Dr. Hisham Burezq, BSc MD FRCSC FAAP
Consultant Plastic & Reconstructive Surgeon
Consultant Pediatric Plastic Surgeon
Canadian Board and fellowship in plastic surgery
Cleft lip is one of the most common birth defects that results in an opening of the upper lip that may include the roof of the mouth (palate) during fetus development in the uterus. Our lips form between four and eight weeks of pregnancy. During this time period of pregnancy, tissues from each side of the face join together in the center to make our lips and mouth. A cleft lip happens when tissues don’t join completely in the center. As a result, a gap forms between the two sides of upper lip. Various degrees can present from a small indentation of the upper lip to large gap that reaches the nose or even include the gums and the roof of the mouth (palate).
Cleft lip repair is performed by a specialized plastic surgeon with a high success rate. The presence of an integrated multi-specialty medical team is very important and essential to obtain the best results (Orthodontic Consultant, Ear, Nose, Throat (ENT) Surgeon, Speech and Hearing Therapist, Pediatric Dental Consultant, Gene Specialist, and Pediatric Consultant).
In these cases, the lip correction operation is a reconstructive surgery in which the lip is reshaped, the muscle is repaired, and the nose openings and cartilage are initially adjusted.
Timing of surgery:
Cleft lip repair is performed between the ages of 3-6 months old; provided that the baby’s jaw and nose correction procedure is completed (which starts one week after birth) and the baby weighs up to 4.5 kg with hemoglobin levels not less than 10.
Cleft Lip Repair Before Surgery Instructions
The baby is allowed to breastfeed for up to 8 hours and drink water up to 4 hours before the surgery.
After the Baby enters the Ward:
The nurse will insert an IV cannula and give the baby the nutrient solution. Your baby will be admitted to the ward before surgery. This cannula is used to give the baby pain medications, nutrients and antibiotics. The cannula is removed by the nurse before the baby is discharged from the hospital and after serving its purpose.
The lip repair operation is a one-day procedure and the baby can leave the hospital on the operation day.
The operation time varies from one baby to another, but it generally takes about an hour and a half, and the baby is then transferred to the recovery room to stay there for about an hour.
Breastfeeding
It is permissible to breastfeed the baby (naturally or artificially) after two hours of the operation. First, the baby starts with the water and sugar solution and then he can drink the usual milk or formula. If the mother has difficulty breastfeeding, a syringe will be provided to help feed the baby for the first 1-2 days.
It is recommended to clean the mouth with water using the syringe, as the presence of milk between the lip and the gums may cause inflammation of the wound.
Wound Care
- At first, the lip will be swollen, and there may be some bruising in the lip and cheek, with the presence of small patches in place of the wound.
- A silicone nasal stent will be placed with a thread that will be removed one week after the operation. Using the stent for 6 months is important to maintain the correction made during the operation. Your doctor will change the size of the stent over time.
- Taking care of the wound and keeping it clean is very important. The wound is cleaned with a piece of cotton filled with water and cleaned gently without pressure. If there is dry blood on the wound, it can be removed gradually using a diluted hydrogen peroxide solution.
- One of the important methods for taking care of the wound is to prevent contact with it either while sleeping or via the baby’s hand, and there are several methods to prevent the baby from reaching the lip. This is important especially in the first two weeks following the operation; due to the wound’s sensitivity in this period.
- After two weeks and if the wound is healed well, your doctor will explain how to take care of the scar, along with doing a massage and using some special creams.
Pain Treatment
Pain results from moving tissues and muscles and affecting some fine nerve endings in the skin during the operation. This is often reduced in a gradual and rapid manner. Pain is treated with a dose of Panadol every 4 hours on a regular basis.
The Scar’s Final Shape after Repair
Wound healing and scar stability takes time and the end result appears one to two years after the operation. 15% of children need a correction procedure before they enter school, which is usually a simple surgical intervention that takes no more than half an hour.
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