Cleft Palate RepairBy
Hedy Marks, MPH
What is cleft palate repair?
Cleft palate repair, also called palatoplasty, is surgery to correct a cleft palate. Cleft palate is a birth defect that occurs when the palate, or roof of the mouth, doesn't fuse together properly during development. It results in a gap or split in the roof of the mouth that can vary in size.
Cleft palate may only affect the soft palate, which is the soft tissue and muscles at the back of the roof of the mouth. This is called an incomplete cleft palate. A complete cleft palate affects the entire palate, running from the soft palate through the hard palate behind the teeth and gums. In addition, the cleft may affect one side of the palate, called unilateral cleft palate, or both sides, called bilateral cleft palate.
Cleft palate repair closes the opening in the palate to restore the structure and function of the palate.
Cleft palate repair is a major surgery with serious risks and potential complications. Most children with cleft palate have the surgery between nine and 12 months of age.
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Other procedures that may be performed
Cleft palate may occur alone or with cleft lip. Cleft lip is a birth defect that occurs when the upper lip doesn't fuse together properly during development. Cleft lip results in a split in the upper lip that can extend up to the nose. Cleft palate and cleft lip may require correction in separate surgeries.
Your child’s doctor may recommend other procedures before, during or after cleft palate repair including:
Dental and orthodontic procedures to repair dental problems, such as gum problems, bone defects, and small, missing, abnormal, displaced or extra teeth
Ear tube placement to prevent or treat middle ear problems including hearing problems, earaches, and ear infections
Jaw surgery to correct an upper jaw that does not grow properly, resulting in an underbite
Pharyngeal flap surgery to improve speech
Rhinoplasty, or nose surgery, to improve the function and appearance of the nose
Why is cleft palate repair performed?
Cleft palate repair treats cleft palate. Left untreated, cleft palate can cause problems with feeding, growth and development, ear infections, hearing and speech, and dental health. Cleft palate repair prevents or minimizes these complications of cleft palate.
Who performs cleft palate repair?
The following specialists repair cleft palates:
Plastic surgeons specialize in aesthetic and reconstructive surgery.
Facial plastic and reconstructive surgeons specialize in plastic and reconstructive surgery of the face. They initially train as plastic surgeons or otolaryngologists (ear, nose and throat doctors/surgeons).
Head and neck plastic surgeons specialize in plastic and reconstructive surgery of the head and neck. They also train as plastic surgeons or otolaryngologists (ear, nose and throat doctors/surgeons) before further specialization.
How is cleft palate repair performed?
Your child’s cleft palate repair will be performed in a hospital. The surgery takes between two to six hours, depending on the extent of surgery.
The goal of cleft palate repair is to close the separation in the palate and rebuild the roof of the mouth. The surgeon will make incisions on either side of the cleft to create flaps of muscle and tissue. The surgeon will reposition the muscles and tissues, then draw the flaps together and stitch them to close the cleft.
Types of anesthesia that may be used
Your child's surgeon will perform cleft palate repair using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put your child in a deep sleep. Your child is unaware of the procedure and will not feel any pain.
The doctor may use a sedative medication to relax your child before surgery. It is usually given by mouth. Your child’s care team will then start general anesthesia through a breathing mask. After your child is asleep, the team will insert an IV to maintain general anesthesia.
What to expect the day of your child's cleft palate repair
The day of your child's surgery, you can expect to:
Talk with a preoperative nurse. The nurse will examine your child and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all of your child’s clothing and dress your child in a hospital gown. The care team will give your child blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your child's medical history and the type of anesthesia your child will have
Remain with your child in the pre-op area until surgery.
The anesthesiologist or nurse anesthetist will start your child's anesthesia through a breathing mask.
Once your child is asleep, a surgical team member will start an IV to maintain anesthesia.
The surgical team will monitor your child's vital signs and other critical body functions. This occurs throughout the procedure and your child's recovery until your child is alert, breathing effectively, and his or her vital signs are stable.
Wait in the waiting room during your child's cleft palate repair. The team will call you to the recovery room once your child arrives from surgery. Parents are often present when their child wakes up from surgery.
What are the risks and potential complications of cleft palate repair?
As with all surgeries, a cleft palate repair involves risks and potential complications. The majority of cleft palate repair procedures are successful, but complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of cleft palate repair
Potential complications of a cleft palate repair include:
Damage to nerves, blood vessels, and muscles
Poor wound healing
Pulling together or puckering of tissue at the incision, called contracture
Regurgitation of food and liquids into the nose, which is usually temporary
Reducing your child's risk of complications
You can reduce your child's risk of some complications by following the treatment plan and:
Giving your child’s medications exactly as directed
Making sure your child follows activity, dietary and lifestyle restrictions before the procedure and during recovery. For example, make sure your child drinks only liquids or semi-liquids as directed. Use a bottle or cup. Do not use straws or utensils until your child's doctor recommends it.
