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Cleft Lip and Palate Surgery – Information for Parents

 

Prior to Admission

Your child will be seen at the Craniofacial Center for a pre-op visit prior to surgery.  At that visit, the details of the surgery, preoperative requirements, and recovery will be discussed.  Your child will also need to see their primary physician for a history and physical within 2 week of the operative date.

Coming to the Hospital

After surgery, your child will be taken care of either on the pediatric ward or in the pediatric intensive care unit (PICU).  Both of these units are located on the 3rd floor of the hospital.   During the hospital stay, we will show you how to take care of your child at home.  The pediatric units provide diapers, formula, and baby food.  You are welcome to bring a few items to make your baby feel more comfortable and secure—such as a favorite toy, stuffed animal, or blanket.  Parents may stay in their child’s room after surgery.  Each unit has specific visiting hours and guidelines.  Please check with the nursing staff on your unit for details.

Day of Admission

The Pre-Surgery department will contact you the day before your child’s surgery.  They will tell you the time of the surgery and at what time you need to arrive. The Admitting/Registration Desk is located in the Main Lobby at Mercy Medical Center.  Remember to bring your insurance card with you.  When checking in, let them know that your child is scheduled for surgery that day.  After you are admitted, you and your child will be taken to the pre-surgery area where the nurses and anesthesiologist who will be taking care of your child will meet with you.  Dr. Maurice will also visit with you there.

Surgery time varies with each case depending on the size of the cleft and the amount of repair that is required.  Surgery time on average is between 2 and 4 hours. 

During surgery, you may wait in the Surgical Waiting Room, which is located on the first floor of the hospital across from Starbucks.  After surgery, Dr. Maurice will speak with you.  After surgery, your child will either go to the recovery room or directly up to the PICU.  From the recovery room, your child will be transferred to a Pediatric Unit.  You will be reunited at this point. 

After Surgery

Your child may be awake, sleepy, or asleep when he or she is transferred from the recovery room to the pediatric unit.  Your child will have a few tubes and wires attached to him or her.  These may include a pulse oximeter (a monitor that helps measure the oxygen level in your child’s blood), cardiac monitor (a monitor that record’s your child’s heart rate and rhythm), and an IV (a plastic tube that goes into your child’s vein so he or she can receive fluids and medicines that can’t be taken by mouth).  Your child may have some discomfort after surgery.  We will give your child pain medicines through the IV or by mouth.

Care During Recovery

There will be a suture line where the repair was performed.  The area may appear swollen; this usually decreases within 3 to 5 days.  After a cleft lip repair, there may be small tapes (steri-strips) over the suture area.  For some cleft lip repairs, a plastic stent may also be placed in the nose to help maintain its shape.  You may notice some blood-tinged drainage from the surgical site.  Do not be alarmed; this is normal for a day or so.  Your child may be fussy or irritable for a while after surgery; this may last about 3 to 5 days.

To help prevent falls, be sure to keep the side rails of your child’s crib up.  Your child will be placed in arm immobilizers to help prevent him or her from touching his or her mouth and disrupting the repair.  Under supervision, the arm restraints should be taken off four times a day to check for skin irritation.  Loosen only one at a time, and do not let your child’s hands near his or her mouth.  Exercise your child’s arms when the restraints are off so that they don’t become stiff.  Otherwise, your child should remain in the restraints at all times.  Your baby must wear the restraints for 2 weeks following surgery.  Arm immobilizers can make your child clumsy, so if your child is walking, watch for falls.

Following a cleft lip repair, try to keep your child from rolling onto his or her stomach for 2 weeks following surgery to avoid irritation of the incision.

After You Go Home

If steri-strip were placed over a cleft lip incision, leave these in place until they fall off by themselves. 

If non-dissolvable sutures were used, your child will be taken back to the operating room for suture removal the following week.  If dissolvable sutures were used, your child will return to the office in approximately 1-3 weeks for a check-up. After a cleft lip repair, there will be a scar on your child’s lip that will become less noticeable over time.  Sun exposure to the incision should be minimized for 12 months to reduce darkening of the scar.

Feeding After Surgery

After cleft lip and palate surgery, your child can resume feeding with the same nipple and bottle used prior to surgery.  On occasion, some children may resist feeding from a bottle.  If this occurs, we may teach you how to feed instead with a syringe during the hospital stay.  We will instruct you on what you need to do to feed your child.  Feeding may go slowly at first, but will return to normal with time. 

Do not use pacifiers, straws, sippy cups, popsicle sticks, or anything hard for 3 weeks following surgery as these may damage the repair. 

Pain Management

Immediately after surgery, your child will receive pain medication through the IV.  When your child is tolerating fluids, he or she will be given liquid pain medications by mouth (usually either Tylenol with hydrocodone or regular Tylenol).  You will be sent home with a prescription for pain medications for your child.  It may be helpful to give pain medication 30 minutes before feedings to ease pain with eating.  Ibuprofen (e.g. Advil, Motrin) can be used only after being OK’d by Dr. Maurice.

When to Contact Dr. Maurice’s Office After Cleft Repair

  • Bleeding from the incision
  • Rupture of the suture line
  • Signs of infection (increased redness, warmth, swelling of the incision, or pus-like drainage)
  • Temperature over 102 degrees F when taken rectally
  • Refusal to take fluids or persistent vomiting
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1111 6th Avenue
Des Moines, Iowa 50314

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