Pediatric Cleft Lip Surgery & Palate Surgery in NYC
The purpose of cleft lip surgery and palate surgery is to give your child a normal appearance and function to their lip and palate. A cleft lip is a gap between the lip and/or nostril edges that can occur in up to 1 out of every 1000 newborns and it is estimated that more than 4,400 babies in the United States per year are born with a cleft lip (with or without a cleft palate).
If left untreated, a cleft lip and palate can negatively affect your child’s quality of life. This can include difficulty eating, ear infections leading to hearing loss, speech and language delays, issues with teeth, and difficulty breathing.
With cleft lip surgery, your child can live a happy, healthy life. Cleft lip surgery under Dr. Nicholas Bastidas, M.D. goes beyond the procedure - In addition to offering state-of-the-art pediatric cleft lip repair, our care staff coordinates any care your child might need before and after surgery, including check-ups throughout childhood to make sure your child’s face develops properly.
What Is A Cleft Lip & Palate?
A cleft lip is a common birth condition. Due to random chance in fetal development, some infants are born with a gap or two in their upper lip. This happens when the tissues in a baby’s face do not fuse properly when they develop in the womb, leaving an opening. If the cleft lip extends up into the nose, this is known as a complete cleft lip.
Cleft lips can occur on one side of the face (known as unilateral cleft lip) or both sides (known as bilateral cleft lip). A bilateral cleft lip involves two sides of the lip, often creating a wide nose with a short columella, the tissue connecting the tip of your nose to the base.
Cleft lips can be surprising to look at, but they mainly pose a problem because they inhibit children’s growth, making feeding, speech development, and breathing difficult. Cleft lips also make children more likely to suffer from ear infections and hearing issues. Consequently, these babies need cleft lip surgery at an early age so that they can be healthy.
A cleft palate is a condition affecting the roof of the mouth, also known as the palate. This is when the palate does not completely close. It tends to be more common on the left side, but it can occur on either side of the mouth. Typically, a cleft palate extends from the front of the mouth (hard palate) to the back (soft palate). Some babies are born with both a cleft lip and cleft palate, while others are only born with one condition.
What Causes A Baby To Have A Cleft Lip & Cleft Palate?
According to the Centers for Disease Control and Prevention (CDC), cleft lip and cleft palates are due to birth defects during pregnancy. While much is unknown about the specific causes of these defects, it is generally believed they are a result of a combination of factors. These factors include changes to the baby’s genes, certain medications (specifically those to treat epilepsy), what the mother eats or drinks during pregnancy (including if she is diabetic), and things the mother comes into contact with during pregnancy (including smoking).
When Does Cleft Lip Develop in the Womb?
Cleft lip can sometimes be detected with ultrasound between the 13th and 20th weeks of pregnancy. In most cases, your doctor will be able to identify the cleft lip prior to birth, though some minor cases may go undetected.
What Does Cleft Lip Look Like in Ultrasound?
While sometimes cleft lips are not apparent until birth, some babies are diagnosed with them before birth via ultrasound. As soon as you know your baby might have a cleft lip, our experienced team will work with you to help your child.
Cleft Lip Surgery & Palate Repair Surgery
While many parents are nervous about their newborn undergoing cleft lip surgery at such a tender age, Dr. Nicholas Bastidas and his team have extensive experience and will do everything possible to keep your baby safe and comfortable. We’ll work with you so you know exactly what is going on and what to expect.
The goal of cleft lip surgery is to provide your child with a normal appearance and function. The Mayo Clinic confirms that surgery can correct cleft lip and cleft palate and result in minimal scarring. Cleft lip surgery generally happens when a baby is about 3 or 4 months old.
Sometimes prior to the cleft lip surgery, an appliance known as Nasoalveolar Molding (NAM) is used to better shape the nose, and taping is provided to narrow the gap. If your child has a bilateral cleft lip, surgery might occur around 5 months old to take full advantage of the molding forces from the NAM.
Preparation For The Cleft Lip Surgery Procedure
Your child will need to avoid certain foods and drinks the day before the procedure. You will receive a full list of details from our care staff prior to the cleft lip surgery. In the months leading up to your child’s surgery, you will meet Dr. Bastidas and his team and we will ensure that all your questions are answered and that any concerns are addressed. We currently are requiring COVID-19 testing 72hrs before any cleft surgery.
Cleft Lip Surgery Procedure
Dr. Bastidas has spent decades studying unilateral and bilateral cleft lips and how to optimize surgical outcome. As a result, his cleft lip surgery technique is combination of art and science, while straightforward and reproducible. It will take about two hours, and you will be able to bring your baby home that same day instead of staying overnight. Dr. Bastidas never uses any physical restraints for your child post-operatively. Additional support for the nose may be provided during the procedure.
Your baby will be given general anesthesia in a pediatric operating room with the best pediatric staff. Since Dr. Bastidas can conduct the cleft lip and nasal repair within two hours, this will minimize your child’s exposure to the general anesthesia, which recent studies have found might be harmful to children in operations lasting longer than three hours. Local anesthesia is also administered prior to making any incisions. This serves as a direct nerve block, which significantly reduces the amount of general anesthesia necessary. Your baby will not feel any pain during the cleft lip surgery.
