What to Expect:
Cleft Palate 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.
You will also have an appointment this same day with the anesthesiologist in pre-operative clinic. At this appointment you will be instructed when to arrive the day of surgery and when your baby needs to stop eating and drinking before surgery. We encourage you to have the baby drink a lot the day before surgery and up until the time when oral intake should be stopped. It is more difficult to place IVs in babies who are dehydrated (from not drinking enough fluids). During this visit with the Pre-op clinic you will also be instructed where to check-in on the day of surgery.
We try to make small babies the first case of the day which usually means a 6 a.m. arrival for a 7 a.m. surgery start time. If you are traveling from a long distance and would like to stay at the Ronald McDonald house the night before, these arrangements can be made.
The Day of Surgery:
You will be instructed to arrive at the Surgery Center an hour to two hours before surgery. You will check in at registration on the first floor of the hospital. Once you are checked in, you will be taken to the pediatric holding area (you may be with your child in this area). It is time for the baby to come down to the operating room, you will be instructed to bring the baby to the holding area of the operating room (again you will be allowed to be with your baby). The baby will be examined by the plastic surgeon and the anesthesiologist again and this is a good opportunity to ask any last minute questions you may have. The baby will be given some oral medication to help make them sleepy. When it is time to go back to the operating room, the anesthesiologist will carry the baby back to the operating room and you will be shown how to obtain a pager so that we may contact you during the case.
The baby will be put under anesthesia using a mask. Once the baby is asleep, the IV will be started and the baby will be intubated (the breathing tube will be inserted to breathe for the baby during surgery). The baby will be positioned on the table and prepared for surgery. Once the case starts, 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.
After you have had the opportunity to meet with the surgeon, his nurse will escort you back to the recovery room so that you can be with your baby. Your baby will spend a variable amount of time in the recovery room, and then go to a room on the pediatric 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:
One parent is allowed to stay with the baby during their hospitalization. There is a waiting room at the end of the hall of the pediatric ward which has chairs that convert into beds. The other parent is welcome to stay there and the parents may switch off during the course of the baby's stay.
The pediatric plastic surgery nurse will teach you how to care for the surgical incisions and assist you with feeding issues.
Most babies spend two to three nights in the hospital after the palate repair. Their discharge will be dependent upon how well they are feeding and tolerating oral pain medication.
The surgeons make rounds on the baby daily. Please feel free to ask any questions during this time. You will also be visited daily by the pediatric plastic surgery nurse who will ensure that you understand how to care for your baby once he or she is discharged. All of your questions will be answered, and you will receive detailed discharge instructions before you leave the hospital.
After Discharge until the First Postoperative Clinic Visit:
Your baby will be discharged with arm restraints. These are to remain in place for two weeks to prevent the baby from sticking his/her fingers in the mouth and disturbing the surgical site. It is very important for you to keep the arm restraints on your baby. You will also be sent home with Haberman feeders and/or Brecht syringes for feeding. You will be well-versed in their usage prior to discharge.
Your baby will be seen in the clinic for the first postoperative visit approximately two weeks after surgery. During the 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 palate will be examined to make it is intact. Any feeding concerns will be addressed at this time as well. If all is well, the arm restraints may be removed, and you will be instructed on how to resume the baby's diet.
Subsequent Postoperative Visits:
The next postoperative visit occurs at six weeks after surgery. The palate will be examined again to make sure it is intact. Please note that once a normal diet has resumed you may find sutures in the stool. This is very normal and is no cause for alarm.
In most cases, after the six-week visit, we will see your baby again at twelve weeks postoperatively, then at six months postoperatively, and then every three months thereafter.