Cleft Care Protocol

Children with Cleft Lip and Palate

Cleft lip repair: 3 to 6 months
Cleft palate repair: 9 to 12 months
Ear tubes at palate repair: 9 to 12 months
Lip/nare revision: 4 years
Phase I orthodontics: 7 years
Alveolar bone graft: 6 to 10 years
Phase II orthodontics: 15 to 17 years
Orthognathic surgery: 15 years for females; 18 years for males
Definitive rhinoplasty: Teenage years

Cleft Lip Protocol

Surgery at 3 to 6 months
Before Surgery
Consultation before surgery
Pre-operative work-up in pediatric plastic surgery clinic and pre-care visit
No formula, breast milk or solids after midnight before surgery. May have clear liquids up to 4 hours before surgery.
Cefazolin 25 mg/kg IV
On call to the operating room
Surgery
2 to 3 hours
After Surgery
Discharged to home or admit for 23 hours
Keflex (elixir) for 3 to 5 days
Tylenol with codeine or oxycodone suspension for pain
Clinic visit in 1 week
Steri-strips on lip and nasal stents (if placed) until post-operative clinic visit
Arm restraints until post-operative clinic visit
Child may breast or bottle feed
Repeat post-operative clinic visits to monitor healing and refer to Craniofacial Center

Cleft Palate Repair

Surgery at 9 to 12 months
Before Surgery
Consultation before surgery. Instruct regarding cleft palate nipples/bottles, monitor feeding and growth.
Patient to have Craniofacial Center Team pre-operative evaluation
Patient to start sippy cup (no ball valve) at least 2 months prior to surgery
Pre-operative work-up in pediatric plastic surgery clinic and pre-care visit
No formula, breast milk or solids after midnight before surgery. May have clear liquids up to 4 hours before surgery.
Cefazolin 25 mg/kg IV
On call to the operating room
Surgery
2 to 3 hours
After Surgery
Keflex (elixir) for 5 to 7 days
Tylenol with codeine or oxycodone suspension for pain
Floxin gtts for 5 days if PE tubes placed by ENT surgeon
Clinic visit in 2 week
Sippy cup (no ball valve) or syringe feeding for 2 weeks
Diet applesauce consistency
No pacifiers; no bottle feeding
Arm restraints until post-operative clinic visit
Repeat post-operative clinic visits to monitor healing and speech