The Centers for Disease Control and Prevention estimates that each year about 2,650 babies are born with a cleft palate in the United States. Thankfully, there are effective and successful options, which pediatric plastic surgeons Shitel Patel, MD, and Jacqueline Wegge, MD, offer at Up Pediatric Plastic Surgery. If you’re in the area of Houston or Webster, Texas, call to find out how you can repair your child’s cleft palate. Or you can use the booking form online to schedule an appointment.
If your child was born with a cleft lip and cleft palate, you should address the lip first, at about three months old. If your child has a cleft palate alone, the surgeons at Up Pediatric Plastic Surgery recommend surgery when your child is between nine and 12 months old. The reason behind this is that the doctors want to make sure your child is eating well and gaining weight before the surgery.
During a cleft palate surgery, the doctor rearranges your child’s own tissues to close the gap and create a seal between their mouth and nose.
In order to do this, the surgeon lifts the tissue off of the hard palate, moves it to the middle, and closes it in two layers. The surgeon then repositions the muscles of your child’s soft palate. This requires freeing them from all of their abnormal attachments and placing them into the back of your child’s palate where they can work properly. This is a very delicate part of the operation, which the surgeon performs using a microscope.
At the end, the surgeon closes your child’s soft palate in two layers, including the uvula, and sews the muscle together in its proper position.
After surgery, you should count on spending one or two nights in the hospital. Your child can eat as soon as they wake up from surgery, but sometimes it takes children a few days before they’re eating normally due to pain and the different way their mouth feels. You can go home when your child is able to eat and drink, and the pain is controlled.
You may notice raw areas on the inside of your child’s mouth and a line of stitches down the center, both of which are to be expected. These stitches dissolve on their own over the course of a few weeks, at which time you might notice some of them fall out, or your child may swallow them.
Expect there to be some bloody drainage from your child’s nose and mouth for the first few days and even up to a week. It’s extremely important that you only feed your child soft foods and prevent them from placing any objects in their mouth (toys, fingers, utensils, etc.) for the first few weeks after surgery to allow the palate to heal properly. You may feed your child with a sippy cup, short nippled bottle, syringe, or red rubber catheter.
The first month after your surgery with Up Pediatric Plastic Surgery is the most important. In up to 20% of cases, it’s 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. In these cases, you have to wait until the tissues heal and strengthen, and then your child will need another surgery to fix the hole.
If your child’s palate is healed after a month, it’s unlikely that a hole will form.
After the palate repair, it takes several years for your child to form enough speech to know whether or not their palate is functioning properly. Your doctor at Up Pediatric Plastic Surgery has you work with speech pathologists because almost all cleft children need some form of speech therapy.
If there are problems with your child’s speech, you may have to have another surgery to help your child’s palate function better. This happens in about 25% of children.
The odds are that, yes, your child will need further work to ensure that their mouth and nose function properly and look normal. This work includes an ABG, or alveolar bone graft, and a rhinoplasty to correct their nose.
Cleft patients often have noses that form abnormally and cartilage that is usually very weak. The surgeons do as much as they can to fix the nose at the time of the initial lip and palate repair, but it isn’t possible to use many of the techniques necessary to improve these deformities on a baby.
In most cases, the cartilage must be strengthened and repositioned, the bones need to be broken, and part of the septum needs to be removed to straighten it. In general, it’s best to do all of these things once your child is done with growth at 16-18 years of age.
Before this happens, the surgeons at Up Pediatric Plastic Surgery perform an ABG when your child is approximately nine to 11 years old. The purpose of the bone graft is to fill the gap in the gum line so that the upper arch is stable, and there is somewhere for the canine tooth to erupt. If there’s no bone in this area, that tooth will be lost, and there won’t be a secure way for the orthodontist to move the teeth with braces.
The ideal time for the bone graft is when the canine is starting to descend into the cleft, so it’s the orthodontist who lets the surgeons know when your child is ready for surgery.
For compassionate and thorough care of your child’s cleft palate, call Up Pediatric Plastic Surgery, or use the online booking form to schedule an appointment.