Cleft Lip Repair

Your baby needs 2 operations: one to fix a cleft lip, the other to remove the sutures (stitches). This page tells you what you need to know before, during and after both surgeries.

For information on what a cleft lip is, please read "Cleft Lip and Cleft Palate."

Important information

Name of your baby's surgeon:

Telephone number:

Take your baby to the doctor for a physical examination

Six weeks before the operation, take your baby to their family doctor or paediatrician for a general physical examination. Your surgeon will give you forms for your baby’s doctor to fill in. Please complete these forms and return them right away to your surgeon’s office. Your baby will also need a blood test before the operation. Your family doctor will arrange this.

Before going to the hospital

The night before the operation, please give your baby a bath and wash their hair. Your baby will be staying overnight at the hospital after the operation. Please bring clothes, toys, and toiletry items that you and your baby will need. Ask the nurse what services you can access during your stay.

Eating and drinking before the operation

Your baby will be given a special sleep medicine called a general anaesthetic for the operation.

Your baby may have solid food until midnight the night before the operation. Your baby can have formula up to 6 hours before the operation or breast milk up to 4 hours before the operation.

Your baby may then have clear fluids up to 3 hours before the operation. Examples of clear fluids are apple juice and water but not orange juice.

You must follow these feeding instructions to lessen the chance of throwing up, which could hurt your baby's lungs.

If you do not follow these feeding guidelines, your baby's operation will be cancelled.

If you are unsure of these instructions, please call the clinic nurse a few days before the operation.

A cleft lip repair operation usually takes about 2 to 3 hours

Your baby will have a general anaesthetic for the operation. This means they will be asleep and feel no pain during the operation.

When the operation is over, your baby will be taken to the recovery room for about 1 to 2 hours. During this time, you may be able to see your baby for a short visit. When your baby is ready, they will be moved to the Plastic Surgery Unit.

Pain management after the operation

If your baby has pain after the operation, pain medicine will be given as needed. You know your baby best. If you have concerns about your baby’s pain, speak to the surgical and nursing staff.

Eating and drinking after the operation

After the operation, your baby will feed the same way as before the operation (breastfeeding or bottle feeding).

To make sure your baby is getting enough liquids, your baby will receive special liquids through their intravenous (IV) line. An IV is small tube that is put in the vein of an arm or leg. The IV will stay in place until your baby can drink and keep liquids down.

Milk and other liquids

Your baby‘s first drink will be clear fluids or breast milk. Once your baby can keep down clear fluids, they can have formula.

Your baby may not want to drink at first because their lip will be sore from the operation. To help your baby drink, the nurse may give them pain medicine about 1 hour before feeding.

Your baby may take a longer time to feed following the operation. This may be because there is still some pain and swelling. Your baby may also have to get used to the new shape of their mouth and may need to adjust their suck, swallow, and breathe pattern. Your nurse, lactation consultant, or an occupational therapist (OT) will help you feed your baby if there are problems or if you need help.

If your baby was wearing an orthodontic plate before the operation, they will no longer need it. It may take a little time for your baby to get used to feeding without the orthodontic plate.

Over time, feeding gets easier.

Solid foods

If your baby has been eating infant cereal or strained foods, they will not be able to have them until the sutures (stitches) are removed. The food can get into the suture line and make it hard to clean. The suture line is the area that has been closed with stitches.

It will be about a week before the sutures are removed.

Positioning your baby: awake and asleep

The head of your baby’s bed will be raised slightly. This will help reduce swelling around their lip. Your baby will not be able to have time on their tummy because they could rub the suture line and slow down the healing process.

Activity

Your baby must wear arm restraints after the operation to prevent them from putting hands or other objects in the mouth. These arm restraints are soft, stiff tubes that fit over your baby's arms and stop the elbows from bending. Your nurse will give you the restraints and teach you how to use them. Your baby must wear these restraints 24 hours a day for up to 3 weeks after the operation.

Visiting and staying overnight at the hospital

In general, hospitals let one parent stay over night with their baby during recovery. The parent is responsible for bringing personal items they needs during their stay with their baby. If you are unsure, ask the nurse what, and what not, to bring.

Your baby will look different

Be aware that your baby will look different after the operation. There may be some swelling and/or bruising around the lip and face. This could increase up to 2 days after the operation, but will go away within 5 to 7 days. Your nurse and surgeon will answer any questions you may have about the way your baby looks.

