Primary Surgery

Depending on the type of cleft, your baby may require one or more surgeries to repair the cleft of the lip and/or palate. To get a good outcome it is important that your baby is in the best possible health at the time of surgery. You may find the following information useful in preparing for your child's stay in hospital.

Repair of the lip

If your baby is growing as expected, this is usually performed at 3 months of age if there is also a cleft of the palate, and at 6 months of age (as a daycase procedure) if the cleft involves the lip, only. With the baby asleep under a general anaesthetic, the edges of the cleft are incised and some of the lip, nose and cheek tissue mobilised in order to bring the edges of the cleft together. No skin or other tissue is taken from anywhere else. Your baby should be able to feed normally as soon as they return to the ward.
Babies with bilateral clefts of the lip that also run into the hard palate will require 2 operations to close the lip (and the hard palate behind it).
A little bleeding from the nose or mouth is to be expected. Your baby will spend one to two nights in hospital and should be able to go home with over-the-counter pain relief. In most cases all the stitches are dissolvable and therefore do not have to be removed.

Repair of the palate

If your baby has a cleft of the lip and palate, part of the hard palate cleft may be repaired at the time of the lip repair. For all other clefts of the palate, the repair usually is done in one operation, between the 6 and 12 months of age.
The operation is done with the baby asleep under a general anaesthetic. The surgeon makes incisions on the inside of the cleft, through which they can release the palate from its surrounding tissues. This allows the palate to come together in the midline and to be repaired in several layers. There are usually some gaps left on two sides in the mucosa, the pink lining tissue of the mouth, that will heal within a matter of days.
Your baby should be able to feed normally as soon as they return to the ward. If they are reluctant to take a bottle that night, fluid may be given through a drip in the first 24 hours.
A little bleeding from the nose or mouth is to be expected. Your baby will spend one to two nights in hospital and should be able to go home with over-the-counter pain relief. The stitches are dissolvable and therefore do not have to be removed.

Alveolar Bone Grafting

If the cleft affects the jaw just behind the lip, a gap may remain in the bone beneath the gum. This needs to be filled with bone in order to allow the canine tooth (“eye tooth”) to erupt. The operation is performed by a Maxillofacial surgeon and involves admission to hospital for 2-3 days. The best time to do this operation is determined from an X-ray of the teeth, and can vary from 9-12 years of age.
Under a general anaesthetic, the gum is opened to expose the gap in the alveolar bone. A bone graft is then taken from the pelvic bone through a small incision and packed into the gap within the alveolus. The bone is covered with tissues of the gum. Following the operation, a soft diet for 2 weeks and careful cleaning of the teeth are required. In most cases all the stitches are dissolvable and therefore do not have to be removed.