Cleft Palate Repair (Palatoplasty)

Preparation

Most cleft palates are repaired between 10-18 months of age. This is done before speech develops to avoid speech habits that will be difficult to understand. Make an appointment to see your plastic surgeon when your baby is about 8 months old. Advice will be given regarding if your child will be ready for this surgery.

Prior to scheduling surgery, you should have a Pediatric Otolaryngologist or ENT (Ear, Nose, and Throat doctor) examine your child for any sign of ear infections. Ear infections are common with cleft palates, and frequent infections can cause hearing loss. If the ENT doctor recommends ear tubes be placed to help keep the ears open, it may be possible to do both procedures at once. The Texas Cleft and Craniofacial Team has Otolaryngologists on the Team who work closely with your plastic surgeon.

Surgery

There are several different ways to repair a cleft palate. Tissue in the palate will be detached and rearranged to close the cleft. The muscles of the soft palate are also repositioned to aid speech. The plastic surgeon will determine which method will work best for your child during surgery.

A cleft palate repair is a longer procedure than a cleft lip repair. This requires a 2 to 3 day hospital stay due to swelling, which could block your child’s airway. We also want to make sure your child receives enough fluids and can drink appropriately after surgery.

Restraints (“no-no’s”) will be placed on your child’s arms to prevent bending of the arm close enough to touch the tender area with hands or toys. These restraints can be removed under CLOSE supervision for bathing and exercise. They should be kept on for about a week or longer if your child tends to put their fingers or other various objects in the mouth.

**Bottle feeding is not permitted for almost 1 month after the palate repair. Your child should be drinking from a sippy-like type cup prior to surgery. Find a sippy cup that does not require suction (inquire with the team for recommendations). We suggest you try to wean your child a couple of months prior to surgery (it will be easier for both you and the child when you care for them at home after surgery).

At-Home Care

Feeding: Prior to surgery, we encouraged you to wean your child to a sippy cup. However, if the child is still taking a nipple, you will need to use a rubber catheter and a syringe to deliver liquids between the jaw and cheek (avoiding the palate). Do NOT put anything into the mouth to cause injury for 3 weeks after surgery, including utensils, straws or pacifiers. Food should be soft and mushy. You may need to add water or run the food through a blender to make it easy to eat. Jello cubes are a good source of intake. Most babies will prefer food over milk – do not be alarmed if the baby does not desire the same amount of milk they were taking before surgery. After each feeding, rinse your baby’s mouth out with a syringe using water to avoid food getting stuck in the incision areas.
Dehydration may occur and it is important to recognize the following signs: decrease in number of wet diapers, dry mouth, decrease/absence of tears, thirst, less elasticity in the skin, eyes and fontanel (baby’s soft spot on head) appear sunken, irritability or sleepiness. If any of these symptoms occur, please call the clinic immediately to determine if you need to go to the emergency room for intervention.
Pain Management: A prescription of Tylenol with Codeine might be given for pain before discharge from the hospital. After a day or two with Tylenol with Codeine, switch to regular Tylenol (ask your pediatrician for dosing). If no prescription medication is given, use acetaminophen (Tylenol), which is available at your local drug store. If your child has excessive pain or a temperature of 1010F or higher when you return home, please call the office immediately.
Stitches/Sutures: Most children have a tongue stitch during palate surgery to prevent breathing problems after the surgery. This stitch will be removed the following morning. Other stitches placed will take 3-4 weeks to completely disappear.
Recovery/Healing: The palate takes about three weeks to heal. A scab (eschar) inside the mouth will appear white – this is normal. Until the palate has healed and we have given you clearance to start brushing teeth, it is recommended to maintain oral hygiene by drinking water after each feeding (food can still trap within the stitches of the palate). The baby’s palate will also be somewhat stiff after surgery. It can take three to six months until it is moving adequately.
Speech therapy may resume once the palate is healed and we have given you clearance. This is usually 3-4 weeks after palate surgery. A speech evaluation by our team’s speech pathologist will be ordered 3-6 months following palate surgery.
Before leaving the hospital, it is highly encouraged that you get your child’s pain medication filled at the pharmacy. There is a Walgreen’s connected by a sky-bridge to the hospital. They are located in the Hermann Professional Building (6400 Fannin). Doing so ensures that you will have pain medication in a timely manner. If you have any issues receiving the medication, please call the office immediately.

Follow-Up Visit

A post op appointment should be scheduled during your pre-op visit. In the event that you do not have the appointment scheduled, please call the office to schedule your post-op appointment for 7-14 days after being released. You may see the surgeon, or surgical Physician Assistant. If there are any other medical concerns, please call the office number at any time (832) 325-7234. If you are calling after office hours, please leave a message with the answering service and we will return your call as soon as we can.