Cleft Palate:

How does a baby get Cleft Palate?

Cleft Palate is a birth defect which means they occur when the baby is developing inside the mother's womb. The cause for a baby to have Cleft Palate might be genetic (hereditary). Cleft Palate has also been associated with smoking or use of certain medications during pregnancy however, all these associations are inconclusive. Cleft Palate is seen more commonly on males vs. females.

What are the types of Cleft Palate?

Cleft Palate can be 1) Unilateral Cleft Palate - the gap in the palate on one side of the midline, 2) Bilateral Cleft Palate - the gap in the palate is on both the sides of the midline. Cleft Palate can be 1) Complete Cleft Palate - the gap extends all the way from the upper lip to the floor of the nostril, 2) Incomplete Cleft Palate - the gap does not separate the palatal structures all the way. There is another type of Cleft Palate known as sub-mucous cleft or Invisible Cleft Palate. In this type of Cleft Palate, there is a gap in the soft palate which cannot be seen. Invisible Cleft Palate is much uncommon however, it occurs when the surface tissues are joined together but the underlying musculature is not completely joined, causing a gap which is not visible.This type of invisible Cleft Palate causes a delay in speech and sometimes is the only apparent symptom that might lead to further investigation of this problem.

What are the problems associated with Cleft Palate?

• Feeding Problems
  • Cannot suck effectively
  • Milk gets into the nasal cavity and may result in choking or aspiration
  • Teething Problems
• Missing teeth
  • Increased number of cavities
  • Malocclusion of teeth - When teeth are bunched together or on top of each other.
• Speech Problems
  • Nasal voice
  • May develop nodules on the vocal cord due to vocal abuse
  • Delayed speech and language development
  • Difficulty with articulation and proper pronunciation of words
• Ear Infections
  • Most children with Cleft Palate are prone to middle ear infection
  • Hearing Loss
  • May be associated with repeated ear infection
• Psychological Problems
  • To pay the price for looking and sounding different.
• Social Problems
  • Suffer isolation and alienation

What will my child's 'Health Professionals Team' comprise of?

It is important that several health professionals with different expertise are involved to assess and monitor your child's progress as he / she grows up. The team of health professional for surgical correction and rehabilitation of a child with Cleft Palate will include:

• Pediatrician - May be the first one to examine and diagnose the problem of Cleft Palate and make appropriate referrals
• Dietitian - Provides guidelines on proper feeding during infancy, weight gain and preparation for Cleft Palate surgery
• Plastic or Reconstructive Surgeon - To perform surgical repair of Cleft Palate.
• Speech Pathologist - To work on the speech and language development of your child
• Audiologist - To monitor hearing which may be impaired due to middle ear infection
• Ear, Nose and Throat (Otorhinolaryngologist) specialist - Treats middle ear infections
• Oral Surgeon - Performs jaw alignment and tooth extractions
• Dentist and Orthodontist - For repositioning of teeth and designing of prosthetic devices like braces and bridges.
• Genetic Counselor - Counsels and provides information on genetic background of Cleft Palate.

How do I prepare my child for Cleft Palate surgery?

Cleft Palate is usually repaired between 12 - 18 months of age. Your child will be hospitalized the night before for pre-operative assessment like blood and urine testing, and a chest x-ray. You will be instructed not to feed anything to your child for at least 10 hours before the Cleft Palate operation. Also make sure that your child does not have any viral infections like flu, cough, cold or diarrhea.

What does the procedure for the repair of Cleft Palate involve?

Depending on the extent of the gap in the roof of the mouth, Cleft Palate repair operation will be done accordingly. Your surgeon will make an incision on both sides of the cleft, moving the tissue from the sides to the midline thus closing the gap in the roof of the mouth. This attempt at restoration of normal anatomy of mouth would hopefully enable your child to eat and speak properly over time. The operation to repair Cleft Palate may take 2 - 3 hours and your child will be required to stay in the hospital for 3 - 4 days.

What is the recovery period like following Cleft Palate surgery?

Your child will feel some pain and soreness following the Cleft Palate surgery. Your child will be irritable and may require some medication to calm down and relieve the pain and soreness which commonly occurs following the operation to repair Cleft Palate. Your surgeon might prescribe antibiotics to minimize the chances of infection while in the hospital. Your surgeon will provide you with instructions on feeding and general care of the baby during the crucial couple of days after surgery for Cleft Palate. It is very important that you follow these instructions closely so that your child's palate heals properly. Your child may have to be put in restraints to make sure he / she does not rub the area with stitches. Your child will be hospitalized for about 4 - 5 days, the stitches need not be opened as they dissolve on it's own after a few days.

What is the outcome of Cleft Palate surgery?

The outcome of surgical repair of Cleft Palate is quite satisfactory. Most commonly the defect can be corrected in a single operation, seldom a second operation is required. If the cleft is extensive and cannot be closed in one surgery, then the operation is performed in two stages. There will not be a visible scar however, people who had Cleft Palate which was repaired can be identified by the nasal quality of their voice.

Benefits of surgical repair of Cleft Palate

The team approach to correcting Cleft Palate and other problems associated with it has several fold benefits. Cleft Palate is usually accompanied by Cleft Lip. The repair operation to correct these problems restores symmetry or balance of facial features to a great extent but not completely. The surgeons have mastered sophisticated techniques that has improved the success rate of surgery for Cleft Palate many fold. If the surgery to repair Cleft Palate is performed in the first year of life, chances are that ability to feed properly, talk, facial growth and development of social skills will be less problematic in the years to come.

Risks of surgical repair of Cleft Palate

• Incomplete closure of the cleft - A small hole may still be present in the roof of the mouth after the operation for Cleft Palate has healed. A second operation may be required to completely repair the Cleft Palate.
• Infection of the incision site
• Allergic reaction to anesthesia
• Bleeding, swelling, bruising and delayed healing - It is normal to have some bruising and oozing of bloody discharge around the mouth and nose which will subside in a week or so.

Alternatives to surgical repair of Cleft Palate

There are none, your child can either live with the defect in the upper lip for the rest of his / her life or undergo the plastic surgery for Cleft Palate during the first year of life.

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