Overview

What Is a Cleft Palate?

What Is a Cleft Palate?

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Children with cleft lip often have a cleft—or split—that also extends into their gum and palate. If your child’s cleft extends into their palate, your child's palate will also need to be repaired.

When children have cleft palate but not cleft lip, this is called isolated cleft palate. Children who have cleft palate but not cleft lip usually have less severe problems. Most of the time, surgeons can repair isolated cleft palate with one surgery.

Cleft palate surgery will fuse or bring together the tissue from both sides of your child's gap. Cleft palate surgery will also realign the muscles inside your child's soft palate so they run in the correct direction. 

Different Types of Surgery

Depending on how wide the gap in your child's palate is, they may need different kinds of palate surgery. 

Your child may have a procedure where surgeons bring the soft palate and hard palate together in one surgery. This surgery will take place before your child is one year old and is called one-stage palate repair.

If your child needs two procedures, the first surgery will repair their soft palate. The second surgery will fix their hard palate. Surgery that has two parts is called two-stage palate repair.

Surgery to repair the soft palate usually happens before your child is one year old. Surgeons then fix the hard palate when your child is a toddler. 

Surgery is slightly different for children who have a cleft palate but not a cleft lip.   

Two-Stage Palate Repair

During two-stage palate repair, surgeons repair the soft palate early in your child’s life. Surgeons then place a temporary plate —or prosthesis—on top of the hard palate (the roof of the mouth).

Surgeons then repair your child's hard palate when they are older. Surgeons use a prosthesis, which is an artificial or fake palate. This prosthesis is replaced about every year until your child's own hard palate is repaired.

Surgeons who prefer two-stage palate repair hope that avoiding the operation on the hard palate when a child is young will prevent the difficulty of a sunken in face (also known as maxillary or midface hypoplasia).

Some surgeons also think that children who have two-stage palate repair will have speech problems later in life.  

One-Stage Palate Repair

During one-stage palate repair, your child will have one surgery instead of two. They also won't need a palate prosthesis on their hard palate (the roof of the mouth). 

During one-stage palate repair, surgeons bring both the hard and soft palate together in the middle of your child's mouth. 

Surgeons also change the direction of the soft palate muscle so it runs across your child's palate in a normal direction.

Furlow Palatoplasty

Some surgeons use a special procedure called a furlow palatoplasty to move the muscles in the correct direction. This procedure lengthens the soft palate and moves the muscles so they run across the palate rather than running front to back.

Using this procedure, our surgeons then bring the rest of the soft palate together. This helps the soft palate and uvula form together, like in a normal mouth. 

Benefits

One-stage palate repair limits trips to the operating room so your child won't suffer from surgical burden or burnout. This can be especially helpful especially for families who:

  • travel a long distance,
  • want to limit the number of times their child recovers from surgery,
  • or want to limit the number of anesthetics their child receives.

Also, some insurances do not pay for the palate prosthesis. This extra cost places a large burden on families. 

Which Surgery is Better?

Our pediatric facial plastic and ENT surgeons offer both one-stage and two-stage palate repair. They also understand the risks and benefits of both surgeries.

Your surgeon will work with you to decide if a single palate surgery is best for your family. It's better for some infants to have a two-stage palate repair. Your surgeon can explain the differences and will involve you in the decision making process. We recognize that one treatment plan does not fit all families.

Our surgeons have experience in managing the lip and nose's form (the way they look) as well as how the lips, nose, mouth, tongue, throat, and voice box works. We can help you choose the type of surgery that is right for your family.

You can read more about how to decide which surgery is better for your child.

What To Expect

  • When you meet with your surgeon, you will receive a handout that explains what to expect during and after surgery. The handout will also explain what care your child will need at home. Reviewing this with your surgeon and our clinic nurses before surgery will make the time after surgery less stressful.
  • For a week or two after surgery, your child will probably need a little extra care and attention. Don’t worry about spoiling your child while they are recovering. It's okay to help your child through their recovery with extra holding and comforting.
  • Your child will stay in the hospital one or two nights depending on how well they from surgery.
  • Your child will have sutures (stitches) that are loosely tied to the middle of their tongue. Doctors usually tape the end of the suture to your child’s cheek. These sutures help your child breathe in case of an emergency. Your child's care team will usually remove these sutures the evening of surgery. 
  • Your child will receive pain medication. Our team will give your child the right amount of medication so their pain is well controlled. We will also closely monitor your child’s pain.
  • We will pay close attention to how much your child is eating and drinking.
  • Your child will wear arm straighteners. These will prevent your child from accidentally hurting themselves while they are healing. 

Our nursing staff cares for many children who have cleft palate surgeries. Our staff will provide you with tips as well as compassionate care after your child’s surgery.

Common Questions

Are there rules against what and how my child can eat and drink?

We don’t put restrictions on how you child eats or drinks after surgery. Most children heal well. Restricting what your child eats or drinks will not make them heal faster.

Will my child be able to drink after palate surgery?

Most children eat and drink easily after palate surgery. Your child will probably have a sore throat and swallowing will feel different. Even though swallowing will feel different, your child will still know how to swallow after surgery.

As a parent, the best thing you can do is figure out what your child wants and needs. 

After your child wakes up from anesthesia, you can begin giving them fluid and soft foods. Some children do best drinking from the bottle or cup they used before surgery. Others may need to be fed with a syringe or similar device while they recover. 

It’s easier for some children to drink liquid food after surgery. Other children do better eating soft solid foods at first.

Remember that your child will eventually return to their usual routine. Most children go home the day after surgery, but some need to stay an extra day or two.

How do I take care of the part of the mouth where my child had their surgery?

The inside of your child's mouth will heal on its own. The most important thing you can do is protect this area while it heals.  Don’t let your child put objects (besides food) in their mouth. 

The stitches in the mouth will dissolve on their own. You do not need to remove them. It’s safe for your child to both swallow or spit out the stitches.

Your child might also have bad breath while they heal. This is normal and will go away once their palate has healed. 

Will my child have breathing problems after palate surgery?

We will monitor your child closely for breathing problems after cleft palate surgery. But your child most likely will not have any problems. 

Sometimes your child’s tongue is swollen. When this happens, your child will need medicine to reduce the swelling.

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