Cleft Palate Repair
Cleft palate is a hole in the roof of the mouth that is present at birth. Early in the development of the baby inside the mother, the left and right sides of the face and the roof of the mouth join together or “fuse.” Sometimes the two sides do not fuse correctly, leaving an opening, or cleft, in the palate. A cleft palate does not mean that the palate is missing, although sometimes it may look that way.

The roof of the mouth is made up of the hard palate in the front, which is made of bone, and the soft palate in the back, which is made up of soft tissue and muscle. When the cleft is in just the back of the soft palate, it is called an incomplete cleft palate. When the cleft runs the length of the palate from the soft palate to just behind the teeth and gums, it is called a complete cleft palate. Because the lip and palate develop separately, it is possible for a child to have only a cleft lip, only a cleft palate, or both a cleft lip and cleft palate.
Left untreated, a child born with a cleft palate will face problems with feeding, growth, development, ear infections, hearing and, most significantly, speech development. It is important to correct the cleft early in a child’s life, usually between 6 and 18 months of age, but sometimes later.
Cleft palate surgery will repair the palate, with the goal of achieving understandable speech. Occasionally, more than one surgery may be needed to completely close the opening in the roof of the mouth or to change the palate to achieve more normal speech. Virtually every child born with a cleft palate is able to lead a healthy, happy life once the cleft has been repaired.
The Surgery
Cleft palate repair is of concern to plastic surgeons, speech pathologists, otolaryngologists and orthodontists with respect to the timing of the operation, the type of palatoplasty to be considered and the effect of the repair on speech, facial growth and eustachian tube function. The objective of this procedure is to close the palatal defect and create an adequately functioning velopharyngeal mechanism for normal speech production.
Surgery of the palate generally occurs between 9-15 months of age. It is done at this time in an effort to provide the child with the best physiological mechanisms for language and speech development. A preoperative work-up with hemoglobin and hematocrit levels must occur within 30 days of surgery. Most children spend 1 or 2 nights in the hospital following surgery. They will return for a follow-up appointment 3-4 weeks after surgery. A visit with the cleft surgeon and other members of the cleft team should occur 3-6 months later.