Cleft palate repair

Cleft palate is a birth defect that occurs when the palate (roof) of a baby’s mouth does not form properly during pregnancy. The palate is what separates the nose from the mouth. Sometimes both the front and back parts of the palate are open, and sometimes only part of the palate is open.

From the time of birth, a cleft palate may cause challenges with feeding, since milk can regurgitate out of the nose. By age 1 or so, an additional issue may be nasally speech, as well as velopharyngeal insufficiency (VPI), or unintelligible speech due to air escaping out of the nose. The child may also experience ear infections and hearing problems.   

Cleft palate can sometimes occur with cleft lip. Together, these birth defects commonly are called “orofacial clefts." Isolated orofacial clefts (clefts that occur with no other major birth defects) are one of the most common types of birth defects in the U.S. 

Cohen Children’s offers superior diagnostic, medical and surgical care for infants and children with cleft palate. Our expert multidisciplinary team features pediatric plastic surgeons, oral surgeons, dentists, orthodontists, prosthetic specialists, ear/nose/throat specialists, geneticists, social workers, speech and hearing professionals and dedicated cleft coordinator nurses. We also perform revision surgeries in children, as well as adults, if they develop a fistula (hole) after a previous surgery.

Prior to surgery, your baby may temporarily wear a palatal obturator, which is a dental prosthesis used to seal the opening in the palate. This will help with feeding (but not with speech). They may also receive temporary myringotomy tubes (ear tubes) from the pediatric ear, nose and throat (ENT) doctor. These silicone tubes are placed inside the eardrum to drain excess fluid and prevent ear infections.

At the time of surgery, we will repair the soft palate (the muscle in the back of the throat) by connecting the muscles and rearranging the tissues to close the cleft. When your child speaks after surgery, the palate will contract, pull up and close the nose off from the mouth, which prevents nasally speech. This is the main goal of palate repair.

Surgery is done under general anesthesia and takes approximately two hours.

Sometimes when rearranging tissue in the mouth, it doesn’t come together perfectly and can leave a fistula (small hole), evident about a month after surgery. This hole can affect speech and cause VPI (as mentioned previously). In this case, your child will need additional surgical procedures to close the hole.

After surgery, your child will stay overnight, and our expert multidisciplinary team will assist with feeding, IV hydration and pain control. When your child goes home, they may need pain medication for the first few days after surgery, and their mouth will be swollen for the first week or two. The incision should heal in three to four weeks. During the weeks following surgery, your child will need to be on a liquid or semi-liquid diet.