cleft lip repair may provide additional benefits such as improved appearance of surgical scars, accelerated weight gain from ease of feeding, and heightened maternal-infant socialization.

How soon after birth is a cleft palate surgery?

A cleft palate usually is repaired with surgery called palatoplasty (PAL-eh-tuh-plass-tee) when the baby is 10–12 months old. The goals of palatoplasty are to: Close the opening between the nose and mouth. Help create a palate that works well for speech.

Which is the typical time line for a newborn to undergo cleft lip repair quizlet?

Cleft lip repair: A cleft lip usually is repaired between 3 and 6 months of age.