Cleft Palate

Cleft Palate - Dr. Bradley A. Cherry - Cherry OMS

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.

Consultation

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:

  • Your concerns and an evaluation of your child’s condition
  • The options available for cleft palate repair
  • The likely outcomes of surgery and the potential risks and complications associated with the procedure
  • A recommended course of treatment

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:

  • Honestly share your concerns.
  • Fully disclose your child’s health history, including current medications, vitamins and herbal supplements.
  • Sincerely commit to precisely following all of Dr. Cherry’s surgical and after-care instructions.

Procedure

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.

Postoperative Recovery

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:

Feeding Instructions
  • Feed your child carefully, using a cup or the side of a spoon to drop fluids and food into the mouth. Do not allow the spoon to touch the roof of the mouth. Do not allow your child to chew on anything. Remember, no bottles or pacifiers!
  • Give your child water to drink after each feeding, to rinse the surgical area and to keep it clean.
  • Give your child no hot food or hot fluids.

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:

First Week

Full liquid diet including:

  • Milk
  • Formula
  • Juices
  • Well-melted ice cream
  • Slightly warm broth
  • Gelatin that you have dissolved in any of the liquids, but not gelatin in solid form
Second Week

Soft diet, that consists of foods that “melt in the mouth,” such as:

  • Ice cream
  • Sherbet
  • Frozen yogurt
  • Puddings
  • Custards
  • Smooth yogurts
  • Soft cereals
  • Gelatins
  • Pureed baby foods
  • Other foods that do not need to be chewed
Third Week

Usual foods that your child would normally eat.

Activity Guidelines

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:
  • Fever (temperature over 101°F)
  • Severe pain not relieved by the recommended pain medicines
  • Vomiting and/or diarrhea
  • Bleeding from and/or a change in the suture line (area of surgery)
  • Any direct injury to the repaired palate
  • Drainage from the suture line that looks like pus or smells bad

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:

  • Bleeding (hematoma)
  • Infection
  • Incisions healing poorly
  • Scars healing irregularly, including contracture (puckering or pulling together of tissues)
  • Irregularities and asymmetries as residual effects
  • Complications of Anesthesia – Click to learn more
  • Allergies to tape, suture materials and glues, blood products, topical preparations or injected agents
  • Damage to deeper structures – such as nerves, blood vessels, muscles and lungs – can occur and may be temporary or permanent
  • Possibility of revisional surgery

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.