Cleft lip surgery
Lip surgery is usually performed within the first days to months after birth. The procedure generally takes 1 to 2 hours, depending on the severity of the cleft. Immediately after the surgery, the babies are monitored in the neonatal intensive care unit and are fed either by tube or from a bottle. On the first postoperative day (24 hours after surgery), it may be possible to gradually start breastfeeding if the situation allows and if there is no accompanying cleft palate that would prevent the baby from sucking.
Nostrils
During the primary lip surgery, the nose is also corrected as it is affected by the cleft. After the surgery, babies must wear so-called nostrils – splints that maintain the ideal shape of the nose. Regular care of the nostrils is essential. At least once a day, the nostrils should be removed from the nose, rinsed under running water, checked for blockages, cleaned if necessary, and then reinserted. For fixing the nostrils to the nose, "steristrips" (available in pharmacies) have proven effective. To make insertion smoother, it is recommended to coat the ends of the nostrils with something like Ophthalmoseptonex, Actimaris gel, or a lubricating gel, but care must be taken to keep the nostrils clear. If the baby has a cold, it is not necessary to keep the nostrils in all day, but they should be inserted for at least 2 hours daily. Once the cold subsides, the nostrils should be worn all day again, with breaks only for cleaning.
For post-operative check-ups at the clinic, it is rarely possible to come without nostrils.
Nostril Size
For primary surgery in newborns, most patients require Stryker size 1 nostrils or Pharmacleft size 2.
If nostrils need to be worn for a longer time, signs that it’s time to change to a larger size include the nostrils becoming loose and no longer providing support for the nasal passages. When this happens, it is advisable to start using a larger size. If the larger nostrils cannot be fully inserted immediately, it is not a problem; it usually becomes possible within a few days.
Stitches
Absorbable stitches are used during the surgery, which dissolve over time. Immediately after the surgery, the wounds are protected with steristrips. When discharged from the hospital, the wounds typically are no longer covered and it is then possible to start gently applying ointments such as Ophthalmoseptonex, Bepanthen, or calcium ointment in a thin layer twice a day. It is also possible to gently wipe the wound with a moistened gauze pad as needed, but at least twice daily, to prevent residue (e.g., milk) from sticking to the stitches.
Pressure Massages
Pressure massages should be started no earlier than 14 days after surgery and only once all stitches have fallen out. Pressure should be applied to the scar area using the pad of the finger, pressing firmly against the bone with enough force to blanch the fingernail bed and the skin beneath the finger. Only pressure should be applied—no circular motions or stroking. Each spot on the scar should be pressed for 30 seconds, repeated 3 times in a row. It is recommended to massage with the nostrils in place to avoid unwanted pressure on the nasal wing and subsequent asymmetry of the nose. Pressure massages should be done twice daily before applying ointments, for at least 6 weeks. Initially, the scar may be painful and the baby may be irritable, but this should improve daily.
Scar Ointments
Special scar ointments that provide gentle, long-term pressure massage can be used at night. Alternatively, adhesive silicone scar dressings (e.g., Mepiform and others) can be applied. Cut out a rectangle the size of the scar plus about 5 mm, apply it to the scar at night, remove it in the morning, and reuse the same piece as long as it sticks.
Sun Protection
Fresh scars must be thoroughly protected from the sun. Careful protection is recommended for at least 1 year after surgery. Use UV 50+ sunscreens and reapply at least every 2 hours when exposed to sunlight.