Updates

Cleft palate repair at North Austin Campus

Conditions

min. read

In North Austin, we perform cleft palate surgery to repair gaps in the “hard” (front) and “soft” (back) parts of the roof of the mouth in babies born with a cleft palate. All the parts that we need to repair the cleft palate are already close to the cleft, we just need to move them into a better position. In addition to closing the cleft, our surgeons also reposition the muscles at the back of the palate that your child will use to speak. Cleft palate surgery is therefore important not only to separate the mouth and nose by repairing the cleft gap, but also to prepare your child for their first words. 

  • We usually repair a cleft palate when a baby is 10 to 12 month of age.
  • If the surgery takes place too early, it can affect the growth of the upper jaw.
  • If the surgery takes place too late, it can affect early learning of certain speech sounds.
  • If a baby has a small jaw such as in Treacher Collins syndrome or Pierre Robin sequence, we repair their palate between 12 to 18 months of age to minimize the risk of breathing problems after surgery.
  • The surgery lasts less than 2 hours.
  • Your surgeon repairs the cleft palate from inside the mouth using a special mouth retractor and magnifying glasses.
  • They carefully raise the side “shelves” of the palate on each side of the cleft based on a small artery and move them across the cleft to repair the mouth lining.
  • They release the muscles at the back part of the palate and repair them across the cleft in a better position for speech function.
  • Sometimes they use fat or mouth lining from the inside cheek area to repair very wide cleft palates.
  • Your baby will spend the first night in hospital for observation and leave the next day.
  • Some babies need to stay longer than one night if they are slow to feed after surgery.
  • We need to protect the cleft palate repair for two weeks after surgery.
  • Two wounds on each side of the cleft repair on the roof of the mouth need to heal by themselves. The inside of the mouth heals quicker than skin, and these wounds usually fully heal after two weeks.
  • It is common for your baby to have some blood drops in their spit for one to two days.
  • We will give you soft arm protectors to prevent your child from putting their hands in their mouths after they go home. We will let you know how long to use these protectors.
  • Depending on how your baby fed before, you can use a specialty bottle for clefts or breast feeding immediately after surgery.
  • If your child was starting to eat adult type food before surgery, they will need to eat soft foods like a 6 month old for two weeks after surgery.
  • We control your child’s pain after surgery with Tylenol and ibuprofen. 
  • We will check your baby’s mouth 2 to 3 weeks after surgery. Usually by this time all wounds have healed and you can return to normal feeding without the need for arm protectors. 
  • Once we confirm the cleft palate is repaired we will wait until your child is older before checking how the speech muscles at the back of the palate are working.
  • Once your child starts to be able to sentences of a few words, we will arrange for you to meet with our speech language pathology team so then can listen to how your child makes certain sounds. This is usually around 3 years of age. 
  • If the speech pathologist hears any air escape from the nose during certain sounds, they will order some other tests. 
  • If the air escape persists after speech therapy, we may recommend secondary speech surgery. 
  • The main risk after cleft palate repair is that part of the cleft with open after surgery and cause a small hole between the nose and the mouth known as a “fistula”.
  • The risk of fistula is low and occurs after less than one in every twenty cleft palate repairs.
  • If the fistula is small and is not causing any problems we will usually recommend leaving it alone and repairing it at the time of another scheduled surgery.
  • If the fistula in large or causing problems with speech or feeding, we can repair the fistula in different way depending on its size and location.
  • In wide cleft lip and palate, it is common for there still to be a small hole into the nose found inside the gap in the gum line (alveolar fistula) after a cleft palate repair. You surgeon will repair this at the time of the alveolar bone graft surgery.