Notifying your child's doctor immediately of any concerns, such as bleeding, fever, or increase in pain
Telling all members of the care team if your child has any allergies
Understanding and following instructions on how to care for your child’s wound after surgery
How do I prepare my child for cleft palate repair?
You are an important member of your child's healthcare team. The steps you take before surgery can improve your child's comfort and outcome.
You can prepare your child for cleft palate repair surgery by:
Answering all questions about your child's medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your child's medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your child's age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Giving or stopping medications exactly as directed. This may include not giving your child ibuprofen (Advil, Motrin). Your child's doctor will give you instructions on what medications are safe for your child to take.
Making sure your child does not eat or drink before surgery as directed. Surgery may be cancelled if your child eats or drinks too close to the start of surgery because your child can choke on stomach contents during anesthesia.
Making sure your child wears the obturator before the surgery, as directed. An obturator is a device worn inside the mouth. It helps with feeding and maintaining the gum line before repair.
On the day of surgery, think about bringing your child's "lovey"—a stuffed animal, blanket, or other familiar object—to comfort and reassure your child. Also, you should pack a large long-sleeved shirt for your child to wear home from the hospital.
Questions to ask your doctor
Facing your child’s surgery can be stressful. It is common for parents to forget some of their questions during a doctor’s office visit. You may also think of other questions after your child's appointment. Contact your child's doctor with any concerns before surgery and between appointments.
It is also a good idea to bring a list of questions to your child's preoperative appointments. Questions can include:
Why does my child need cleft palate repair? Are there any other options for treating my child's condition?
What type of procedure does my child need? Will my child need more surgery later?
How long will the surgery take? When can my child go home?
How long can I remain with my child before surgery? How soon after surgery can I see my child?
Can my child bring a comfort item to keep during the procedure?
What restrictions will my child have after the procedure?
What medications will my child need before and after the surgery?
How will you treat my child's pain?
How do I care for my child after cleft palate repair? How will my child eat and drink during recovery?
When should my child follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my child's cleft palate repair?
Knowing what to expect after cleft palate repair can help make your child's road to recovery as smooth as possible.
How long will it take to recover?
Your child will stay in the recovery room after surgery until he or she is alert, breathing normally, and his or her vital signs are stable. You can be with your child during recovery. Your child may cry, look confused, or vomit as they wake up from anesthesia. These are normal reactions to anesthesia. Vomiting can be treated. Other symptoms will go away as the anesthesia wears off.
Your child will likely have dissolvable sutures, or stitches, on the roof of the mouth. Your child will also be wearing soft padded arm restraints. Arm restraints prevent your child from touching the wound, sucking a thumb, or putting things in the mouth. Your child will wear restraints for about two weeks.
Your child may regurgitate food and liquid through the nose for up to three months after cleft palate repair. This is normal. It will resolve as swelling decreases and the muscles in the soft palate learn to work properly.
Recovery after surgery is a gradual process. Full recovery time varies depending on the procedure, and your child’s general health, age, and other factors.
Will my child feel pain?
Pain control is important for healing and a smooth recovery. There will be pain and discomfort after your child's surgery. Your child's doctor will treat any pain so your child stays comfortable. Call the doctor if your child’s pain gets worse or changes in any way because it may be a sign of a complication.
When should I call my child’s doctor?
It is important to keep your child's follow-up appointments after cleft palate repair surgery. Contact your child’s doctor for questions and concerns between appointments. Call the doctor right away or seek immediate medical care if your child has:
Bleeding or foul smelling drainage from the palate
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection, but you should follow your doctor's instructions about when to call for a fever.
Pain that is not controlled by pain medication
Signs of dehydration including low energy, sunken eyes, and few wet diapers
Skin color changes such as pale, blue or gray skin
How might cleft palate repair surgery affect my child's everyday life?
Cleft palate repair surgery will greatly improve your child's ability to speak and develop normally. Cleft palate repair can prevent complications of a cleft palate, including poor growth, hearing and speech problems, recurrent ear infections, breathing difficulties, and potential self-esteem issues.
Some children who have cleft palate repair continue to have speech problems, such as nasal-sounding speech and difficulty pronouncing certain sounds. Additional surgery may correct these problems. Other secondary surgeries may also be necessary to correct jaw or nose irregularities.
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- Cleft Lip and Cleft Palate. Boston Children's Hospital. http://www.childrenshospital.org/az/Site2034/mainpageS2034P4.html.
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- Cleft Lip and Palate Repair. American Society of Plastic Surgeons. http://www.plasticsurgery.org/Reconstructive-Procedures/Cleft-Lip-and-Palate.html.
- Cleft Palate Repair. Children's Hospital of Pittsburgh of UPMC. http://www.chp.edu/CHP/Cleft+Palate+Repair.
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