Updates

Cleft lip repair at North Austin Campus

Conditions

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In North Austin, we use advanced techniques to address all parts of a cleft lip. This includes the length of the lip, the muscle position in the upper lip, and the shape and position of the nostril. Our craniofacial orthodontist is very experienced in a technique called naso-alveolar molding (NAM) that can decrease the width of the cleft lip and improve nostril shape before surgery so that the cleft lip repair is more reliable. 

  • We usually repair a cleft lip when a baby is 3 to 6 month of age.
  • We do not perform cleft lip repair before the age of 3 months since we feel the first few months of a baby’s life should focus on early development and establishing routines and a sense of security whenever possible.
  • Infants undergoing nasoalveolar molding (NAM) may have their cleft lip repair closer to 6 months of age to allow time to complete the pre-molding treatment.
  • The surgery lasts 2 to 3 hours. Wide complete clefts and bilateral cleft lips take longer than incomplete and unilateral clefts.
  • Your surgeon starts by carefully marking the incisions with ink. They use special measuring calipers to make the plan accurate within 1/16th of an inch.
  • We have experience in several types of cleft lip repairs, including the “Fisher technique” and the “Modified Rotation-Advancement technique”. We personalize the treatment based on your baby’s specific type of cleft.
  • All these repairs give excellent results and place the scars to be in the natural lines and creases of the lip and nose. 
  • There is nothing missing in a cleft lip. The skin, muscle and cartilage of the lip and nose are in the wrong position and displaced in different directions.
  • The surgeon uses magnifying glasses and special small instruments to separate the different part of the cleft lip and nose.
  • They will reposition the cartilage of the nostril to make it round and similar in shape to a non-cleft nostril. If the wall between the nostrils (septum) is pushed to one side by the cleft, they will straighten this to improve your child’s breathing as they get older.
  • The surgeon will identify the three layers of muscle in the upper lip and re-orient them to create a lip that will move properly when speaking, whistling and eating.
  • The surgeon needs to tie close to 100 stitches during a cleft lip surgery. You will not see most of them since they place them under the skin. You may see a few stitches on the underside of the lip and inside the nostril. These will all dissolve by themselves.
  • Finally, the surgeon will carefully close the skin of the lip to make sure it is the correct length. In most cases, these stitches are dissolvable and very hard to see. They are purple or white stitches that are thinner than a hair. In wider clefts, we may use a few thin black stitches that we will remove in clinic at the first visit after surgery.
  • There are no dressings or bandages. Your surgeon will only apply a thin layer of antibiotic ointment on the incisions. 
  • In some cases, but not all, you surgeon may place a soft silicone nasal stent in each nostril. They will secure the stent with a stitch and will remove it in clinic 1 to 3 weeks after surgery. The stent helps support the cartilage of the nostril after surgery.
  • If your child has a very wide cleft and naso-alveolar molding (NAM) is not possible your surgeon may recommend a two-stage approach. The first surgery stage is called a “lip adhesion” when the surgeon brings the muscle and skin of the cleft together and places nasal stents. This will narrow the cleft and take tension off the skin as it relaxes. The second surgery stage takes place 1 to 2 months later and is the same as a usual cleft lip repair, but now the cleft is easier to manage. 
  • We will bring you into the recovery room early after the surgery is over to be with your baby. You can hold and cuddle you baby and see if they want to feed. We have found that early reunion of mothers with their baby and early feeding helps decrease the need for prescription pain medicine after surgery.
  • Your baby will not need arm protectors after cleft lip repair.
  • You can feed your baby the same way you did before surgery.
  • Your surgeon will place special nerve blocks to control your baby’s pain after surgery. These blocks last 3 hours and allow us to use Tylenol and Ibuprofen after the block wears off.  Our team may give a very small amount of prescription pain medicine for the first night.
  • Most babies spend 1 to 2 nights in hospital after cleft lip repair. They will need to be feeding well enough to maintain their weight, and they will need to be taking their liquid pain medicine by mouth. 
  • When you and your baby leave the hospital, you can start to return them to their usual activities such as bath time and play toys. We just ask you supervise them closely around older children and pets. They should be off all pain medicine by one week after surgery. 
  • Your surgeon will see you in clinic 7 to 10 days after surgery. They will check your baby’s early scar and teach you how to apply silicone scar gel for 4 to 6 weeks. 
  • Your baby’s upper lip and cheek will swell the day after surgery. The swelling will last for 3 days before going away quickly. 
  • Wide cleft lips and many bilateral cleft lips will appear “tight” after surgery. This is because the surgeon has repositioned the parts of the lip into their correct position but the skin is not used to it. This tight appearance will gradually go away as the skin relaxes and gets used to its new position. 
  • The cartilage of the nostril is also not used to being in a new position. In a wide bilateral cleft lip repair, the nostrils can look folded or collapsed immediately after surgery. Over time, the cartilages will continue to grow in their new position and the nostril shape will improve. 
  • Once the cleft lip has healed, we will continue to see you in clinic to follow your baby’s early scar. 
  • The scar will go through different phases of healing. From 3 weeks to 6 months after surgery, the scar will appear pink and will feel firm to the touch. We will teach you how to use silicone scar gel and light finger massage to help the scar soften more quickly. The pink color of the scar can last for 1 to 2 years before becoming more like skin color. 
  • Early scars will also go through a contraction phase where the lip scar with tighten and shorten. Over time, this will relax as the scar matures. 
  • Some children form heavy scars called “hypertrophic scars”. These look like raised scars that tighten more than usual. Hypertrophic scars usually get better with time. In rare severe cases, we may recommend special steroid injection into the scar as a brief day surgery procedure. 
  • Infection is a risk of every surgery. The risk of infection after cleft lip repair is the same as other skin surgeries. We will give your child an antibiotic while they are asleep during surgery. If there are any signs of infection (redness, swelling, tenderness, drainage) after your baby goes home, we will see your baby in clinic and start oral antibiotics. 
  • Scar formation is not a complication of surgery, but will depend on your child unique way of healing. With the same surgeon and same technique, each child will have a slightly different scar. With our technique, the need for a second lip revision surgery is rare. We will wait until the scar has fully matured over 2 to 3 years before deciding on a cleft lip revision. Most scars will take care of themselves with time.