Cleft Lip and Nose Repair

For 1-2 weeks after surgery, your child may need extra attention and understanding. It is OK to respond to your child’s need for extra holding and comforting.

Your child will have an IV (intravenous) tube in place for giving fluids and pain medicines.

Some children will have soft plastic tubes called stents in the nose. These stents maintain the shape of the nose while it heals.

The lip and nose will be swollen. You may see a little bloody drainage around the lips and nose. You will see stitches on the lip and under the nose, and they will be covered in ointment.

When your child wakes up, you can try to feed them using whatever bottle or cup you normally use. Breast-fed babies can nurse right away. Most children will eat fairly well after surgery but a few will refuse feedings at first.

The nurses will help you find a way to feed your child. This may include giving pain medicine just before feedings, and possibly using a syringe or squeeze bottle for feedings until your child is willing to go back to their usual feeding method.

Older children can eat their normal diets but should start with softer foods at first.

We partner with you and your child to prevent and relieve pain as completely as possible. You know your child best. We encourage you to take an active part in your child’s recovery by talking with your care team about options for your child. After a surgery your child is likely to have some pain and discomfort. In addition to medicine prescribed for pain, we will work with you to create a plan that encourages coping activities to treat pain and provide support. No matter the level of your child’s pain, we join you to assess and respond right away. Help your child get better, faster with good pain treatment.

You can read more in our handout “Acute Pain: Pain relief for a surgery or medical procedure.” seattlechildrens.org/pdf/PE503.pdf

Some prescription pain medicines can cause constipation. If this is a problem for your baby, you may give 1 to 2 ounces of pear juice each day until it gets better, if your baby’s healthcare provider says it is OK.

Older children should drink more fluids than usual, like juice and water, and eat high fiber foods. If needed, stool softener medication can also be prescribed.

Talk with your doctor about using an infant glycerin suppository if your baby is very uncomfortable from constipation. You can buy them over-the-counter at any pharmacy.

Check with your doctor first before giving any type of medicine to your child.

Try to avoid letting scabs or crusts build up on your child’s stitches (which closed the incisions). Clean your child’s lip and nose incisions with warm water and a little mild soap every day. Pat dry. Apply petroleum jelly (Vaseline) to the incisions 3 or 4 times a day to keep them moist and greasy. Wipe or wash away the old petroleum jelly with a clean finger, clean soft cloth, or moist Q-tip before applying a new layer.

If the lip incisions get “crusty,” loosen the crusts gently with warm water and remove them as often as needed. If there is dried blood that is hard to remove, you can use a mix of half hydrogen peroxide and half water to loosen the crusts. Soak the area thoroughly with the mixed hydrogen peroxide and water solution. The crusts or dried blood will wipe off easily.

Your child will not hurt the incision by touching it or putting their fingers in their mouths. Your baby should avoid regular use of a pacifier because the outside rim (flange) can press against the lip incision.

Older children should not participate in sports or gym class for 6 weeks unless your doctor says otherwise. They should also avoid playgrounds, ball games and anything with wheels (bikes, scooters, skates).

Your surgeon will tell you if your child’s stitches will dissolve on their own or if we need to remove them about 1 week after surgery. You should have an appointment to have the stitches removed before you leave the hospital.

If your child has nasal stents, try to keep them from getting clogged with dried mucus or blood. Your nurse will show you how to put saline drops or spray in the stents to keep the nasal stents clear.

Put saline into the stents 4 or more times a day. They are less likely to clog the more often you do this. This will not hurt your child, though they may sneeze or not like it. This is fine — the stents are stitched in and should stay securely in place.

Sometimes the nasal stents will become blocked. As long as 1 side stays open, this is usually not a problem. If both sides get blocked, or if your baby has any trouble breathing or eating due to clogged stents, please call.

As the nasal swelling goes down, the stents may look looser, but you don’t need to do anything. Nasal stents are usually kept in for at least a week, and sometimes longer. We will remove them during the next clinic visit.

Keep your child’s incisions clean the first week or 2 after surgery. Once the incisions are healed, we will tell you how to care for the scars at the next clinic visit. This may include the use of sunscreen, massage or products to put on the scar.

Call us if you have any question about your child's care or if your child has any of these warning signs:

• A temperature over 101.5°F or 38.5°C
• Increased swelling or redness of the lip or any drainage from the incisions
• Poor feeding
• Pain that is not helped by the medicines
• Any difficulty with the nasal stents

If you are calling Monday through Friday between 8 a.m. and 4:30 p.m., call 206-987-1117 or, toll-free, 866-987-2000 ext. 1117, to reach 1 of the nurses.

If you need to reach someone during evening, weekend, or holiday times, please call the Seattle Children’s Hospital operator at 206-987-2000 or, toll-free, 866-987-2000, and ask for the plastic surgery provider on call