A parental guide to cleft lip and palate surgery

As a parent, it can be scary when your little one needs surgery. A cleft lip and palate often necessitate surgery early in life. Fortunately, the outcome after surgery and additional therapies is usually excellent.

Here, we will briefly take you through what to expect as the parent of a child undergoing cleft lip and/or palate surgery.

What is a cleft lip and palate?

A cleft lip and palate is the incomplete formation of the upper lip and roof of the mouth, respectively. Cleft lip and palate are present at birth and can occur separately or together. During early fetal development, tissue cells migrate from the periphery of the face to the center, forming facial structures.

The lip and palate are formed between weeks 4 and 9 of fetal development. If cells making up the lip do not join completely in the center, cleft lip results. Similarly, if cells making up the roof of the mouth do not join completely, a cleft palate results. Cleft lip and palate occur in approximately 1 of 1,600 newborns in the United States.

Causes of cleft lip and palate

The cause of cleft lip and palate is largely unknown, but is likely a combination of genetic and environmental factors. It is important for mothers and fathers to understand that they could not have done anything to prevent cleft lip and palate, and that their baby will likely have excellent health after corrective surgery.

Things to know when your child is born with cleft lip and palate

Most of the time, children with cleft lip and palate are otherwise very healthy. Although your newborn may not have a life-threatening health problem, caring for a child with unique needs can be challenging, and it is normal to feel overwhelmed. Your child will likely need additional support to optimize feeding, speech and breathing.

It is important to remember you are not alone; your pediatrician will connect you with specialists to assist with these needs. With early intervention, your child will develop with a normal ability to eat safely, speak and breathe.

When can your child have corrective surgery?

Cleft lip repair can be performed between 2-6 months and cleft palate repair surgery can usually be performed between the age of 9-18 months. More than one surgery may be required in some cases.

What should you expect when you bring your child to the plastic surgeon?

During the consultation with your plastic surgeon, they will gather a detailed medical history, examine your child's cleft lip and/or palate and develop a surgical plan tailored to their specific anatomy. Additionally, you should be prepared to discuss your questions and concerns.

Will insurance cover the cost of surgery?

Yes, your insurance should cover the cost of your child's surgery. Before the surgery, you can work with staff at your surgeon's office or a social worker to ensure any prior authorization needed for insurance purposes is completed.

What can you expect on the day of surgery?

You will be asked to arrive at the hospital or surgery center with your child a few hours before the scheduled surgery. When you arrive, your child will be checked in and brought to a pre-operative area, where you can help them change into a surgical gown. A surgical nurse will start preparing your child for surgery.

Additionally, the pediatric anesthesiologist and your plastic surgeon examine your child and ensure all of your questions are answered. You will be asked to sign a consent form stating that you fully understand the procedure, alternatives and risks associated with the surgery. You will be able to stay with your child until they enter the operating room.

Prior to the surgery, the pediatric anesthesiologist will administer either intravenous sedation or general anesthesia to ensure your child is safe and comfortable during the surgery. During a cleft lip surgery, your child's surgeon closes the gap in the lip and reconstructs any nasal deformity. They may manipulate skin, muscle and cartilage.

During the surgery, incisions are made in the tissue in the roof of the mouth to allow the tissue to be brought together in a way that facilitates closure of the gap in the palate. Closures will be made with either absorbable or removable sutures.

You will be able to see your child soon after surgery in the post-operative area. Your child will likely stay at the hospital overnight and can typically go home the next day if they are cleared by breathing and swallowing specialists. Your surgeon will give you instructions for surgical site care, complications to watch out for and feeding.

Care after surgery

You will have a follow-up appointment with your surgeon to ensure your child is healing well after surgery and discuss whether your child will need additional surgeries. You will continue to work with a team of specialists to help with feeding, speech and general health.

It is important to know you are never alone when it comes to caring for a child with cleft lip and palate. Although there is a lot to learn, your plastic surgeon and other specialists are there to walk you through every step of the process.