As a parent, you may feel a great sense of shock and sadness when you see your newborn baby have a small cleft on their upper lip or a cleft on the roof of their mouth. You may wonder, "Why did this happen to my baby?" But don't worry. This is not as serious as you think, and it can be completely cured with surgery. Let's talk about everything simply and clearly.
What are cleft lip and palate?
Simply put, this is a cleft or split in a baby's upper lip and roof of the mouth. This is a congenital disorder , meaning it occurs while the baby is still in the womb. This cleft occurs when the tissues of the lip and roof of the mouth do not fuse together properly as the baby's facial features develop.
- Cleft Lip: This is when the two sides of a baby's upper lip do not come together, leaving a small gap. This gap can be as small as a small line, or it can be a large gap that goes all the way to the nostril. Sometimes it also affects the gums.
- Cleft Palate : This occurs in the upper part of the mouth, called the palate. This can be in the hard palate at the front or the soft palate at the back.
Often, both conditions occur together, but some children may have only a cleft lip or a cleft palate.
What are the benefits of these surgeries?
These surgeries are not just done to make the child's lips and mouth look beautiful. There are much more important things than that. This cleft can cause health problems for the child, such as hearing problems, dental problems, and speech difficulties .
So, this surgery greatly helps the child develop these abilities:
- Eating and drinking: When the cleft is present, it is difficult for the baby to suckle and drink from a bottle. This discomfort will go away after surgery.
- Breathing : Sometimes, if there is a cleft in the nose , breathing difficulties can occur. Surgery can also correct this.
- Hearing: Cleft palate can cause frequent ear infections and hearing loss. Surgery can reduce this risk.
- Speaking: The palate plays a very important role when we speak. A child with a cleft palate may have difficulty pronouncing words clearly. This condition can be completely corrected with speech therapy after surgery.
At what age is the baby operated on?
These two surgeries are not usually performed at the same time.
Cleft Lip Surgery
This surgery is usually done when the baby is between 3 and 6 months old . Sometimes, before the surgery, a small treatment is done right after the baby is born to prepare the lip tissue for surgery. For example, lip taping or a special device called nasoalveolar molding (NAM) is used to shape the nose and gums. Some children may need further surgery later to further shape the lips and nose.
Cleft Palate Surgery
This surgery is often done when the baby is about 12 months old . That is, before the baby starts talking. If a child has both a cleft lip and a cleft palate, the cleft lip surgery is usually done first . It may take two or more surgeries to completely fix the cleft palate. Surgery on the gums or jawbone is usually done after the child is about 10 years old.
What happens before the surgery? How should we prepare?
This is not something a single doctor does. A team of doctors works on your child. That team includes surgeons, speech therapists, otolaryngologists, and dentists.
Before the surgery, the surgeon will meet with you and examine your child to decide what type of surgery is best. About a week before the surgery, your child's pediatrician will examine your child to make sure he or she is healthy enough for the surgery. You should tell the doctor about any allergies your child has and any medications he or she is taking.
The baby's stomach must be empty because anesthesia is used for the surgery. Therefore, the doctor's instructions regarding food and drink must be followed exactly.
| Pre-surgery dietary instructions (general) | |
|---|---|
| Milk (powdered milk/cow's milk) | It should be stopped at least 6 hours before surgery. |
| Breast milk | Sometimes it is allowed up to 4 hours before surgery. |
| Clear liquids (water, apple juice) | It is allowed to be given up to 3 hours before surgery. |
| Solid food / baby food | It should be avoided after midnight on the day of surgery. |
Ask your doctor about any questions or concerns you may have. This will give you a clear understanding of what will happen on the day of your surgery.
What happens during the surgery?
Both of these surgeries are performed under general anesthesia . This means that the baby is completely asleep. The baby does not feel any pain.
Cleft lip surgery
The main goal of this is to close the gap in the lip and give the upper lip and nose a beautiful, natural shape. The doctor makes small incisions in the skin on both sides of the gap, brings the skin sections together, and sews them together with dissolvable stitches. This surgery usually takes less than two hours.
