How many surgeries does it take to fix a cleft palate?

Medically Reviewed on 1/14/2021

If a child has a cleft lip and palate, treatment will be divided into several surgeries.
If a child has a cleft lip and palate, treatment will be divided into several surgeries.

The first surgery corrects the cleft lip, whereas the second surgery repairs the cleft palate. Other surgeries may be required as well, depending on the severity of the condition. A minimum of one surgery is required to repair a cleft palate. The requirement for further surgeries depends on the patient’s progress. A separate surgery will be used to repair the lip; additional surgeries may be needed to make the lip appear normal or improve speech.

What is cleft palate repair?

Cleft palate repair involves joining the sides of the cleft, and if performed in young children, the surgery greatly improves the chances of developing normal speech, good facial structure, and better tooth alignment.

  • A cleft palate occurs when two halves of the palate fail to close during the early stages of pregnancy. Though the condition is similar to cleft lip, it can exist on its own.
  • 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.
  • Surgery to repair a cleft palate is usually performed before the age of 18 months but can be done for children as young as 6 months.
  • A second surgery may be performed before the infant is 18 months old to repair the hard palate. Some surgeons perform a single operation at 11 to 12 months of age when the baby begins to make the sounds b, d, and g.
  • Early repair does have its advantages; it promotes speech development. However, the downside is that early repair may impede normal facial development.
  • In a few cases, cleft palate surgery may be delayed because of heart, lung, or breathing issues that needed be addressed first, and later, surgeries are sometimes needed to shape the palate. The oral maxillofacial surgeon may decide the best course of action based on the particulars of the child's condition.

What happens after cleft palate repair?

Cleft palate repair causes some discomfort and there is a period of recuperation, but the long-term gains make the process worth it.

  • After the surgery, the patient may drool excessively, be sleepy, and have blood-tinged saliva, but all these symptoms are normal.
  • Usually, the first 1-2 days after surgery are spent in the hospital under observation, and then, the child may recover at home.
  • Parents may 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, which prevent the elbows from bending toward the mouth, may be required.
  • 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 a bottle or nipple if the infant is still nursing.
  • No hard foods can be eaten for 6 weeks after surgery. For the first week, only liquid food can be eaten, such as yogurt, pureed food, soup, and ice-cream.
  • 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.

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Can cleft palate be prevented?

Cleft lips/palates can't always be prevented. Diet during pregnancy may influence the development of a cleft lip/palate. Folic acid deficiencies during pregnancy can cause cleft palates; therefore, mothers are encouraged to take folic acid supplements (400 micrograms a day). Certain medications and environmental factors can also contribute to the development of craniofacial anomalies. A study found that cleft lip and cleft palate may be linked to low folic acid intake, alcohol abuse, and smoking while pregnant. Hence, pregnant women should avoid smoking and alcohol consumption and be in a safe environment as much as possible.

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Medically Reviewed on 1/14/2021
References
Patel PK. Cleft Palate Repair Treatment & Management. Medscape. https://emedicine.medscape.com/article/1279283-treatment