Pre-operative care and surgery for cleft lip and/or palate

A child who is born with a cleft lip and/or palate in the UK will usually have the cleft in the lip closed (operated on) at 3 months of age, and the cleft in the palate closed at 6–9 months of age. These children may also need other operations throughout childhood and into adulthood (see ‘Cleft treatment pathway‘). It is not always necessary for a child with a very small cleft lip to have an operation – sometimes small lip closures are done only for cosmetic reasons.

All of the parents we spoke to whose child had a cleft lip had agreed that their child should have their lip closed at approximately 3 months of age. Similarly, all parents whose child was born with a cleft palate had consented to have their child’s palate closed or were making preparations for future surgery. Prior to having a cleft lip and/or palate repair it is important that the child is free from coughs and colds, chicken pox and other viral infections as the surgical team will not operate if a child is unwell. This can delay the closure of a cleft lip and/or palate.

Tamsin and Andrew describe the process they went through leading up to their son’s first surgery to close his bilateral cleft lip.

Age at interview 29

Gender Male

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All families have the opportunity to discuss any surgery their child might undergo at a multi-disciplinary team (MDT) meeting and they can ask questions directly to the surgeon who will perform the lip and/or palate closure. A clinical nurse specialist (CNS) will also be contactable to answer any questions that families might have regarding surgery for cleft lip and/or palate.

Michelle tells how she coped with her son having his cleft lip repaired at 3 months.

Age at interview 33

Gender Female

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One of the issues is that any surgery on the face will alter the child’s appearance and so parents and other family members will need to adapt to the fact that their child will look different after the operation.

Millie and Michael discuss how they prepared themselves for their son’s cleft lip closure at 3 months knowing that he would lose the smile they were familiar with.

Age at interview 20

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Knowing that their child would be anaesthetised and have an operation caused concern for parents. Many parents found it difficult to watch their child have a general anaesthetic before their operation. Of the parents we interviewed, it was common for the child’s father to be there when the mask was placed on the baby’s face, and mothers were more likely to stay overnight in hospital – usually for one night only, before the child is discharged and allowed to go home.

Iva discusses her experience of her son’s lip repair at 4 months and how she found it difficult to know that he would have a general anaesthetic.

Age at interview 29

Gender Female

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The surgery to close cleft lip and palate can take 2–3 hours, but this depends on the type of cleft (unilateral: one-sided cleft, or bilateral: 2-sided cleft) and whether, for example, the nose is affected.

Rebecca and Russell’s daughter had her cleft palate closed and the operation took longer than they had expected

Age at interview 23

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In rare cases a cleft palate can split again during the healing process for no apparent reason after it has been closed, and the child will have to undergo surgery again.

Safiya’s son had to have his cleft palate closed again as it had split after the first surgery.

Age at interview 21

Gender Female

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Laura’s daughter received a late diagnosis of a cleft palate and was given 2 weeks’ notice of her palate closure surgery.

Age at interview 22

Gender Female

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Andy and Diane were anxious in the lead up to their son’s closure of his cleft lip but were reassured by the skill of the surgeon.

Age at interview 36

Gender Male

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The cleft treatment pathway

In the UK, a baby with a cleft lip has the cleft closed at approximately 3 months of age, and a cleft palate closed at...