Cleft palate surgery
This has several goals: to close the cleft palate, to create a palate that allows the child to speak normally, and to stop food and drink from coming out of the nose. This surgery is a bit complicated. The doctor rearranges the tissues on both sides of the palate, closes the cleft, and sews it up with dissolvable stitches. This surgery takes about two to three hours.
What to expect after surgery?
After the surgery, the child may be a little sick and anxious. This is normal.
After cleft lip surgery:
Soft splints are placed on the baby's hands to prevent them from putting their hands in their mouths and tearing the stitches. This can be a little uncomfortable for the baby. The baby can be breastfed shortly after the surgery. However, it may be a little difficult at first. Until the baby is able to drink on their own, fluids are given through an intravenous (IV) catheter . The baby usually has to stay in the hospital overnight.
After cleft palate surgery:
The child will need to stay in the hospital for one or two days. After the surgery, liquids will only be allowed to be drunk from a cup. Spoons and straws will not be allowed. It is normal to have some swelling in the mouth and a little blood in the saliva. The stitches in the mouth will dissolve in a few weeks. When you go home, you will be given painkillers and antibiotics to prevent infection.
How do you take care of the baby after you get home?
The doctor will give you clear instructions on how to care for your baby after you get home. It is very important to follow those instructions exactly.
| Area of concern | Instructions |
|---|---|
| After Cleft Lip Surgery | |
| Food and drink | You can give baby food diluted with a little water. Feed from a cup. You will need to use a special bottle or syringe. If you are feeding from a spoon, ask your doctor. |
| Caring for the cutting path | The area around the mouth will be swollen and blue for a few days. Clean the incision with warm water and keep it dry. The stitches will dissolve in a week or two. After that, a pink scar will remain. Apply an ointment that the doctor recommends. Be sure to wear sunscreen when going out in the sun. |
| After Cleft Palate Surgery | |
| Food and drink | For a few weeks, liquids should only be given from a cup. Do not use straws. Give only soft, mashed foods. Ask your doctor about the exact diet. |
| Caring for the inside of the mouth | The stitches will stay in place for about a month. It is normal to have a little blood in your saliva. Your mouth will be swollen for about a week. There may be increased nasal discharge, and you may hear a snoring sound. |
| Pain | The pain may last for about two weeks. This can affect the baby's eating, drinking, and sleeping. Give the painkillers prescribed by the doctor exactly on time. |
Are there any risks with these surgeries?
As with any surgery, there are some risks involved. However, these surgeries are generally very safe. The main risks that may occur are:
- Bleeding
- Infections
- Adverse reactions to anesthesia
- Difficulty breathing
- The surgery may not be completely successful or more surgeries may be needed.
Your doctor will tell you more about these risks.
When should we see the doctor immediately?
The doctor will schedule a visit to see your child about a week or two after surgery. However, if you notice any of the symptoms below, you should call your doctor right away.
| Emergency - seek medical advice immediately | |
|---|---|
| Fever | If the temperature is higher than 101.4°F (38.55°C), or if the fever does not go down despite medication. |
| Difficulty breathing | If the baby's skin turns blue/pale. |
| Bleeding | If you have excessive bleeding from the nose or mouth (pink blood in the saliva is normal). |
| Signs of infection | If the cut is oozing pus or blood, or if it is very red and swollen. |
| Symptoms of Dehydration | If your baby doesn't cry when he cries, his eyes seem sunken, his mouth is dry, or he doesn't urinate at least once in 6 hours. |
| Problems with seams | If the stitches have come loose, come loose, or the incision seems to be open. |
Take-Home Message
- Cleft lip and palate are conditions that occur while the baby is still in the womb, but can be treated very successfully with surgery.
- The best thing you can do as a parent is to keep your baby calm and follow the doctor's post-operative instructions exactly.
- You are not alone on this journey. A large team of doctors, nurses, and other professionals are there to help your child.
- Don't be afraid to ask your doctor any questions or doubts you may have.
- With proper treatment, these children can live healthy, happy lives without any long-term problems, just like any other child.
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