The lip repair is typically closed with non-absorbable sutures or absorbable sutures and tissue glue. Non-absorbable suturesmay be cleaned gently with soap and water, and are typically removed in the operating room 5-7 days after surgery. Absorbable sutures and tissue glueslowly break down over 10-14 days, often with a crusty or flaky appearance.
What is the purpose of a cleft lip repair?
- Separating the mouth and nasal tissues by closing the defect along its length
- Re-establishing soft palate muscle function to promote normal speech
- Recreating normal relation of the soft palate to the auditory canal and Eustachian tube to allow for normal hearing
- Promoting as much as possible the normal growth and development of the upper jaw and teeth
How to cure cleft lip?
Treatment Of Cleft Lip And Palate
- A) Cleft Lip. Surgery to treat cleft lip, which is to close the gap between the lip, should happen between 2-3 months after birth.
- B) Cleft Palate. A cleft palate can be temporarily covered by a palatal obturator which is a device that fits in the roof of the mouth that covers the gap.
- After Surgery Care Plan. ...
What to expect after cleft lip surgery?
After cleft lip surgery there will be sutures (stitches) in your child's lip. The amount of stitches in the incision line will depend on the extent of the initial deformity and the technique used by the surgeon for closure. The area will be pink around the stitches and slightly swollen. To protect the lip from the child
Does Jeff Withey have a repaired cleft lip?
He is born in Griffin Georgia and his father served during the Civil War and Mexican-American War. At birth, he already has cleft lip and cleft palate and it was repaired surgically by his uncle who is a surgeon. After the surgery, he went through a speech therapy that was performed by his mother. The cleft lip is also visible in his upper lip line.
How do you clean a cleft lip after surgery?
Wash the area daily with plain, warm water, and pat it dry. Other cleaning products, such as hydrogen peroxide, can make the wound heal more slowly. Do not use antibiotic ointments on the incision unless your doctor has told you to. Keep the area clean and dry.
How you will take care of an infant following a cleft lip repair?
Drinking and EatingGive soft, pureed or mashed foods for 3 weeks. ... Do not give foods that have chunks, lumps or pieces, such as seeds, grains, pulp or skin.Do not give hard, crunchy foods such as cold cereal, cookies, crackers or chips.Use only a spoon for feeding.Do not let your child feed themself.More items...
How long does it take for a cleft lip to heal?
Most children are back to their usual behaviour about a week after surgery. It usually takes about 3 to 4 weeks for the incision to heal. The incision will leave a pink or red scar. You can expect the scar to feel hard and tight at first.
What is a priority of nursing care for an infant after cleft lip repair?
Desired OutcomesNursing InterventionsRationaleFeed the infant slowly and burp frequently.Burping frequently during a feeding will reduce spitting up and prevent excessive swallowing of air.7 more rows•Mar 22, 2022
How long does a cleft palate repair take to heal?
How to Protect the Cleft Palate Repair. Once you get home, your child's palate will take three weeks or more to heal.
Which goal is priority after surgical repair of cleft lip?
After Surgery Care. The goal after surgery is to protect the new repair and stitches. For this reason there will be some changes in the child's feeding, positioning, and activity for a short time. Remember, these are only temporary!
Is cleft lip a disability?
FACT: A cleft is not a 'disability'. It may affect a child in ways that mean they need extra help, but most children with a cleft are not affected by any other condition and are capable of doing just as well at school as any other child.
How do you massage a cleft scar?
Scar massage is performed by using the pads of your fingertips and applying firm pressure to your scar and then moving in a circular motion over the scar. The pressure should cause the scar to blanch (turn pale) but not so hard that it hurts.
How many surgeries does it take to fix a cleft palate?
That varies from patient to patient. At the minimum, one surgery is needed to repair the lip and a separate surgery is needed to repair the palate. However, several surgeries are needed to make the lip appear as normal as possible. And sometimes additional surgeries involving the palate are needed to improve speech.
Which of the following will most likely be compromised in a newborn with cleft lip?
While assessing a newborn with cleft lip, the nurse would be alert that which of the following will most likely be compromised? Rationale: Because of the defect, the child will be unable to from the mouth adequately around nipple, thereby requiring special devices to allow for feeding and sucking gratification.
How do you feed a baby with a cleft lip and palate?
Most babies born with a cleft lip (and no cleft palate) feed well without any special equipment. They usually can breastfeed or use a regular bottle-feeding system. The only change needed might be positioning the nipple so the baby can latch.
What is a Logan bar for cleft lip?
