When Is Cleft Palate Repaired

What is a cleft palate?

"Palate" is another name for the roof of your mouth. The palate is both the roof of your mouth and the floor of your nose. The palate has 2 parts: the front, or difficult palate, and the back, or soft palate. The hard palate is made of bone and the soft palate is made of muscle.

Fig. 1 – Submucous cleft palate

A cleft is simply a gap, separation, or hole that results from aberrant fetal development. A cleft palate is a birth defect that results when tissues of the palate fail to fuse during early fetal development. This failure occurs during the 8th and 12th week of gestation. The condition varies from a defect in the muscles of the soft palate just (asubmucous cleft palate, Fig. 1) to a complete separation of the skin and bone of both the hard and soft palate (Fig. two). It is too possible to have a cleft of the soft palate, without a cleft of the hard palate (Fig. 3). But it is not possible to have a cleft of the hard palate without a cleft of the soft palate. Cleft palate surgery is required to repair a cleft palate.

How common are scissure palates?

Fig. 2 – Cleft of hard and soft palate

Roughly 1 out of every 900 children are born with a crevice palate. About 70% of these children will also have a crevice lip. The other 1 3rd will take only a scissure palate. Most fissure palates involve both the difficult and soft palate.

What causes a cleft palate?

Fig. 3 – Cleft of soft palate

It may surprise yous to know that despite years of research nosotros still do not have a great understanding of why crevice palates occur. Virtually doctors and scientists agree that clefts are a combination of genetic as well every bit environmental factors including drugs, infections, maternal disease, and perhaps vitamin deficiencies.

Other birth defects can occur in children with cleft palates. Some of these defects are obvious and some are more than difficult to detect. However, near children born with a fissure lip and/or palate are otherwise normal, good for you children.

How do I feed my child with a cleft palate?

It is extremely hard to successfully breast feed a child with a cleft palate. This is one of the many reasons that children in developing countries born with crevice palates do not survive past infancy.

In order for a child to breast feed (or bottle feed with a conventional nipple), he/she needs to create suction inside the mouth. Suction cannot exist created when there is an opening, or cleft, in the roof of the mouth.

Some well-intentioned friends and/or medical professionals may encourage yous to attempt and chest feed your kid anyhow. Unfortunately encouraging a mother to breast feed a child with a cleft palate just sets mother and baby upward for failure. But residuum assured, there are means to successfully feed a kid with a cleft palate.

Special nipples are available that permit you lot to assistance deliver formula or pumped chest milk from a bottle into your infants mouth. Feeding a baby with a cleft palate takes time and patience. Many resources are available to aid you and your family unit larn the techniques to successfully feed your kid. More specific information is available on our cleft lip and palate feeding page. If yous are having difficulty successfully feeding your child, please call our office to adapt some assist.

Why is a cleft palate repaired?

Fig. 4 Nasal air escape

If a kid can swallow and beverage with a scissure palate, you may wonder why a scissure palate needs to exist repaired at all. The reason is simple—speech.

Most human oral communication and language requires regulation of air catamenia through the nose and mouth. If air leaks out of the nose while we are speaking, many of the sounds we brand do not sound correct. When a lot of air leaks out of the nose, our voice communication becomes virtually unintelligible.

A kid with an unrepaired crack palate cannot stop air from rushing out the nose during speech (Fig. 4). This makes it very difficult for a kid to learn how to speak correctly. It besides makes information technology hard for others to understand his/her spoken communication.

How is a scissure palate repaired?

The repair of a scissure palate requires fissure palate reconstructive surgery and general anesthesia. The fissure is repaired by bringing the tissues around the cleft together. There is no demand for bogus materials or bone grafts in society to repair the palate (Fig. v).

(However, it is important to call back that some children with cleft lip and palate have a scissure in the gum line in improver to a cleft in the hard palate. Although the fissure of the difficult palate is repaired early in life, the cleft in the gum line is not repaired until your child is much older—usually betwixt half-dozen and 8 years sometime. Repair of the mucilage line does involve a bone graft.)

Fig. 5 – Cleft palate before and afterwards repair.

When is the correct time for cleft palate surgery?

Cleft palates are typically repaired betwixt viii and 12 months of age. Clefts of the soft palate can usually be repaired early (8 to x months of age). Clefts of the hard and soft palate are best repaired later (10 to 12 months of historic period). Research tells u.s. that the before the fissure is repaired the better the speech results volition exist.

