Cleft palate (palatoschisis) is among the most common birth defects affecting children in North America. The incomplete formation of the upper lip (cleft lip) or roof of the mouth (cleft palate) can occur individually, or both defects may occur together. The conditions can vary in severity and may involve one or both sides of the face.
A cleft, or separation of the upper lip and/or the roof of the mouth, occurs very early in the development of your unborn child. During fetal development, certain components of the upper lip and roof of the mouth fail to form normally. Most cleft lips and cleft palates can be repaired through specialized surgery techniques – improving your child’s ability to eat, speak, hear and breathe, and achieving a more normal appearance.
The success and safety of your child’s cleft palate procedure starts with a consultation with Dr. Cherry and depends very much on your complete candidness.
Be prepared to discuss:
Be candid about your concerns for your child and your plastic surgeon’s ability to meet his or her special needs. The success of your child’s procedure, safety and overall satisfaction requires that you:
Medications are administered for your child’s comfort during the surgical procedures. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for your child.
The repair of a cleft palate requires careful repositioning of tissue and muscles to close the cleft and rebuild the roof of the mouth. Incisions are made on either side of the cleft, and specialized ﬂap techniques are used to reposition muscle and the hard and soft components of the palate. The repair is then stitched closed, generally at the midline of the roof of the mouth, providing enough length of the palate to allow for normal feeding, speech development and continued growth throughout life.
Cleft lip and cleft palate incisions can be closed with removable or absorbable sutures.
A special note: It is important to understand that while a cleft may be surgically repaired in a single procedure, treating a child born with a cleft continues through adolescence and sometimes even adulthood. As a child grows, secondary surgery procedures to improve function and appearance may be required.
The resulting external scars of a cleft repair are generally positioned in the normal contours of the upper lip and nose. Over time, these will fade; and your child’s ability to grow and function normally will continue to improve.
For the first three weeks after your child’s surgery, the cleft palate repair will not be not strong enough to resist damage that could be caused by foreign objects (or fingers!).
In order to prevent injury, promote healing, and maintain your child’s comfort, it is important that you follow these guidelines for the first three weeks after surgery:
Please note: Your doctor or speech pathologist will meet with you after surgery to talk about a feeding plan. Since each child is different, the plan will be specific to your child. However, the following guidelines may be helpful:
Full liquid diet including:
Soft diet, that consists of foods that “melt in the mouth,” such as:
Usual foods that your child would normally eat.
Any object your child puts in his or her mouth (including little fingers) could ruin the repair. Therefore, your child must wear arm restraints (“splints”) for the first 10 days after surgery. These must not be removed except in an emergency or with physician contact.
Relief of Pain
You can expect your child to have mild to moderate pain for a few days. Give liquid acetaminophen (Tylenol®) as directed on the package. If a stronger medicine is needed, give it as prescribed.
Report any of these problems to Dr. Cherry’s office right away:
Risks & Side Effects
The decision to have cleft surgery is extremely personal. Dr. Cherry will explain the beneﬁts, goals and potential complications. Dr. Cherry and his staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure, the alternatives and the most likely risks and potential complications.
Some of the risks include:
Be sure to ask questions: It’s natural to feel some anxiety, whether preoperative stress or excitement over the anticipated outcome for your child. Please discuss these feelings with Dr. Cherry.