Cleft Palate Repair

Cleft palate is a common congenital disability that occurs as a failure of palatal tissues to come together and form the roof of the mouth. The incidence of cleft palate is around one in 600 infants every year. Hereditary background and environmental factors play a crucial role in the formation of cleft palate.

Cleft palate repairs are the best and the only way to improve the quality of life. Additionally, it allows the child to speak and swallow properly. Cleft palate repairs involve joining of both the sides of the cleft. This helps to close the space between the nose and oral cavity and improves the chances of developing good facial structure and tooth alignment in the jaw.

Usually, cleft palate repairs are performed anytime before the age of 18 months. This allows the gradual development of the soft tissue as the child grows older. In today’s article, we will discuss in detail about cleft palate repair surgery and its recovery.

What is a cleft palate?

A palate is usually made from two essential parts of the mouth – the hard and soft palate. Failure of these tissues to close properly during early developmental stages leads to the formation of cleft palate. (1)

Cleft palate is not only one of the most noticeable facial defects, but it also affects the functioning of the mouth in a baby. Some of the problems associated with cleft palate include –

  • Difficulty in feeding
  • Difficulty in eating and swallowing
  • Impaired speech
  • Frequent middle ear infections. In severe cases, it can also lead to hearing loss

Cleft palate is a common birth defect in the United States. One in every 600 babies is affected every year with cleft palate.

What causes the development of cleft palate?

Although the definite cause of cleft palate is unknown, it is believed that genetics and environmental factors play a significant role in increasing the incidence. Some of the common environmental factors may include –

  • A habit of smoking during pregnancy(2)
  • Alcohol addiction
  • Intake of illegal drugs during pregnancy
  • Uncontrollable diabetes
  • Lack of specific prenatal vitamins for example – folic acid

What is the treatment for cleft palate repair?

Prenatally, a cleft palate can be diagnosed through ultrasound imaging. Confirmation of the defect is done by a procedure called amniocentesis. In this process, some of the amniotic fluid is removed for testing genetic abnormalities.

Cleft palate repair surgery is often the best and the only option to close the space caused by the cleft and allows the child to resume normal activities. We will deal with this procedure in three parts as follows –

Before cleft palate repair surgery

Cleft palate surgical repairs are usually scheduled before the age of 18 months. The conventional surgical procedure is performed in two parts. First, the soft palate is repaired to improve the speech of the child. A second surgery is performed to repair the hard palate. (3)

However, with the advancement in technologies, surgeons can fix the cleft palate in one single operation which is performed around the age of 11-12 months.

Early repair of cleft palate brings in a lot of advantages in terms of speech and facial development. However, in patients with heart, lung, or breathing issues, cleft palate surgeries can be delayed.

During Surgery

Cleft palate repair surgery is performed under general anesthesia. An oral maxillofacial surgeon is the most qualified health care professional o perform this surgery.

During the procedure, incisions are made on both sides of the cleft; the tissue and underlying muscles are rotated to bring each end close to one another to close the cleft. This junction is secured with dissolving stitches. (4)

Post-surgical recovery

Following the surgical procedure, the patient will experience swelling around the palate. Often the child may feel very sleepy and have frequent episodes of blood tinged saliva in the mouth. Therefore, the first two days of recovery are usually spent in the hospital for medical observation.

During the recovery period, parents or caregivers are instructed to follow the instructions given below to allow quick healing –

  • Prevent the child from touching the surgical site
  • Prevent the child from putting any objects in the mouth
  • Do not use a pacifier or a sippy cup until instructed by the doctor. Instead, use a regular cup or a bottle with a nipple. (5)
  • Do not give hard foods for the first six weeks after surgery
  • It is best to put the child on a liquid diet for the first week of recovery, for example – yogurt, soup, or ice cream.
  • Follow up with the doctor routinely to check the healing of the site.

What is the cost of cleft palate repair?

Typically, cleft palate repair surgeries are expensive as it comes under cosmetic procedures. The cost of cleft palate surgery ranges from $5000 – $10,000. However, health insurance policies can help to reduce this amount significantly to a couple of hundred or thousand dollars.

Health insurance coverage may vary among insurers. Please check with your insurance provider if they cover post-surgical therapy as well, for example – speech therapy and physiotherapy.

Take away message

Cleft palate repairs are mainly done by surgically joining the tissues to close the space. Often, the surgical procedure is planned before the age of 18 months to allow proper facial and speech development of the child.

As crucial the surgical procedure may be, the post-surgical recovery is equally important to care of. Parents or caregivers should carefully follow all the post-surgical instructions to allow faster healing and recovery.

Cleft palate repair surgeries can be expensive. Therefore, check with your insurance provider and plan your expenses well before you schedule the surgery.