For cleft lip surgery, the muscle of your child’s lip is repositioned to create a natural lip line. Dr. Bastidas restores the three layers of the upper lip and the skin, as most cleft lips are missing parts of all three layers. The incision is made as a back-cut across the lip/nose junction, placing the scar in a less visible location. To add fullness to the lip, Dr. Bastidas performs a vermillion Z-plasty, preventing the vertical line from appearing when your child smiles.
Step 3Closing the
Dissolvable stitches are placed and reinforced with surgical glue. This allows for a pain-free post-op visit with minimal scarring. Tape is glued over the incision to prevent your child from touching their mouth and nose so that the area can heal. Arm restraints are not used, as these are not helpful and tend to be uncomfortable for your baby.
Step 4Cleft Lip is Corrected
Cleft lip repair is just as much an art as it is a science. The gender of your baby and racial makeup is considered when reconstructing the lip. The goal of the surgery is to provide your baby with a normal, healthy lip appearance and function, and with minimal scarring.
Home Care for After Cleft Lip Repair Surgery
As a parent, you will be given our cell phone numbers and email addresses so that you can easily communicate with our team following your child’s cleft lip surgery. Our care staff will also provide you with detailed instructions before you leave the hospital. These instructions will tell you everything you need to know, including how to care for the surgical site, specific feeding instructions, and any specific issues to monitor.
Your child will need to avoid straws, utensils, and pacifiers for several days. They can drink any liquid they want, but food needs to be smooth (a purée consistency) and fed from a cup or bottle. For example, yogurt, pudding, and any foods placed in a blender are acceptable.
As a result of Dr. Bastidas’ pediatric cleft repair expertise, your child will not require prescription pain medications. You will be sent home with only Tylenol or Ibuprofen for pain control, as that is all that is necessary for your child’s wellbeing and recovery.
Follow-up appointments from cleft lip surgery occur at 1 week, 1 month, and 3 months after the procedure for evaluation of healing and scar formation. We begin an aggressive scar massage treatment and apply silicone scar cream at the 1 month follow-up visit. Additionally, we prefer to see our patients once a year after to monitor their growth and evaluate the need for any minor revisions if necessary.
Call the surgeon immediately if you notice any of the following:
- A fever greater than 101.4°F
- Difficulty breathing with pale, blue, or gray skin
- Foul-smelling drainage from the scar or nose
- Bleeding from the scar or nose
- Dehydration which typically appears as not urinating often enough and lack of energy
How long does cleft lip surgery take to heal?
Cleft lip surgery typically takes 3 to 4 weeks to heal. Your child’s mouth will likely be swollen for the first two weeks after the procedure. The incision from the procedure will initially be pink or red and over the course of several months will fade.
Dr. Nicholas Bastidas’ Expertise in Pediatric Cleft Repair Surgeries
The patient above underwent repair of a unilateral cleft lip by Dr. Bastidas. The before and two year post-operative results are shown. We were able to restore his beautiful smile and offer a minimal scar that is well hidden in an anatomic landmark (philtrum of the lip). The surgery was 90 minutes and he went home the same day only needing tylenol or ibuprofen for pain control.
In the above series of photos you can see the timeline for how the cleft lip scar will mature over time. Dr. Bastidas uses state-of-the-art scar treatments to help minimize scarring which might include using silicone gels, steroids, and laser therapy.
A cleft involving both sides of the lip (bilateral) can be a difficult cleft lip to reconstruct. In this beautiful boy we were able to achieve a highly satisfactory result, restoring overall facial balance and enabling him to smile.
Dr. Nicholas Bastidas’ goal is to be the best cleft surgeon for your child. His experienced, gentle approach can correct the cleft problem and ensure your child has the best chance to thrive as they grow.
Dr. Bastidas is a Board Certified Plastic and Reconstructive Surgeon who specializes in the treatment of pediatric cleft repair and craniofacial abnormalities. He is a native New Yorker and is fluent in both English and conversational Spanish. As a graduate of the prestigious New York University (NYU) Medical School, he received his Medical Doctorate (M.D.) with distinguished honors in cell biology research after defending a thesis on vascular stem cell biology. He was then accepted into the NYU combined Plastic Surgery program (an accelerated six year residency) where he performed reconstructive and aesthetic surgery at NYU Langone Medical Center, Bellevue Hospital, and Manhattan Eye and Ear Infirmary. He then went on to complete an additional year of subspecialty training (fellowship) in Craniofacial and Cleft Surgery at the Children’s Hospital of Philadelphia and Hospital of the University of Pennsylvania.
To date, he is the recipient of four research grants, including one from the National Institute of Health. He is the author of over 31 peer-reviewed publications and has presented his research at national and regional plastic surgery meetings. Additionally, Dr. Bastidas is a volunteer surgeon with the international organizations Operation Smile and Smile Train, and has attended several surgical missions providing cleft and craniofacial surgery to impoverished children and adults.