Cleft Palate Program
All babies with cleft lip and palate can have surgery to restore function and a more normal appearance. Surgical repair is most often done in stages, and in varying ages based on your child’s facial growth. Your child’s plastic surgeon at White Memorial Medical Center will explain what type of surgery your child may need and when they may occur.
Plastic and Reconstructive Surgery
If your child was born with cleft lip or palate or both, your baby’s pediatrician will recommend surgery to close the opening. Our three plastic surgeons specialize in plastic and reconstructive surgery. All surgeries carry some uncertainty and risk. When surgery is done by qualified plastic surgeon with experience in repairing cleft lip or palate, the results are remarkable. However, as with any operation, there are risks associated with surgery and specific complications associated with this procedure. In cleft lip surgery, the most common problem is asymmetry, which is when one side of the lip and nose doesn’t match the other side. The goal of the cleft lip surgery is to close the opening in the first operation. Sometimes, a second operation may be needed. In cleft palate surgery, the goal is to close the opening in the roof of the mouth so the child can eat and a mechanism for normal speech production can be restored without impairing normal facial growth. Our plastic surgeons will discuss the details of the procedure including the possible risks and complications, recovery and results you can expect. Your plastic surgeon will also answer any questions you may have about the procedure.
Lip Repair or Cheiloplasty
The first surgery that your child will have is the repair of cleft lip to rebuild muscles and tissues around his/ her mouth and nose. Cleft lip repair is usually done by 10 weeks of life, when your baby is at least 10 pounds and with no other medical problems. It is done as an outpatient surgery, and barring all complications your child will be able to go home on the same day.
Cleft Palate Repair or Palatoplasty
The primary goal for repairing the palate is to achieve acceptable speech. Cleft palate repair is usually performed by 10 to 12 months of age. As with cleft lip repair, the tissue of the palate is detached and rearranged to close the cleft. The muscles of the soft palate are also repositioned to allow for the best possible function for speech. The child must be at least 17 pounds and weaned off from the bottle. Your child will need to stay in the hospital for two to three days to monitor their condition and progress in feeding.
Alveolar Cleft Repair with Bone Graft
The cleft of the dental arch, the gum or the alveolus is left unrepaired at the time of the initial lip repair to allow the dental arch to grow. At the time of “mixed dentition,” (when the secondary teeth are erupting) the arch is correctly shaped by orthodontia (using an expansion device) and the resulting gap or cleft is filled with bone harvested from the iliac crest. This provides the necessary bone to support the incoming teeth.
Sometimes, the palate does not oppose or close off the nasopharynx as needed during speech. This results in hypernasal speech (velopharyngeal incompetence). This can occur in patients who have had a previous cleft palate repair and children without previous surgery as in the case of congenital palatal insufficiency or submucosal cleft.
The surgical method to correct this condition is sphincter pharyngoplasty, where the vertically oriented muscles of the posterior tonsillar pillars are elevated as superiorly based flaps and reoriented horizontally to create a sphincter. Pharyngeal flap is a surgical procedure that aids in velopharyngeal closure, whereby a flap of skin (mucosa) is taken from the back of the throat and attached to the soft palate to achieve closure of the opening between the oropharynx and the nasopharynx during swallowing and speech.
As your child grows, he may need more surgeries at different ages, such as lip revision, rhinoplasty (surgical repair of deformed nose) or palate fistula repair. Your child will be screened regularly and your child’s plastic surgeon will discuss any treatment plan, and future surgeries during your clinic visit.