Suture care

It is important that you keep the suture line clean. It is normal for a small amount of blood to ooze along the suture line for up to 24 hours after the operation. After each feed, you will need to clean the suture line with cotton swabs, a mild soap and water. You will also apply a thin layer of antibiotic ointment such as Polysporin to the suture line. Your nurse will teach you how to do this. Your baby will feel some discomfort during cleaning, but the baby’s crying will not harm the sutures.

Nasal stent

Your baby may or may not have nasal stents in both nostrils after the operation. A nasal stent is a small, soft tube, about the thickness of a straw, which holds the nostril open. These tubes are usually stitched (sutured) in place after the first operation. Your surgeon will discuss this with you and your nurse will show you how to care for them. The sutures will be removed when you return to the hospital to have the other sutures removed.

For more information, please see "Nasal Stents."

Your baby will stay in the hospital for 1 or 2 days

Once your baby has recovered from the operation and you feel able to take over their care, your baby can go home. Before you go home, you will be given the instructions you need to care for your baby and any follow-up appointment will be scheduled.

Caring for your baby at home after the first operation

Once your baby returns home, please follow these special instructions:

  • Keep the arm restraints on your baby 24 hours a day for 3 weeks after the operation.
  • Gently clean the sutures with warm water, mild soap and cotton swabs. Clean the sutures after each feed. Apply a thin layer of Polysporin or Vaseline.
  • Your baby must not use a soother. The outside ring of the soother will rub the sutures.
  • Your baby must not be on their tummy for 2 weeks after returning home.
  • If your baby has nasal stents sutured in, gently clean around them with warm water, mild soap, and cotton swabs after each feed. Apply a thin layer of Polysporin or Vaseline.

When to call the doctor

When at home, call the Plastic Surgery Unit or your baby’s surgeon right away if your baby:

  • is not eating or drinking
  • has a fever
  • has redness or oozing from the suture line

Back to the hospital for the second operation to get the sutures out

Your baby will need to return to the hospital 4 to 7 days after the operation to have the sutures removed. Removing the sutures is another operation. Both the sutures in your baby's lip and the sutures holding the nasal stent in place will be removed. Like the cleft lip repair operation, your baby will have a general anaesthetic.

As with the first operation, your baby must follow the instructions described above: see "Eating and drinking before the operation" and "Before going to the hospital."

The operation lasts about 30 minutes. After the operation, your baby will be taken to the recovery room.

Your baby may feel pain following the operation. You can give your baby acetaminophen (Tylenol) every 4 hours as needed. Your nurse will give you more information about this.

Your baby will stay in the hospital for up to 4 hours. Once your baby has recovered from the operation and you feel able to take over their care, your baby can go home.

Caring for your baby at home

Once your baby returns home, please follow these special instructions:

  • Keep the arm restraints on your baby 24 hours a day for 2 more weeks.
  • Clean the incision line after each feed. You should clean the incision line with cotton swabs, warm water and a mild soap. Apply a thin layer of Vaseline. Do this for 2 more weeks.
  • Your baby must not be on their tummy for 2 more weeks.
  • Your baby cannot have a soother.
  • Remove the nasal stents after each feed. Clean with cotton swabs and a mild soap and water, and put the stent back in. Nasal stents should be worn 24 hours a day.

A follow-up appointment

Your baby will return to see the surgeon 4 to 6 weeks after going home.

Key points

  • Fixing a cleft lip involves 2 operations. Your baby will need to stay in the hospital overnight after the first operation.
  • Your baby will eat the same way as before, either breastfeeding or bottle feeding.
  • Your baby will need to wear arm restraints to stop them putting things in their mouth.
  • Your baby will look different after the operation.
  • Contact the clinic if you have any questions or if your baby has signs of infection.

Cindy Guernsey RN, BScN

1/10/2011

At SickKids:

For both the surgery and the removal of sutures (stitches):

Please bring your child to unit 6B in the Atrium (Surgical Day Care Unit) 2 hours before the operation. You will fill in some forms with the nurse and your child will have a final assessment before the operation. One parent can stay at the bedside with the child after the operation.

Breast-pumping equipment is available on the Plastic Surgery Unit (8C). Ask the nurse.

For general information about your child’s stay at The Hospital for Sick Children, please read The Family Guidebook.

If you have any further questions, please call the Cleft Lip and Palate Coordinator (416-813-7491) or the Plastic Surgery Unit (416-813-6932).





Notes: