What to Expect:
Cleft Lip Surgery
Before Surgery
You will meet with your surgeon to discuss the details of the surgery and to have all of your questions answered in detail. A preoperative history and physical exam will be done, and you will be given an informed consent form to sign that gives us permission to do the surgery. You will also get detailed instructions for the preoperative and postoperative period, including feeding, wound care, and how to detect problems. Your baby will have to have an empty stomach before going to surgery, and you will be given specific instructions on when to stop feeding him/her. If your baby gets sick before surgery, you should notify us so that we can decide whether or not to proceed with the scheduled procedure.
The Day of Surgery
You will arrive in the Surgery Center about an hour before surgery. [Details of checking in, etc]
You will be able to stay with your baby until he or she is taken to the operating room. After that, the nurse in the operating room will call out periodically to update you on the progress of the surgery. When surgery is almost complete, the nurse will call you to come to the waiting area to meet with your surgeon, who will discuss the surgery with you and, usually, show you pictures of the immediate surgical result.
Your baby will spend a variable amount of time in the recovery room, and then go to a room on the pediatric ward. You will be able to see your baby once he/she is brought to the ward.
For most of the rest of the day, your baby will be sleepy and may not be very hungry. We will make sure that adequate fluids and glucose are delivered through the IV and that your baby has enough pain medication to be comfortable. Initially, feeding is done with either a Haberman feeder or a Brecht syringe. If the baby was breast-feeding prior to surgery, breast feeding may resume after 24 hours.
A pacifier must not be used for the first two weeks after surgery. Arm restraints are used also for two weeks after surgery, to prevent the baby from accidentally disturbing the surgical site.
In the Hospital
You should expect the lip and cheek to be swollen in the first two or three days after surgery. This is quite normal. In some cases, the eye on the side of the cleft may even swell shut.
The pediatric plastic surgery nurse will teach you how to care for the surgical incisions and nasal stents and assist you with feeding issues.
Most babies spend one night in the hospital and are discharged on the first day after surgery, when they are feeding well and tolerating oral pain medication.
All of your questions will be answered, and you will received detailed discharge instructions before you leave the hospital.
After Discharge until the First Postoperative Clinic Visit
Your baby will be seen in the clinic for the first postoperative visit approximately one week after surgery. During this first week, he/she may not be quite normal; babies can be more fussy than usual or have disturbed sleep schedules.
When your baby comes to the clinic, the sutures will be removed from the lip. To do this, the baby will be swaddled in a blanket and gently held still by the nurse while the surgeon removes the sutures. It is normal for babies to cry during this procedure because they are being held still, but it is not painful.
After the sutures are removed, steri-strips will be applied to the lip, and your surgeon will show you how to do this yourselves. It is very important to apply the steri-strips as directed in order to get the optimum scar. You will also be given silicone sheeting, and instructed on when and how to apply it to the scar. Again, the purpose of the steri-strips and silicone is to achieve the best possible scar.
Subsequent Postoperative Visits
The next postoperative visit occurs at three weeks after surgery. At this visit, the nasal stents will be removed. This is a simple, painless procedure that consists of cutting one stitch and sliding the stents out of the nostrils.
You will also be instructed on massage of the lip at this visit; this is another important scar-management technique. You will be reminded that the lip will tend to pull upward as the scar contracts; this is a normal phenomenon, and the lip will relax down again with time. Massaging the lip will help counteract this tendency of the scar to contract.
In most cases, after the three-week visit, we will see your baby again at six weeks postoperatively, then at three months postoperatively, and then every three months thereafter.
By one year after surgery, the scar is usually mature and the lip is symmetric again.