What happens during surgery and recovery?
Palate repair is generally performed when your child is 9-12 months old. They must be eating well and gaining weight in order to recover properly from surgery. During surgery, we re-arrange your child’s own tissues to close the gap and create a seal between the mouth and the nose. In order to do this, we lift the tissue off of the hard palate, move it to the middle, and close this it in two layers. This leaves raw spots on the sides of the roof of the mouth near the teeth. These spots will heal in on their own with time like a skinned knee. We then need to reposition the muscles of the soft palate. This requires freeing them from all of their abnormal attachments, and placing them into the back of the palate where they can work properly. This is a very delicate part of the operation, and is usually done with a microscope. The soft palate is then also closed in two layers, including the uvula, and the muscle is sewn together in its proper position.
After surgery, you may notice the raw areas on the inside of the mouth, and a line of stitches down the center. These stitches will dissolve on their own over the next few weeks, at which time you might notice some of them fall out, or your child may swallow them. Expect that there will be some bloody drainage from the nose and mouth for the first few days/week. You will usually spend 1-2 nights in the hospital. You will be able to go home once your child is able to eat and drink and pain is controlled. Your child will be able to eat as soon as they wake up from surgery, but sometimes it takes children a few days before they are eating normally due to pain and the different way that their mouth feels. It is extremely important that you only feed your child soft foods, and prevent any objects from being placed in the mouth (toys, fingers, utensils etc.) for the first few weeks after surgery to allow the palate to properly heal. You may feed your child with a sippy cup, short nippled bottle, syringe or red rubber catheter. You may clean the outside of the nose gently with a warm washcloth or q-tips with peroxide, but do not stick any objects in the nose (including suction bulbs).
The first month after surgery is the most important for healing of the palate. In up to 20 % of cases it is possible that a hole may form, or some or all of the suture line may fall apart. Once this process begins, it can’t be stopped. The tissues will have to be allowed to heal and strengthen, and your child will then need another surgery in the future to fix the hole. If, after a month, the palate is healed, it is unlikely that a hole would form in the future. After the palate repair, it will then take several years for your child to form enough speech and vocabulary for us to know whether or not the palate is functioning properly. You will be followed along by our speech pathologists. Almost all cleft children will at least need some form of speech therapy but, in about 25 % of children, they will also need one or more additional surgeries to make their palate function well. (see section on speech surgery).
Palate repair is generally performed when your child is 9-12 months old. They must be eating well and gaining weight in order to recover properly from surgery. During surgery, we re-arrange your child’s own tissues to close the gap and create a seal between the mouth and the nose. In order to do this, we lift the tissue off of the hard palate, move it to the middle, and close this it in two layers. This leaves raw spots on the sides of the roof of the mouth near the teeth. These spots will heal in on their own with time like a skinned knee. We then need to reposition the muscles of the soft palate. This requires freeing them from all of their abnormal attachments, and placing them into the back of the palate where they can work properly. This is a very delicate part of the operation, and is usually done with a microscope. The soft palate is then also closed in two layers, including the uvula, and the muscle is sewn together in its proper position.
After surgery, you may notice the raw areas on the inside of the mouth, and a line of stitches down the center. These stitches will dissolve on their own over the next few weeks, at which time you might notice some of them fall out, or your child may swallow them. Expect that there will be some bloody drainage from the nose and mouth for the first few days/week. You will usually spend 1-2 nights in the hospital. You will be able to go home once your child is able to eat and drink and pain is controlled. Your child will be able to eat as soon as they wake up from surgery, but sometimes it takes children a few days before they are eating normally due to pain and the different way that their mouth feels. It is extremely important that you only feed your child soft foods, and prevent any objects from being placed in the mouth (toys, fingers, utensils etc.) for the first few weeks after surgery to allow the palate to properly heal. You may feed your child with a sippy cup, short nippled bottle, syringe or red rubber catheter. You may clean the outside of the nose gently with a warm washcloth or q-tips with peroxide, but do not stick any objects in the nose (including suction bulbs).
The first month after surgery is the most important for healing of the palate. In up to 20 % of cases it is possible that a hole may form, or some or all of the suture line may fall apart. Once this process begins, it can’t be stopped. The tissues will have to be allowed to heal and strengthen, and your child will then need another surgery in the future to fix the hole. If, after a month, the palate is healed, it is unlikely that a hole would form in the future. After the palate repair, it will then take several years for your child to form enough speech and vocabulary for us to know whether or not the palate is functioning properly. You will be followed along by our speech pathologists. Almost all cleft children will at least need some form of speech therapy but, in about 25 % of children, they will also need one or more additional surgeries to make their palate function well. (see section on speech surgery).