Information technology is also important that your child has transitioned away from bottle feeding to eating tabular array foods and drinking from a "sippy" loving cup before palate surgery. Using a bottle and nipple immediately after cleft palate surgery may harm the newly repaired palate.

Submucous clefts are not repaired early in life. A submucous cleft only needs to be repaired if spoken communication and language are affected. Approximately 50% of children with a submucous crack palate will require surgery to repair it. The other half will not need any surgery. It is commonly possible to make up one's mind the need for submucous cleft palate repair between three and 6 years of age.

Are in that location any instructions I need to follow before cleft palate surgery?

Your child must have a concrete exam by his or her pediatrician or family doctor inside 7 days before surgery to make sure he or she is in expert wellness. The doctor you see needs to consummate the History and Physical form provided by our role. You lot must bring the completed course with you the twenty-four hour period of surgery.

Your child should be drinking from a "sippy" cup and eating table foods before crack palate surgery. Near children begin this transition 1 month before surgery. If you lot are having trouble weaning your child off the bottle, please let your surgeon know at least 4 weeks before your planned engagement for surgery. Your surgeon will delay cleft palate surgery if your kid even so requires any bottle feeding.

For your kid's prophylactic, it is very important that he or she have an empty breadbasket when anesthesia is given. Please follow our preoperative Eating and Drinking Guidelines. If you practise not follow these guidelines, your child's surgery will be cancelled.

What can I look later surgery?

A cleft palate repair surgery usually takes between two and three hours. Your medico will talk to yous every bit soon as the surgery is over.

Your child will wake upwardly in the recovery room after surgery. This may take 45 minutes to an hour. When your kid is awake, he or she will exist admitted to the hospital. You can accompany your child when he/she is transferred to your hospital room. One or both parents can stay with your child the entire fourth dimension he/she is in the infirmary. In fact, we encourage at least one parent to stay with your kid during the hospitalization.

Later on surgery, your child volition have soft splints wrapped effectually the arms. These splints prevent your kid from inserting hands and objects into the rima oris. These splints can easily be removed when you are belongings your kid. The arm splints should be worn at all other times for 2 weeks later on surgery.

Children usually start drinking 24 to 36 hours later surgery. Your child will receive fluids through an intravenous catheter until he/she starts drinking by mouth. Children are usually discharged from the hospital later on 2 nights. In some cases a child may have trouble feeding or demand a little more time in the hospital to control pain.

How should I take care of my kid after surgery?

At that place is no special wound intendance required post-obit a scissure palate surgery procedure. If you look at the roof of your child's oral fissure during the first 2 weeks after surgery you lot may see white areas on the within borders of the teeth. These white areas are scabs that grade inside the mouth. There is no cause for alarm—these white plaques do not represent infection and will slowly disappear as your kid'due south mouth heals.

In addition to drinking from a "sippy" cup, it is okay to feed your child solid foods. It is important that these foods exist soft, without any big chunks or granules which may get stuck in the healing gaps between the palate and the teeth. Vegetable purees, noodles, applesauce, and the like are ideal. After 2 weeks from surgery your child tin can resume eating whatever foods in his/her normal diet.

If your child seems to have discomfort you can safely give Tylenol® (acetaminophen), Children's Motrin® (ibuprofen), or other hurting medicine prescribed by your doctor. If yous are not sure what medicines are safe, please telephone call your doctor.

Your doctor will ordinarily prescribe a short class of antibiotics for your child later on surgery.

What else do I need to know?

A postoperative visit is usually scheduled three to 4 weeks afterwards surgery. Your doc will check the palate to see how it is healing, and ensure that cleft palate surgery recovery is on track.

Dissolving stitches are used to repair the palate. These stitches will slowly deliquesce over 4 to half-dozen weeks. It is not unusual to see these stitches along the center of the palate even a calendar month after surgery.

In rare cases an opening will appear in the palate afterward surgery. This is called a fistula [FIS-chew-lah] and results from poor wound healing. If your child develops a fistula it may need to be repaired. Some small fistulas can be left lonely until your child is older. Large fistulas may be repaired earlier. Your surgeon will await at least 12 months later on the initial palate repair before repairing whatever fistulas.

Source: https://www.childrensmn.org/services/care-specialties-departments/cleft-craniofacial-program/conditions-and-services/cleft-palate/

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