Cleft Palate Surgery

What are the problems associated with Cleft Palate?
Feeding Problems
Cannot suck effectively
Milk gets into the nasal cavity and may result in choking or aspiration
Teething Problems
Missing teeth
Increased number of cavities
Malocclusion of teeth – When teeth are bunched together or on top of each other.
Speech Problems
Nasal voice
May develop nodules on the vocal cord due to vocal abuse
Delayed speech and language development
Difficulty with articulation and proper pronunciation of words
Ear Infections
Most children with Cleft Palate are prone to middle ear infection
Hearing Loss
May be associated with repeated ear infection
Psychological Problems
To pay the price for looking and sounding different.
Social Problems
Suffer isolation and alienation
What will my child’s ‘Health Professionals Team’ comprise of?

It is important that several health professionals with different expertise are involved to assess and monitor your child’s progress as he / she grows up. The team of health professional for surgical correction and rehabilitation of a child with Cleft Palate will include:
Pediatrician – May be the first one to examine and diagnose the problem of Cleft Palate and make appropriate referrals
Dietitian – Provides guidelines on proper feeding during infancy, weight gain and preparation for Cleft Palate surgery
Plastic or Reconstructive Surgeon – To perform surgical repair of Cleft Palate.
Speech Pathologist – To work on the speech and language development of your child
Audiologist – To monitor hearing which may be impaired due to middle ear infection
Ear, Nose and Throat (Otorhinolaryngologist) specialist – Treats middle ear infections
Oral Surgeon – Performs jaw alignment and tooth extractions

Dentist and Orthodontist – For repositioning of teeth and designing of prosthetic devices like braces and bridges. Genetic Counselor – Counsels and provides information on genetic background of Cleft Palate.
How do I prepare my child for Cleft Palate surgery?

Cleft Palate is usually repaired between 12 – 18 months of age. Your child will be hospitalized the night before for pre-operative assessment like blood and urine testing, and a chest x-ray. You will be instructed not to feed anything to your child for at least 10 hours before the Cleft Palate operation. Also make sure that your child does not have any viral infections like flu, cough, cold or diarrhea.

What does the procedure for the repair of Cleft Palate involve?

Depending on the extent of the gap in the roof of the mouth, Cleft Palate repair operation will be done accordingly. Your surgeon will make an incision on both sides of the cleft, moving the tissue from the sides to the midline thus closing the gap in the roof of the mouth. This attempt at restoration of normal anatomy of mouth would hopefully enable your child to eat and speak properly over time. The operation to repair Cleft Palate may take 2 – 3 hours and your child will be required to stay in the hospital for 3 – 4 days.

What is the recovery period like following Cleft Palate surgery?

Your child will feel some pain and soreness following the Cleft Palate surgery. Your child will be irritable and may require some medication to calm down and relieve the pain and soreness which commonly occurs following the operation to repair Cleft Palate. Your surgeon might prescribe antibiotics to minimize the chances of infection while in the hospital. Your surgeon will provide you with instructions on feeding and general care of the baby during the crucial couple of days after surgery for Cleft Palate. It is very important that you follow these instructions closely so that your child’s palate heals properly. Your child may have to be put in restraints to make sure he / she does not rub the area with stitches. Your child will be hospitalized for about 4 – 5 days, the stitches need not be opened as they dissolve on it’s own after a few days.

What is the outcome of Cleft Palate surgery?

The outcome of surgical repair of Cleft Palate is quite satisfactory. Most commonly the defect can be corrected in a single operation, seldom a second operation is required. If the cleft is extensive and cannot be closed in one surgery, then the operation is performed in two stages. There will not be a visible scar however, people who had Cleft Palate which was repaired can be identified by the nasal quality of their voice.

Benefits of surgical repair of Cleft Palate

The team approach to correcting Cleft Palate and other problems associated with it has several fold benefits. Cleft Palate is usually accompanied by Cleft Lip. The repair operation to correct these problems restores symmetry or balance of facial features to a great extent but not completely. The surgeons have mastered sophisticated techniques that has improved the success rate of surgery for Cleft Palate many fold. If the surgery to repair Cleft Palate is performed in the first year of life, chances are that ability to feed properly, talk, facial growth and development of social skills will be less problematic in the years to come.

Risks of surgical repair of Cleft Palate

Incomplete closure of the cleft – A small hole may still be present in the roof of the mouth after the operation for Cleft Palate has healed. A second operation may be required to completely repair the Cleft Palate.
Infection of the incision site
Allergic reaction to anesthesia
Bleeding, swelling, bruising and delayed healing – It is normal to have some bruising and oozing of bloody discharge around the mouth and nose which will subside in a week or so.
Alternatives to surgical repair of Cleft Palate

There are none, your child can either live with the defect in the upper lip for the rest of his / her life or undergo the plastic surgery for Cleft Palate during the first year of life.