The Logan Bow is an external device comprising a curved bow-shaped metal bar, with spikes attached to its cross bars, and is widely used as part of a cleft lip management to maintain postoperative apposition and to avoid excessive strain after cheiloplasty for a cleft lip.
How do babies with cleft lip eat?
Most babies born with a cleft lip (and no cleft palate) feed well without any special equipment. They usually can breastfeed or use a regular bottle-feeding system. The only change needed might be positioning the nipple so the baby can latch.
Can cleft lip babies use pacifiers?
See the education sheet, "Cleft palate repair: Feeding your child". Again, all feedings should be followed by a water rinse. No nipples, pacifiers, or straws are permitted. Your doctor will decide if a cup with a small lip can be used.
What are elbow restraints used for?
Elbow immobilizers (also known as welcome sleeves) are put on the arms of infants and young children following certain types of surgeries or procedures. The welcome sleeves are worn to prevent the child from bending their elbows and touching the surgical repair or important medical device.
What is cleft palate surgery called?
A cleft palate usually is repaired with surgery called palatoplasty (PAL-eh-tuh-plass-tee) when the baby is 10–12 months old. The goals of palatoplasty are to: Close the opening between the nose and mouth. Help create a palate that works well for speech.
How to clean a cleft lip incision?
A common recommendation is to apply the cleaning solution with a cotton swab in a circular motion without applying pressure directly on the incision. Your surgeon may also recommend an antibiotic ointment, such as bacitracin or Neosporin, which you apply to your child’s incision after you have cleaned the skin and allowed sufficient time for the site to dry. 3 This is used to help protect the incision from nasal drainage by creating a barrier between the drainage and the skin, as well as inhibit the growth of germs. This is especially important since the incision for a cleft-lip repair is so close to the nose and mouth, which is a particularly dirty area. Antibiotic ointment can also be useful because it prevents the formation of a scab-like crust at the incision, which can sometimes be painful. Typically, your surgeon will recommend you apply the ointment about three times a day for two days, but again, each case is different.
Why is it important to repair a cleft lip?
Updated on October 01, 2020. Proper management of your child’s cleft lip repair is very important to prevent damage to the surgical site. Any complications can lead to additional scarring, a longer healing period, and even increase the possibility that your child will need extra surgeries. This article will explain how to best care ...
What to do after cleft lip surgery?
Managing Pain. Your child will have some pain after their cleft lip repair, which will be controlled using pain medications. Right after surgery, this will probably be a narcotic pain medication that is given through your child's IV. As your child recovers, they will require less and less pain medicine.
Why is antibiotic ointment important for cleft lip?
Antibiotic ointment can also be useful because it prevents the formation of a scab-like crust at the incision, which can sometimes be painful.
How to keep a child from bumping their nose?
When you are holding your child, cradling them is preferred to keep them from bumping their lip and nose into your shoulder until they have fully healed. When they are lying down, be sure to keep them off their stomach as well by keeping them in either a side or back-lying position.
Can antibiotics be taken after cleft lip surgery?
If your doctor has prescribed antibiotics to be taken after the cleft lip repair, make sure you give the medication to your child on time, as directed, and until the bottle is completely gone. Keeping your child’s incision and sutures clean is very important in preventing infection. Some surgeons will have you clean the incision regularly, ...
Can you use forks on a child's mouth?
1 If you are spoon-feeding, you need to ensure that you are using the side of the spoon for feeding. Do not use forks or other utensils, as they can damage the incision.
What is a cleft lip?
Cleft lip is a common birth defect (problem). With cleft lip, the skin on your child's upper lip has not grown together normally. Clefts may look different from one child to another. Some clefts may only be a small notch in the red part of the lip. Other clefts may have an opening into the floor (bottom) of the inside of the nose.
What to do after lip surgery?
Speech therapy: Even after surgery, your child may need help learning how to talk in a normal way. A speech therapist is specially trained to help your child learn to speak better. Your child may need to work with a speech therapist for many years. Your child also may need more surgery to fix his lip.
What is a cleft on the inside of the nose called?
Other clefts may have an opening into the floor (bottom) of the inside of the nose. The cleft may be on one or both sides of your child's lip. If it is on one side, it is called a unilateral (u-nih-LAH-ter-al) cleft. If it is on both sides, it is called a bilateral (bi-LAH-ter-al) cleft.
How to give a child liquids?
Use a cup, a rubber-tipped syringe, or the side of a spoon to give your child liquids. Do not use a bottle or a straw.
How to make a child feel better after surgery?
