Cleft Repair Surgery – Why is the surgery performed and what are the benefits of the surgery.

What is Cleft palate repair?

Cleft palate repair is a surgical procedure used to repair abnormalities in the hard and soft palates. In some babies born with cleft lip and palate, a portion of the palate (the front anterior portion) is fixed at the same procedure as the lip. The connecting of the soft palate muscles in a more natural posture is an essential element of the procedure.

The earliest we do the operation is when babies are approximately six months of age. To enable the two parts of the palate to be brought together, certain raw patches are sometimes left on the side of the palate. Children are normally admitted to the hospital for two nights, however they might  be discharged after one night.

Before the procedure

In the weeks leading up to the procedure, doctors recommend that you keep your child away from children or people who have colds, the flu, or other diseases.This reduces the chances that your baby’s procedure may have to be postponed due to illness. Because babies eat better on solids rather than milk soon after surgery, it is beneficial to wean your child between 17 weeks and six months before the procedure.

What occurs before the surgery?

In the month coming up to the procedure, you will need to bring your kid in for a pre-admission visit. The objective of this session is to go through the upcoming procedure and address any concerns you may have. Your child will need a medical examination and maybe a blood test. Pictures may be taken for medical records. 

A doctor may also visit you to explain the procedure in further detail, clarify any concerns you may have, and acquire your permission for surgery. Please notify the physicians if your infant has any medical issues, such as allergies. Please bring any medications your infant is taking with you on the day of the procedure.

What does the cleft palate repair procedure involve?

Your child may be admitted to the hospital the day of or the night before the procedure. One of the surgeons does the procedure. It entails reattaching tissues that were not connected before to birth . Depending on the degree of the cleft, the procedure normally takes two to four hours.

What kind of anesthesia is used?

An anesthesiologist who specializes in anesthesia for newborns and children administers a general anesthesia to your baby. One parent or caregiver may be permitted to accompany your infant to the anesthesia room and remain with them until they are unconscious.  To protect breathing, a tube is then inserted into the airway (trachea). A cannula (thin, plastic tube) is inserted into a vein and is generally kept in situ for a short period of time following the procedure. Fluids may be given to your infant via this tube both during and after the procedure, if required.

Are there any risks?

There is a little chance of infection after the procedure, however your infant will be given an antibiotic. Every anesthesia has a risk of problems, although it is quite low. There is a risk of bleeding during and after the procedure, however your kid will be given a tranexamic acid injection during the procedure and an intravenous infusion afterwards to minimize this risk. Your baby’s mouth will be uncomfortable after the procedures, partially because of the procedure itself, but also because the surgeon will need to move it around to heal the palate. The doctors will give your infant pain relievers so that he or she is not uncomfortable, especially during feeding.

If your baby’s mouth swells internally after the procedure, he or she may have trouble breathing for a time. If this occurs, the physicians will insert a temporary tube into your child’s nose to help them breathe until the swelling subsides. For the first few days, doctors will use a ‘saturation’ monitor to measure the quantity of oxygen in your child’s blood.

After the procedure, your baby will be sent to the recovery room, and one parent or caregiver will be permitted to accompany your infant while he or she awakens. Doctors offer pain relievers before your kid wakes up, but they may still be in pain. Children are often upset, maybe as a result of hunger. There is usually some bleeding in the first several hours following the procedure. This is often caused by the nose rather than the mouth.

When will my baby be able to feed?

Doctors encourage your infant to eat as soon as he or she is awake following the anesthesia. The first feeding may be challenging. If your infant is having difficulty feeding, doctors may recommend using a naso-gastric tube, which is put through one nostril and down into the stomach, for the first few meals.

What happens after the procedure?

There may be some bleeding from the nose or mouth at first, but this normally ends shortly. Only in rare cases may further steps be required to stop the bleeding. The corners of your baby’s mouth may become uncomfortable following the procedure.Raise the head of the cot and cuddle your kid over your shoulder to keep them more upright, reduce swelling, and make them more comfortable.

When your baby returns to the ward, milk and puree food may be given to him or her as soon as he or she is awake. If your infant does not like drinking from a bottle, fluids may be taken more readily using a spoon, syringe, or beaker. If your infant is hesitant to swallow, more fluid may need to be given through drip. Once they are able to drink normally again, the drip will be withdrawn. To keep the wound clean, give your infant some cooled, boiled water after each meal and medication.

Because your baby’s lips will be uncomfortable following the procedure, he or she may not want to eat or drink much. Various medications may be administered at regular intervals to alleviate discomfort and make eating more pleasant.

When you return home,

• Sleeping
• Raising the head of the cot might assist to decrease edema. 
• Feeding

Your baby should be back to a regular eating regimen of milk and puree food by the time he or she returns home. To begin with, newborns often prefer the consistency of puree food to milk, but they will tolerate fluids better after they become adjusted to their new palate. Encourage your child to consume cereal and packaged items that need mixing with milk. This will maintain fluid levels and ensure that they get enough nutrition.

Continue to use your child’s regular bottle since they are used to it. It may take some time for your youngster to acclimate to his or her new palate and feeding schedule. In the future, you may wish to try a tougher bottle or a teacher beaker, but please seek our guidance before making any modifications to your child’s eating.They recommend that your baby avoid hard meals for two weeks following the procedure and not use a dummy during this time, unless otherwise approved by your physician. Avoid allowing your kid to put their fingers or toys into their mouth, since this might cause injury.

Please remember to rinse your child’s mouth with cooled, boiling water after all milk, medications, and meals for at least two weeks after the procedure. This aids in the cleansing of the palate and prevents food from accumulating at the surgery site, which might lead to infection or wound disintegration.

Medicines

Pain relievers, such as paracetamol syrup or ibuprofen syrup, may be administered at home by following the dosing recommendations on the package. We recommend that you give your kid frequent pain relievers for at least two weeks following the procedure, giving a dosage around 30 minutes before feeding.

Infection

Infection following cleft palate surgery is uncommon, although symptoms include:

• Palate enlargement or redness
• Irritability
• Temperature increase
• Appetite loss

If your kid exhibits any of these symptoms, please contact the  doctor, since antibiotics may need to be repeated.

Stitches

These are dissolvable and will dissolve in two to three weeks, but for the time being, you should continue to rinse your baby’s mouth with cooled, boiling water after eating, drinking, or taking medication.When the sutures come out, a tiny hole in the palate may be left, which may mend without the need for further surgery. When your kid returns for a follow-up visit, this will be verified.

Followup

If your child has undergone a cleft palate procedure, he or she may need to return to the hospital five days later for a wound check. This should be scheduled before you leave the hospital.

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