Cleft lip and cleft palate surgery are among the most common congenital conditions affecting infants worldwide. These conditions occur when the tissues that form the upper lip or the roof of the mouth fail to fuse properly during early pregnancy. Fortunately, advances in surgical techniques have made it possible to repair clefts with high success rates.
However, as with any surgical procedure, You will come across Complications of Cleft Lip and Palate Surgery. While most children recover well and go on to lead normal lives, it’s essential for parents and caregivers to understand what could go wrong, how to spot problems early, and how to minimize risks through proper care and follow-up.
Overview of the Surgeries
Before exploring the risks, it’s helpful to briefly understand the procedures themselves:
- Cleft lip surgery is usually performed around 3–6 months of age. The goal is to close the gap in the upper lip and restore a natural appearance and function.
- Cleft palate surgery is generally done between 9–18 months of age. This surgery closes the opening in the roof of the mouth, enabling proper speech development and feeding.
Both surgeries are typically performed under general anesthesia and may require additional follow-up procedures as the child grows.
Complications of Cleft Lip and Palate Surgery
Common Surgical Risks
Infection
Infections can occur at the surgical site, especially if the wound is not kept clean. Signs of infection include redness, swelling, warmth around the area, pus discharge, or fever. Most infections are mild and treated with antibiotics, but severe infections may require drainage or hospital readmission. Follow all post-operative care instructions carefully, including cleaning the wound and avoiding activities that may introduce bacteria.
Bleeding and Hematoma Formation
Some bleeding is expected during and after surgery, but excessive bleeding may lead to hematoma—a collection of blood under the skin or tissue. In rare cases, a hematoma may need to be drained surgically. Ensure your child avoids trauma or rough activity after surgery, and notify the surgeon immediately if swelling or discoloration develops suddenly.
Poor Wound Healing
Sometimes, the surgical site doesn’t heal as expected. This may be due to infection, excessive tension on the wound, or underlying medical conditions such as anemia or poor nutrition. Poor healing can lead to scar tissue formation or wound breakdown. Good nutrition, close follow-up, and avoiding strain on the repair site are essential.
Specific Complications of Cleft Lip Surgery
Asymmetry and Cosmetic Concerns
While cleft lip surgery aims to restore normal appearance, achieving perfect symmetry—especially in bilateral clefts—is challenging. The nose and lip may appear uneven or scarred. Minor revisions are common and often done in later childhood or adolescence to improve appearance and function.
Lip Tightness or Stiffness
Some children experience tightness in the upper lip after surgery, which may limit smiling or speech articulation. Physical therapy or minor revision surgery may help release tension and improve mobility.
Scarring
All surgeries leave scars, and cleft lip repair is no exception. While most scars fade over time and can be minimized with careful surgical planning, some may remain more visible, especially in children with a tendency toward keloid or hypertrophic scarring. Silicone gel sheets, scar massage, or cosmetic revision procedures may help improve scar appearance.
Specific Complications of Cleft Palate Surgery
Palatal Fistula (Hole in the Palate)
One of the most common complications of cleft palate repair is a palatal fistula—a hole that reopens between the mouth and nasal cavity. This can interfere with feeding, cause nasal regurgitation, and lead to speech problems.
Studies suggest a fistula occurs in 5% to 35% of cleft palate repair. Small fistulas may close on their own. Larger or persistent ones often require additional surgery.
Speech Problems Despite Repair
Even after successful palate closure, some children experience velopharyngeal insufficiency (VPI)—a condition where the repaired palate does not close properly during speech, leading to hypernasal voice or unclear articulation.
Speech therapy is usually the first step. In some cases, additional surgical procedures such as pharyngoplasty may be needed to improve closure during speech.
Breathing and Airway Complications
Cleft palate surgery involves working near the airway. In rare cases, post-operative swelling or bleeding can compromise breathing, requiring urgent medical attention. Surgeons and anesthesiologists closely monitor children in the immediate post-operative period to manage any airway issues.
Anesthesia Risks
Because cleft repair is done under general anesthesia, there are inherent risks related to being put to sleep, especially in infants. These may include:
- Allergic reactions to anesthesia drugs
- Breathing difficulties
- Temporary drops in oxygen or heart rate
Fortunately, with modern anesthetic techniques and experienced pediatric teams, serious anesthesia complications are rare.
Feeding Difficulties After Surgery
Children may struggle with feeding for a few days after cleft lip or palate repair due to pain, swelling, or changes in oral anatomy. They may resist bottles or have difficulty swallowing. Some may lose weight during the first week post-surgery.
Pediatricians and feeding specialists offer support and recommend modified feeding tools like syringes, soft spoons, or special cups.
Psychological and Emotional Challenges
For older children and teens undergoing revision surgeries, the emotional impact may be significant. Body image concerns, anxiety about appearance, or social stigma can affect self-esteem.
Psychological counseling, support groups, and school-based interventions help children build resilience and confidence.
Long-Term Risks and Revisions
It’s important to understand that cleft surgery is often the first step in a long-term treatment journey. Some children may need:
- Lip or nose revision surgery
- Bone grafting for the upper jaw (usually between ages 7–9)
- Orthodontic treatment
- Speech surgeries or therapy in later childhood
- Orthognathic (jaw) surgery in adolescence
These future treatments are not necessarily complications, but part of a comprehensive cleft care plan that extends through growth and development.
How to Minimize Risk
Many of the risks associated with cleft surgery can be minimized through:
- Choosing an experienced cleft surgeon and multidisciplinary team
- Ensuring good nutrition and general health before surgery
- Following pre- and post-operative instructions carefully
- Attending all follow-up appointments
- Seeking early intervention for speech and hearing concerns
Regular follow-up with the cleft team ensures that any complications are detected and addressed early.
Conclusion
Cleft lip and palate surgery has transformed the lives of millions of children, giving them the ability to eat, speak, and smile with confidence. While the procedure is generally safe and successful, like any surgical intervention, it carries certain risks and potential complications.
By understanding these risks, parents and caregivers can better prepare for the surgical journey, respond quickly to signs of trouble, and support their child’s recovery with confidence. In the hands of a skilled medical team, cleft repair offers life-changing results that go far beyond the operating room—opening doors to communication, development, and a full, active life.
