Cleft Lip & Palate Surgery

Cleft surgery closes a gap in the lip, in the roof of the mouth, or in both, that was present from birth. The lip repair restores the muscle ring around the mouth as well as the skin, so that it works as well as it looks. The palate repair closes the roof of the mouth and rebuilds the muscle sling at the back of it, which is what allows normal speech and stops food and fluid going up into the nose.

The operations are done in the first year of life, in a sequence your child's surgeon will set out at the first appointment. The lip is usually repaired at a few months of age and the palate later in the first year, before speech develops. The exact timing depends on the type of cleft and on your baby's weight, feeding and general health, and it is normal for the dates to move.

Surgery is one part of a long programme run by a team: a surgeon, a paediatrician, an anaesthetist, a specialist feeding nurse, a speech and language therapist, an orthodontist, a dentist and an ear specialist. Most children need further planned procedures in later childhood, and knowing that at the start is better than meeting it at eight years old as a surprise.

The operation is done under general anaesthetic, so your child is asleep throughout and feels nothing. A paediatric anaesthetist manages this, and your child will be weighed, have blood tests including haemoglobin, and be checked for a cold or chest infection beforehand, since an operation is postponed for a few weeks if one is present.

A lip repair takes about one and a half to two hours; a palate repair about two. The surgeon works entirely inside the mouth for a palate repair, so there is no external scar. For a lip repair the scar runs from the nostril down to the lip border and is designed to fall along the natural line there. Stitches are usually dissolvable, and arm splints may be used for a couple of weeks to stop small hands reaching the repair.

This is an Inpatient stay. Expect two to four nights. The first night is spent in a closely monitored area, feeding restarts within hours in the way the team instructs, and you go home when your baby is feeding well, comfortable on simple pain relief and breathing normally.

The first forty-eight hours are the hardest, with swelling and a baby who is unsettled, and regular pain relief given on the clock makes the most difference. Swelling peaks at two to three days and then falls away quickly.

Feeding is the practical centre of the next few weeks. Your team will tell you exactly how to feed, usually with a soft spoon, a special bottle or breastfeeding depending on the repair, and only soft food and fluids for about three weeks after a palate repair. Nothing hard goes into the mouth: no spoons held by the child, no straws, no dummies and no toys in the mouth for three weeks. Arm splints stay on for the period your team specifies.

Most children are back to their usual selves within one to two weeks. The lip scar looks red and raised for two to three months and then softens and fades over a year or more, and massage and sun protection help it. Speech therapy assessment starts in the second year and continues as your child's speech develops, and hearing is checked regularly, because fluid behind the eardrum is very common after a cleft palate and affects both hearing and speech.