Chapter 10: Isolated Lip Repair

This is generally performed when the baby weighs 5 kilograms or more, which is usually at around 3 months of age. Your baby will be in hospital for approximately four to seven days. You will be asked to bring your baby into the hospital the day before the scheduled surgery. This is so your baby can be assessed for fitness for the operation and to make sure that he or she does not have an infection that could complicate the anaesthetic. Blood is crossmatched for transfusion just in case it is needed during or after the operation, but it rarely is used.

Just before surgery your child will be put to sleep by an experienced anaesthetist. The plastic surgeon will then perform the surgical operation that is best suited to your baby's problem and this will take one to two hours. After the operation your baby will be taken to the recovery ward where he or she will be given special attention while he or she wakes up. After two or three hours your baby is sent back to the ward.

A taped protective metal splint called a 'Logan's Bow' will be taped over the repaired lip and your baby's arms will be splinted or restrained to prevent him or her playing with the lip or putting fingers in the mouth. The baby will soon get used to these splints, which need to stay in place for about two weeks. These splints can be taken off when you are with your baby, but when he or she goes back into the cot the splints must be replaced.

At the same time as the lip repair, the nose deformity is corrected, and so, as well as the stitches in the lip, you may also see stitches on the outside of the nose. These are helping to reshape the nostril.

When the metal splint is removed you will notice that the scar is quite red and more prominent than the rest of the lip. This will gradually fade over several months but may take as long as a year to settle completely. Generally, when the cleft is bilateral, both sides of the lip are repaired at the first operation, but sometimes, it is necessary to repair one side and then, after it has healed, in a few weeks the second side is closed.

Some bilateral and some very wide unilateral cleft lips may need a small preliminary operation on the lip or nosetip before the main repair a few weeks later, to enable a better repair to be achieved for these more difficult situations. While the lip is healing, the baby will be fed by a dropper or by a syringe and he or she may lose some weight but will soon regain it. If your baby is breastfed, this may be resumed just after the operation. Bottle-feeding can gradually be resumed when the lip has healed, usually two weeks after the operation. It is important that nothing hard, such as spoons, straws or dummies, are put into the mouth for the first few days after going home.

To promote healing, the suture line and nostrils are cleaned of crusts that may form, or to remove food particles. This can be done with sterile cottonwool buds and hydrogen peroxide solution, after which a thin film of prescribed ointment may be applied to the lip. After the sutures are removed, this cleaning routine needs to be continued for a few days.

You should contact your plastic surgeon or the hospital as soon as possible, if any of the following problems develop:

1. bleeding
2. wound separation
3. any odour or yellow discharge from the lip
4. persistent or unexplained fever
5. poor feeding or weight loss

In the weeks following the lip repair, the skin scar, which initially looks fine and neat, becomes pink in colour, perhaps raised, and hard to the touch. It is also a little tender. At this stage, about four to six weeks after the operation, the lip also looks tight or 'pulled up'.

Later, within six months of the operation, the scar fades and softens, the contour of the lip's Cupid's bow returns to a more normal shape and the lip starts to move normally.

The following diagrams show commonly used surgical procedure for repairing cleft lips.

Further Information

To obtain further information on "Cleft Lip and Palate: A Parent's Guide", please contact Belinda Liston:

Belina Liston
Cleft Palate Clinic Coordinator
The Cleft Palate Clinic
The Children's Hospital at Westmead
Locked Bag 4001
WESTMEAD NSW 2145
AUSTRALIA
T: + 61 2 9845 2079
F: + 61 2 9845 2078
E: BelindaS4@chw.edu.au