Most children feel better quickly after surgery. Let your child rest as much as needed. Your child will return to normal activity when he feels ready.
Can a child have stitches in his mouth?
It is important to watch your child at all times to prevent this from happening. Your child should not put his hands or other things into his mouth.
How to clean a wound after feeding a child?
Your health care provider may give you a special liquid for cleaning the wound. Use a cotton swab (Q-tip) to do so. If not, clean with warm water and soap. Wash your hands before starting. Begin at the end that is closer to the nose.
How to get a cuff off a shirt?
Put on the cuffs over a long-sleeve shirt. Tape them to the shirt to keep them in place if needed. You may take the cuffs off 2 or 3 times a day. Take off only 1 at a time. Move your child's arms and hands around, always holding on and keeping them from touching the incision.
What to do if you have bleeding from a nose incision?
The incision is red, or there is drainage. There is any bleeding from the incision, mouth, or nose. If bleeding is heavy, go to the emergency room or call 911 or the local emergency number.
How to prepare food for a child after surgery?
Older infants or young children will need to have their food softened or pureed for some time after surgery so it is easy to swallow. Use a blender or food processor to prepare food for your child.
How long does speech therapy last?
Your provider will refer your child to a speech therapist. The provider may also make a referral to a dietician. Most times, speech therapy lasts 2 months. You will be told when to make a follow-up appointment.
How long does it take for a child's nose to go away after anesthesia?
There will be some drainage from their mouths and noses. The drainage should go away after about 1 week.
How to fix cleft lip nasal deformity?
Early management of the cleft lip nasal deformity can be approached with Nasoalveolar molding (NAM) to passively mold the alveolar arch, expand the ala, and increase the columellar length , effectively remodeling the dentofacial skeleton.47–49While advocates of NAM cite advantages including facilitation of the primary repair and sufficient alignment of the alveolar cleft segments enabling a gingivoperiosteoplasty (GPP) to be performed at the time of repair, opponents argue that there is a paucity of high-level evidence to support long-term benefits.49–54In a retrospective study performed by Chang et al over an 11-year period assessing primary cleft rhinoplasty outcomes, patients who underwent NAM plus primary rhinoplasty and overcorrection demonstrated the best long-term outcomes. However, this cohort was treated with silicone sheets and nasal conformers for an additional 6 months postoperatively to maintain overcorrection.55
What is the challenge of reconstruction of cleft lip?
The challenge in reconstruction of the cleft lip and nasal deformity is based on restoration of the normal anatomy of the individual orofacial cleft, which can present with varying degrees of severity, as well as correction that anticipates the fourth-dimensional changes that occur over time. Constant self-evaluation of surgical outcomes and course correction is necessary to continually improve and achieve consistent results.
What muscle fibers are involved in unilateral cleft lip?
In the complete unilateral cleft lip and nasal deformity, the superficialis muscle fibers proceed horizontally from the modiolus and insert in a discontinuous manner along the margins of the cleft.28,29These muscular fibers terminate beneath the base of the columella along the noncleft side and beneath the base of the nasal ala along the cleft side. The profundus, while present, is hypoplastic and, rather than projecting anteriorly giving rise to a cutaneous-vermilion junction or white roll, terminates within the vermillion mucosa.14,28,29,31,35In addition, the course of the cleft segment’s paranasal muscle fibers from the ala to the anterior nasal spine is interrupted, contributing to nasal deviation.36,37These aberrant muscular insertions create facial imbalance further intensified by the degree of the retropositioned and hypoplastic maxillary cleft segment. Unopposed muscular forces result in an asymmetric nasal tip via displacement of the caudal septum, the cleft medial crural footplate, and columella toward the noncleft side and compensatory bowing of the septum, flaring of the cleft side LLC, and widening of the alar base towards the cleft side.28,29,31The LLC’s change in position affects its attachment to the upper lateral cartilage (ULC) and weakens both the upper lateral cartilage and scroll region.
What is cleft marking?
Our cleft markings are a modification of Millard’s rotation advancement technique with the addition of an inferior triangular flap from the lateral lip element (Fig. (Fig.2).2). This modification accounts for the vertical height deficiency and lip shortening seen with overcorrection of the nasal deformity in our patient population over time. Additional landmarks include accurate identification of the wet-dry junction along the red line just above the transitional epithelium. This is important for color match, particularly when incorporating Noordhoff’s triangular flap to augment the noncleft side dry vermillion deficiency. Marking of the white roll are to be made above and below Cupid’s bow peak to preserve topography during realignment of this three-dimensional scroll region.
