A cleft palate occurs when the gap in the palate fails to close during the early stages of pregnancy, and though the condition is similar to cleft lip, it can exist on its own. Cleft palate repair involves joining the sides of the cleft, and if performed when children are very young, the surgery greatly improves the chances developing normal speech, good facial structure and tooth alignment.
Before Cleft Palate Repair Surgery
Surgery to repair a cleft palate is usually performed before the age of 18 months, but can be done for children as young as six months, according to the Cleft Palate Foundation. The soft palate is essential in speaking, and some surgeons prefer to repair this first while the infant is young, often at the same time they repair a cleft lip when necessary. Then a second surgery is performed before the infant is 18 months old, to repair the hard palate. Other surgeons perform a single operation at 11 to 12 months of age when the baby begins to make the sounds b, d and g.
The National Insitutes of Medicine explains that early repair does have its advantages, primarily that it promotes speech development. However, the downside is that an early repair may impede normal facial development.
The University of Michigan Medical Center advises that, in some cases, cleft palate surgery should be delayed because of heart, lung or breathing issues that must be addressed first, and later surgeries are sometimes needed to shape the palate. The oral maxillofacial surgeon will decide the best course of action based on the particulars of the child's condition.
Cleft palate repair surgery takes place in an operating room with the infant under general anesthesia. The surgeon makes incisions on both sides of the cleft, then rotates the muscles and tissues and brings them together to close the cleft. Finally, the cleft is stitched with dissolving stitches. The surgeon may also place a stitch with a long thread on the tongue, which can be used to pull the tongue forward if the child's breathing is being obstructed.
After Cleft Palate Surgery
Immediately after surgery, the palate will be swollen and it may leak fluids, and the child may be sleepy and have blood-tinged saliva, but all these symptoms are normal. Usually the first one or two days after surgery are spent in the hospital under observation, then the child can recover at home.
Once settled, parents can help encourage a speedy recovery by making sure their child is comfortable. Caregivers should also do their best to prevent their child from touching the surgical site or putting objects in the mouth. In certain cases velcro arm restraints may be required, which prevent the elbows from bending toward the mouth. .
Children who have recently had cleft palate repair cannot use a pacifier or sippy cup with a spout that protrudes into the mouth. A regular cup is best, or bottle or nipple if the infant is still nursing. No hard foods can be eaten for six weeks after surgery. For the first week, only liquid food can be eaten, such as yogurt, pureed food, soup and ice-cream, according to the University of Rochester Medical Center. A week after surgery the infant can start eating cereal soaked in milk, cooked fruit and vegetables, noodles and other soft foods.
Over time and with proper supervision, the surgical site should heal on its own, and the surgeon can advise when it is safe to resume regular tooth brushing with a soft-bristled toothbrush such as Colgate® My First® Toothbrush. Cleft palate repair causes some discomfort and there is a period of recuperation, but the long-term gains make the process worth it.