Cleft Palate Surgery - a beneficial deformity correction procedure

Cleft Palate surgery called “palatoplasty” repairs the birth defect of cleft palate in the baby. This surgery is performed on the child during infancy by a well-qualified plastic surgeon.

Cleft palate is one of the major deformities faced by many children today. It is a deep cause of worry for the parents and close family members as cleft lip and cleft palate often affect the babies’ growth and development.

In the previous blog, Dr Shrirang Pandit, the Founder of Pandit Clinic and expert Plastic Surgeon wrote about the treatment and procedures for cleft lip. Management of cleft lip and cleft palate is a multispecialty exercise.

This deformity is often treated at multiple levels encompassing different procedures in order to counter the defects which may hinder the facial growth, speech and daily activities of the child.

The first surgery in this repair program is the cleft lip surgery. The next one which follows is the cleft palate surgery.

There are a lot of misconceptions that surround the condition of cleft lip and cleft palate. Although it is a birth deformity, more than often, parents are unaware of the course of action that needs to be followed in case their child has a cleft lip or cleft palate.

This is the reason July is considered as Cleft awareness month and Pandit Clinic’s leading Plastic and Reconstructive surgeon, Dr Shrirang Pandit has decided to write these series of blogs that explain in detail the multiple steps involved in treating the issue.

What Is Cleft Lip And Palate?

Cleft Lip
Cleft Lip is the presence of a hollow space in either one or both sides of the lip. Having a cleft lip drastically changes the appearance of the baby as it seems like a major part of the face is missing. This hampers the appearance of the baby. Cleft Lip Surgery is the first correctional procedure which aims to restore the original features of the face

Cleft Palate
The palate is essentially the roof of the mouth. It is generally divided into the soft palate which is the soft, fleshy part of the roof made of tissue and muscle at the back of the mouth and the hard palate which is the bony part behind the front teeth. In the case of a cleft palate, the roof appears to be missing and there is a cavity present there. This defect can occur either unilaterally or bilaterally. In certain cases, the cleft is only in one part of the palate, which is the soft palate. This is also referred to as an incomplete cleft palate. In certain cases, the cleft runs through the entirety of the palate and this is referred to as complete cleft palate.

Children can have either a cleft lip or cleft palate. There is also a chance that both these defects are present together.

The reasons for having a cleft lip and cleft palate are still being studied by leading research institutions However, there is strong speculation that these issues arrive as a result of genetic factors.

During the time of pregnancy, if the mother has certain nutritional deficiencies, it can be a contributing factor to the presence of a cleft lip and/or palate. Specifically, if the mother has a deficiency of Vitamin B6, it is likely that this defect will be present in the baby

Can Cleft Palate Be Corrected?

Yes, cleft palate can be corrected with the help of plastic and reconstructive surgeries.

Cleft palate repair and correction requires thorough examination and analysis of the case, followed by cleft palate surgery to correct the issue.

Other surgeries may also be necessary to reshape the orofacial region of the child.

What Happens If Cleft Palate Is Not Treated?

Cleft palate plays a major role in hindering the development and growth of the child’s face normally. Some of the activities in which the child faces issues have been listed as follows:

Eating and feeding
Growth of teeth
Incomplete gum development
Speech issues
Chances of hearing impairment
The constant risk of ear infections

All of these issues can be avoided with the timely treatment of cleft palate. The surgery is generally done from 12 months to 18 months. In certain cases, it is also done later depending upon the overall health of the child.

What Is The Treatment For Cleft Palate?

The treatment for cleft palate involves a surgical procedure in order to close the roof of the mouth. In certain cases, multiple surgeries might be required. Also, in case the child is born with both, cleft lip as well as cleft palate, cleft lip is corrected initially and then the surgery for cleft palate is performed.

The first step involves the administration of anaesthesia. Cleft palate surgery is performed under general anaesthesia so that the child remains asleep throughout the procedure and does not feel any pain or discomfort.
The next step involves careful repositioning of the muscles and the tissue in order to close the roof of the mouth.
A variety of flap techniques are used to close the cleft by making incisions on either side of the cleft. This also includes repositioning of the soft palate muscles which play a major role in speech.
This repair is then closed with the help of absorbable sutures along the midline of the roof of the mouth. This helps to get the palate repaired and solve all issues arising with it like eating problems, speech defects, etc.

Is Cleft Palate Surgery Painful?

The Plastic Surgeon first administers anaesthesia on the child. This ensures that the child feels no discomfort or pain throughout the procedure.

Hence, you can be rest assured that the child is pain-free during a cleft palate surgery.

How Many Surgeries Are Necessary To Fix Cleft Palate?

Cleft Palate is a birth defect that needs multiple surgeries over the growing up years of the child to be fully corrected.

Minimum one surgery, namely the cleft palate surgery is necessary to correct the defect. Other surgeries such as Cleft Rhinoplasty, Cleft Orthognathic Surgery etc. may or may not be necessary. This depends on the severity of the defect and the unique challenges faced by the child.

How Is The Recovery After A Cleft Lip Surgery?

The recovery is a crucial part when it comes to cleft lip surgery. Parents need to take the utmost care of the site of the surgery.

The site of the surgery must be taken care of properly. The instructions are provided by the doctor after the surgery. These must be followed to the word in order to have a good recovery.
Pain is a common aspect of the surgery. This can be alleviated with the help of pain medications prescribed by the doctor. Parents must ensure that these are given from time to time in order to have a comfortable recovery.
Instructions are given regarding feeding which must be followed.
There are sutures or stitches inside the mouth where the palate is joined. In case the stitches are removable, they will be removed after a few days according to the healing process.
An arm restriction might be given to the baby so that it does not cause any harm to the site of the surgery. These arm restrictors often disallow the elbows from bending thus keeping the arms of the child away from the mouth.
Certain dietary restrictions must be followed. Solid foods are not permitted for a few days. Doctors often advise on feeding liquids or purees in order to keep the recovery well on track.
One must also take care so as to not use utensils like bottles, pacifiers, straws, etc. as it might cause an injury to the site of surgery.

What Are The Benefits Of Cleft Palate Surgery?

A cleft palate causes a lot of obstacles in the normal growth and development of a child. Repairing the issue at hand has many benefits . Some of them involve:

The muscle of the soft palate function is restored which aids in solving speech-related issues
The defect between the mouth and the nasal tissue is filled up.
The normal relationship between the auditory canal and soft palate is established which solves the problem of hearing impairment.
Encourages the growth of the upper jaw and the front teeth.

All of these benefits greatly help in restoring the normal growth and development of the child.

A cleft palate is not a single surgery that is performed in order to rectify the issue. In some cases, multiple surgeries are required at different ages depending upon the situation at hand. After the first surgery is completed to rectify the cleft lip, the second one involves the correction of the palate which is between the ages 12 to 18 months.

Surgery might be performed at age 5 years to correct any defects within the nose or to improve speech. The next important surgery involves the reconstruction of the gums with the help of bone graft. The last step of the surgery is done in between 18 to 20 years to correct the defects of the nose and the jaws.

It is necessary to have a proper consultation with your plastic surgeon in order to decide the course of the treatment.

We hope that this blog helped you to understand the Cleft palate and the procedure revolving around it.

BOOK APPOINTMENT

If you have any questions or need more information about a procedure, please schedule an appointment with Dr Shrirang Pandit at Pandit Clinic, Pune.