How to mobilize a retropositioned cleft nasal base?
To mobilize the retropositioned cleft nasal base into natural anatomic position, we release the accessory chain along the piriform aperture. The deviated caudal septum is exposed and released from its insertion to the anterior nasal spine. This allows for repositioning of the caudal septum toward the midline and represents a modification of our technique from prior outcome analysis. Patients who did not undergo septal repositioning had an increase in relapse of nasal tip deformity and need for intermediate rhinoplasty at school age.
What is the surgical design for unilateral cleft lip?
In our patient population of predominantly Hispanic ethnicity, our surgical design for the unilateral cleft lip and nasal deformity is a modification of the Millard rotation advancement technique. 15,24,25This modification evolved after analysis of our long-term results, where an unfavorable lip shortening and elevation of Cupid’s bow was noted on the cleft side, despite placement of a small Z plasty above Cupid’s bow. As a result, a triangular flap marked on the lateral lip segment was incorporated into the surgical design and has since augmented this lip length deficiency. In addition, we prioritize correction of the nasal deformity. A component of the repair that has evolved throughout practice is the recognition that the nose is the most visible and central component of the face, while the lip lies in its shadow.
Is cleft lip a heterogeneous population?
The cleft population as a whole is heterogeneous, and many treatment protocols have been developed worldwide to prioritize the needs of individual patient populations.1–5Within different population groups, variations exist in the treatment of patients with cleft lip and nasal deformity. The variations include timing of repair, technique used, sequencing, scar burden, emphasis on facial growth and speech outcomes, socioeconomic restraints, resource availability, and cultural perception.2–12An understanding of characteristics specific to the patient population being cared for is essential to achieving optimal outcomes.
What is cleft lip repair?
Cleft lip repair, also called cheiloplasty, is surgery to correct a cleft lip. Cleft lip is a birth defect that occurs when the upper lip doesn't fuse together properly during development. It can look like a small notch in the edge of the lip or it can extend into the nose and gums. Cleft lip can affect one side of the mouth, called a unilateral cleft, or both sides of the mouth, called a bilateral cleft.
How does a child's doctor fix a cleft lip?
Your child's doctor will perform cleft lip repair using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put your child in a deep sleep. Your child is unaware of the procedure and will not feel any pain.
Why is cleft lip repair surgery performed?
Cleft lip repair treats a cleft lip. Left untreated, cleft lip can cause problems with feeding, growth and development, ear infections, hearing, speech, and self-esteem. Dental problems are also associated with cleft lip.
What are the risks and potential complications of cleft lip repair?
Most cleft lip repairs are successful, but complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
What can I expect after my child's cleft lip repair surgery?
Knowing what to expect can help make your child's road to recovery after cleft lip repair as smooth as possible.
What is lip adhesion?
Lip adhesion procedure or molding plate to bring the sides of a very wide cleft lip closer together before cleft lip repair surgery
How old do you have to be to have cleft lip surgery?
Most children with cleft lip have the surgery between three to six months of age.
Management
Results
- After your childs surgery, they will remain in the hospital until they are able to be supported nutritionally, their pain is well-controlled, and they are finished with necessary intravenous medications or able to take these medications by mouth. Feeding after this surgery can be one of the biggest obstacles you need to overcome in order to take your child home.
Controversy
- You may find that there is a lot of controversy over whether you should breastfeed, bottle-feed, or spoon-feed your child during the time period immediately following surgery (post-op period). The method that you choose will depend on your child's individual circumstances as well as your own personal preferences and your family's needs. Your medical team, including your surgeon and s…
Treatment
- Regardless of the method you choose to feed your child, protection of the incision (wound) area is necessary for your child to heal. It is discouraged to have anything hard in your childs mouth until after the surgical incisions have healed. If you are spoon-feeding, you need to ensure that you are using the side of the spoon for feeding. Do not use forks or other utensils, as they can damage t…
Prevention
- After surgery, your child will have soft arm or elbow restraints on to help prevent them from rubbing or messing with their incision. Generally, the restraints will need to be used for approximately 2 to 3 weeks. During this time, it is important for them to wear the restraints as much as possible. While you are supervising them, it is okay to remove the restraints several tim…
Risks
- You should not worry about your child becoming addicted to narcotic pain medication. Controlling pain will help your child to heal faster because they will get more restful sleep. Pain can also raise a person's heart rate and blood pressure and can cause the release of a hormone called cortisol, which can actually inhibit the immune system. You should also be aware that unrelieved pain ca…