University of Virginia Health System

Treatment of Cleft Lip and Palate

A cleft palate is initially treated with surgery. However, the surgery is usually not done right after birth. Instead, it is delayed until the child is old enough and big enough so that the surgery can be done safely. The usual age at which cleft palate surgery is done varies anywhere from 7 months to 18 months old, and depends upon the individual child and his/her own situation. For example, if the child has other associated health problems, it is likely that the surgery will be delayed.

The major goals of surgery are to:

1. Close the gap or hole between the roof of the mouth and the nose.
2. Reconnect the muscles that normally make the palate work.
3. Make the repaired palate long enough so that when the muscles are working, the palate can perform its function properly.

There are many different techniques that surgeons will use to accomplish these goals. The choice of techniques may vary between surgeons and should be discussed between the parents and the surgeon prior to the surgery.

Are there risks during surgery?

Any surgery has potential complications. The repair of a cleft palate is no different.
The major potential problems following surgery include:

• Breathing difficulty due to swelling in the mouth.
• Bleeding.
• Early or late separation of the repaired palate.
• Infection
• Scarring.

Often, the child will be admitted to the intensive care unit immediately following surgery for closer observation, in case of bleeding or breathing troubles. Scar tissue may take several months to form. Once present, the scar tissue may prevent the palate muscles from working properly, or it may cause the palate to become too short to close off the passageway from the mouth to the nose.

What can be expected after the surgery?

After the palate has been fixed, most children will immediately have an easier time in swallowing food and liquids. However, in about 1 out of every 5 children following cleft palate repair, a portion of the repair will split, causing a new hole to form between the nose and mouth. If small, this hole may result in only an occasional minor leakage of fluids into the nose. If large however, it can cause significant eating problems, and most importantly, can even affect how the child speaks. This hole is referred to as a "fistula", and may need further surgery to correct.

How will speech be affected by the surgery?

Because of the importance of the palate in producing normal speech, it is felt that the success of the palate surgery be judged by how well these children develop their speech patterns following surgery. Every child should be assessed at yearly intervals by a trained speech and language pathologist to determine their speech development. Previous experience has shown that the vast majority of these children will require some speech therapy to train their palate muscles to work properly after surgery. Even with intense speech therapy, studies have shown that in about 1 out of every 4 children, additional surgery will be needed to further correct the palate enough to allow for proper speech production.

Can a cleft palate affect a child's teeth?

If the cleft should also happen to involve the bone that makes up the upper jaw, the developing teeth may also be affected. The cleft can either result in the teeth not growing in properly, or may even cause some of the teeth to be missing altogether. Again, depending upon the severity of the cleft, some of these children will need orthodontic treatment to correctly line up their teeth. Some may even need more surgery to replace the missing bone where the cleft spilts the upper jaw bone.