What to Expect With Cleft Palate Surgery

A cleft palate occurs when the tissues in the roof of a child's mouth fail to close during pregnancy. If your child is born with a cleft palate, a craniofacial team will put together a comprehensive treatment plan to restore your child's mouth. One or more cleft palate surgeries will play a major part in these repairs. Find out what you can expect from cleft palate surgery so you feel informed and supported during this time.

How to Prepare for Cleft Palate Surgery

Cleft palate surgery usually occurs between ages six and 18 months. As your child's primary caregiver, you can best prepare for surgery by bringing all your questions and concerns to your child's medical providers. You should have one or more pre-op appointments where you can ask questions, review your child's medical history, receive instructions for surgery, and complete any paperwork.

In the weeks and days before surgery, take these steps to make sure everything goes as smoothly as possible:

1. Visit your primary care physician (PCP). Your PCP can verify that your child is generally healthy and their size and growth are adequate for surgery. They can also make sure your child's immunizations are up to date.
2. Pack a bag with supplies. Put together a file with your child's medical history, and remember to bring health insurance cards and identification. You might also want to include paper and a pencil to take notes or jot down your questions. Depending on the length of stay, you might need to pack an overnight bag for you and your child. Bring fun and familiar items for your child — like a favorite toy or blanket — and don't forget comfort items for yourself, as well.
3. Follow pre-op instructions. You should receive instructions for the day of the surgery, letting you know the time of the surgery, when to stop food and drink, when and where to arrive, and information on medications. Bathe your child before you go to the hospital and dress them in clothing with front buttons or snaps. This will make it easier to pull on and off without disrupting IV tubes or the surgical site.

How Long Does Cleft Palate Surgery Last?

Cleft palate surgery can take anywhere from two to six hours or more, depending on the repairs needed. Before the surgery starts, an anesthesiologist will give your child medicine to fall asleep, and they will stay in the operating room the entire time to make sure your child feels no pain. Once your child is asleep, a plastic surgeon will make incisions in the palate and rearrange the tissues to close the opening. Normally, no tissue is needed from other parts of the body to complete this procedure. The surgeon will use dissolving stitches to close each layer of tissue and place the muscles in the soft palate in the best position to heal and grow.

Your child may need multiple surgeries to repair the cleft palate completely. If your child also has a cleft lip, it's often repaired before or during cleft palate surgery. If your child has a cleft in the gum, the surgeon will repair it at a later time. This often occurs around the ages of seven or eight when your child's upper jaw has had more time to grow. Plus, as your child grows, they might need additional surgery to improve speech function — this could include lengthening the soft palate or reducing the opening between the nose and the throat.

What to Expect After Cleft Palate Surgery

You can expect swelling and some bloody drainage around the nose and mouth after cleft palate surgery. This includes a small amount of blood in the mucous or saliva, making it appear pink. Now that the opening between the nose and mouth is closed, your child also might have a snottier nose than usual. As the swelling goes down over several weeks, your child should have less congestion. Just like any other surgery or major event, cleft palate surgery might disrupt sleeping and eating habits for a little while. If you have any concerns, please see your medical provider.

How to Protect the Cleft Palate Repair

Once you get home, your child's palate will take three weeks or more to heal. Follow your physician's instructions and take extra precautions to protect the surgical site. Some things to consider:

• Remove hard objects. Anything they can put in their mouth — like small, hard toys, toothbrushes, utensils, or straws — should be kept out of reach during this time. Talk to your physician about using a pacifier after surgery.
• Keep your child hydrated. It's so important that your child is drinking enough liquids. You can monitor hydration by making sure they have the same number of wet diapers as before surgery.
• Be careful when feeding. Your child will need soft, pureed foods for the next three weeks. Avoid any foods that are chunky, lumpy, or crunchy during this time. Use a spoon and do not let the child feed themself for this little while.
• Be careful when cleaning. You will skip the toothbrush for the next three weeks. Instead, use a gauze dipped in water or alcohol-free mouthwash to wipe the front teeth. Drinking plenty of water will help keep the mouth clean during this time.
• Consider arm splints. Your physician might recommend your child wear arm splints during the recovery period. This will keep the child from putting their fingers in their mouth and damaging any repairs.
• Follow instructions for medications. Your child's physician will likely prescribe an antibiotic to prevent infection, as well as some medications to help reduce the pain. Follow all of the physician's instructions to keep your child as comfortable as possible.

Your child will attend multiple post-op appointments to make sure the site is healing correctly. At those appointments, your medical provider will let you know when it's safe to resume normal activities like eating solid foods or brushing your child's teeth. Overall, cleft palate surgery plays an important role in restoring the appearance and function of your child's mouth. Though it might cause some discomfort for a little while, the long-term gains make the process worth it.