Our Summary

This research paper is about how to fix a cleft palate, which is a condition where the roof of the mouth contains an opening into the nose. Fixing a cleft palate helps improve feeding, speech, and ear problems, while also trying to avoid any negative effects on how the upper jaw grows. Before deciding if someone is suitable for this repair, when it should be done, and what surgical method should be used, doctors consider other health conditions, especially heart disease, the length of the lower jaw, and the width of the palate.

There’s also a debate about how to manage the gap in the gum line that often comes with a cleft palate. One option is to perform a surgery called gingivoperiosteoplasty, which can possibly avoid the need for another surgery later. The other option is to do a different surgery called secondary alveolar bone grafting. The choice between these two depends on the risks and benefits, particularly the potential limitation of facial growth and changes to how the teeth fit together that can be caused by the first surgery.

FAQs

  1. What factors determine the timing and surgical method for cleft palate repair?
  2. What is the controversy surrounding the management of the alveolar cleft?
  3. How does cleft palate repair aim to improve feeding, speech, and eustachian tube dysfunction?

Doctor’s Tip

A doctor may tell a patient undergoing cleft palate surgery to follow post-operative care instructions carefully, including keeping the surgical site clean and avoiding activities that may put pressure on the palate. It is important to attend follow-up appointments to monitor healing and address any concerns promptly. Additionally, speech therapy may be recommended to help improve speech and language development post-surgery.

Suitable For

Patients with cleft palate deformities are typically recommended for cleft palate surgery. This includes infants, children, and adults who are experiencing feeding difficulties, speech difficulties, and/or eustachian tube dysfunction as a result of their cleft palate. Candidates for surgery may also have comorbid conditions that need to be taken into consideration before determining the timing and surgical method of repair. Additionally, patients with an alveolar cleft may be recommended for alveolar bone grafting or gingivoperiosteoplasty surgery to address the defect in the alveolar ridge.

Timeline

Before cleft palate surgery:

  • Patient is diagnosed with a cleft palate either prenatally or shortly after birth
  • Patient undergoes evaluation by a multidisciplinary team including plastic surgeons, otolaryngologists, speech therapists, and others
  • Patient may undergo preoperative assessments such as dental evaluations, imaging studies, and speech evaluations
  • Timing and method of surgery are determined based on the patient’s overall health, comorbid conditions, and anatomy

After cleft palate surgery:

  • Patient undergoes surgery to repair the cleft palate, typically between 6-18 months of age
  • Patient requires postoperative care including pain management, feeding adjustments, and monitoring for complications
  • Patient may require speech therapy and other interventions to address speech and feeding difficulties
  • Long-term follow-up is necessary to monitor for potential complications and assess the need for additional surgeries such as alveolar bone grafting
  • Overall, the goal of cleft palate surgery is to improve the patient’s ability to eat, speak, and breathe normally while minimizing the impact on facial growth and development.

What to Ask Your Doctor

  1. What is the recommended timing for cleft palate surgery in my case?

  2. What are the potential risks and complications associated with cleft palate surgery?

  3. How long is the recovery period after cleft palate surgery?

  4. What are the expected outcomes of cleft palate surgery in terms of feeding, speech, and overall function?

  5. Will additional surgeries or procedures be necessary in the future to address any remaining issues related to the cleft palate?

  6. What type of anesthesia will be used during the cleft palate surgery?

  7. How experienced is the surgical team in performing cleft palate repairs?

  8. Are there any specific pre-operative or post-operative instructions I should follow to ensure the best possible outcome?

  9. How will the cleft palate surgery affect my child’s facial growth and development in the long term?

  10. Are there any alternative treatment options or techniques that should be considered in my case?

Reference

Authors: Dao AM, Goudy SL. Journal: Facial Plast Surg Clin North Am. 2016 Nov;24(4):467-476. doi: 10.1016/j.fsc.2016.06.005. PMID: 27712814