Cleft Palate Repair


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. 

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

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 prescriptio