What to expect after cleft palate surgery

What to expect after cleft palate surgery

We do cleft palate repair between the ages of nine and 18 months in order to allow time for your child’s facial structures to grow. Waiting leads to a better overall repair of the bones and muscles that help your child speak.

The information in this handout will help you plan for what to expect as your child recovers from surgery.

Your surgeon’s repair of your child’s palate involves the floor of the nasal passage, the reconnection, and repair of the muscle on the top of the mouth (velopharyngeal muscle) and the roof of the mouth. This will close the cleft, allowing the development of speech and improving feeding abilities.

Appearance

All the parts necessary to repair the palate are present in your child. The tissue on either side of the cleft on the roof of the mouth is divided and moved to the center.

Because a layer of tissue has been moved, it might look like the defects have moved to the side of the cleft. These will look like grooves on either side of the palate. But since these defects don’t go through all the layers of the palate as they did before, this will fill in as the palate heals.

The area around the incision (the cut your surgeon makes) will swell as it heals. The swelling will be the worst the day after surgery and then will gradually go away. You’ll be able to see the sutures (stitches used to close up the site where surgery was done) in your child’s mouth. These will dissolve on their own and do NOT need to be removed.

Pain

• Your child may have some mild discomfort at home. If your infant is irritable and not feeding well, he or she may be in pain. Give acetaminophen (Tylenol®) and Ibuprofen as directed by your child’s doctor. Both come as a tablet, caplet, and liquid. They are used to relieve mild to moderate pain and to reduce fever. It is important to take acetaminophen exactly as directed by your doctor. Follow the directions on the package and ask your doctor or pharmacist to explain any part you do not understand. Do not take more or less of it than prescribed by your doctor. Do not take it any more often than prescribed by your doctor.
• If your child has more than mild discomfort, the doctor may prescribe medicine to help ease the pain. Give pain medicine as prescribed and instructed by your doctor and nurse.
• Try to schedule a dose of pain medicine around bedtime, especially for the first few days at home. This will help your child sleep better

Constipation

• Keep track of your child’s bowel habits. He or she should return to previous bowel habits. If not, he or she may be constipated.
  • Call your child’s pediatrician or Dr. Morrison if you think your child is constipated.

Skin and Wound Care

• The incision is closed with absorbable sutures. You may offer your child a small amount of water after eating or drinking to wash out the mouth and keep things clean. Otherwise no wound care is needed.
• You can bathe your child in the tub as usual.

At-Home Care

A complete list of instructions for taking care of your child at home will be given to you before you leave the hospital. The main things to remember are:

• If you notice any of the following changes in your child, call the surgeon right away:
  • Fever higher than 101.4˚F
  • Trouble breathing or skin color changes (pale, blue  or gray)
  • Bleeding or foul-smelling drainage from the scar
  • Signs of dehydration, including lack of energy, sunken    eyes, dry mouth or not urinating enough/fewer wet diapers
  • Any redness or swelling
• Your child can drink any kind of liquid once he or she gets home. Your child may also eat any kind of food that can be watered down and poured from a cup or bottle, including yogurt (such as Go-GURT®), pudding, milkshakes, or anything that you can grind in a blender to be as smooth as baby food. Remember, though—no utensils or straws!
• After drinking any milk products, have your child drink clear water to wash out the mouth and prevent the buildup of milk along the incision.
• Your child may be given an antibiotic for the first couple of weeks after surgery
• The no-no’s must stay on your child’s arms for at least 2 weeks. You should check them every 2 to 4 hours to make sure they are not too tight, and take them off briefly several times a day to allow your child to bend and move his or her arms. Change the long-sleeve T-shirt after you bathe your child.
• Occasionally, the no-no’s will be taped in place with signs that say, “Do Not Remove.” If that is the case with your child, it is important that you leave them in place until your doctor removes them.