Cleft Palate

A cleft palate is a separation in the roof of the mouth that can start in the back of the palate, or just behind the gum line. The palate is important for normal feeding and speech. With a cleft (or split) of the palate, your baby cannot suck normally and will have problems getting enough milk with breastfeeding. Bottle feeding will be necessary.

• One month: office visit in Dr. Woo's clinic and referral to Genetics (if referral has not already been made)
• Six to nine months: first visit with the craniofacial team
• Twelve to eighteen months:  cleft palate repair (with ear tube placement, if needed)
• Two to five years: craniofacial team visit every year
• Six to eighteen years: craniofacial team visit every two years

If the infant does not pass the screening hearing test in the birth hospital, a follow-up secondary hearing test will be recommended. Follow-up testing is important to evaluate whether the child has hearing loss. A special hearing test, called an auditory brainstem evoked response (ABR), may be scheduled to obtain more detailed information about the baby’s hearing. If there are concerns for hearing loss the infant will be referred to our ear, nose and throat doctor. Regular assessment of hearing, typically at least once a year, is recommended for the first few years of life.  

Children with cleft palate can have a higher chance of developing ear infections and hearing loss secondary to fluid behind the eardrum. The muscles of the palate also function to open and close a structure called the eustachian tube. The eustachian tube connects the ears to the back of the nose, allowing the inside of the ear to drain any fluid out. Because of the abnormal position of the muscles in children with cleft palate, the eustachian tube cannot drain the ear as well as in children without a cleft palate. Fluid collecting behind the ear drum over time can increase the child’s chance of having ear infections and can ultimately affect hearing.

It is important for children with cleft palate to be evaluated by the ear, nose, throat physician, and to have regular hearing checks. Parents and pediatricians should be aware of the child’s increased risk of ear infections. Often, if the eustachian tube isn’t draining fluid as well as it needs to, leading to infections or hearing loss, it is helpful to relieve the fluid collection using ear tubes (also called ventilation tubes or myringotomy tubes). Ear tubes are often place at the time of the surgery for the cleft palate, but sometimes need to be placed sooner under a separate anesthesia. During the ear tube surgery, small metal or plastic tubes, are placed into a small incision in the ear drum. The tubes stay in place for one to two years and help prevent infections and further fluid build-up.

Clefts of the palate are usually repaired with a single surgery around one year of age. To close the cleft, your child’s doctor will release and pull in the tissue from the sides of the palate to close the opening in the center. No bone is placed under the cleft repair and nothing is taken from another part of the body. Stitches are used that will dissolve in three to four weeks. Usually, the baby is discharged from the hospital the day after surgery. Some children may stay in the hospital longer if they need extra time to feed comfortably. 

Your baby will be asleep for the operation. The specialist who gives the sleeping medications, an anesthesiologist, is one of a staff of doctors trained and experienced in giving anesthesia to young infants and children.

Parents need to protect the cleft repair from trauma, so fingers, pacifiers, or objects should be avoided in the baby’s mouth for three weeks after surgery. 

To keep the baby’s hands and fingers out of the mouth, arm restraints may be used to keep the elbows straight. These restraints are completely optional and are provided for the convenience of the family.

For the first three weeks after surgery, your child’s diet will be limited to soft foods and liquids. Food should be soft enough to be mashed with a fork. Options include pasta, pudding, yogurt, shredded or chopped meats, mashed vegetables, liquids and any baby food in a jar. Three to four weeks after surgery, the baby may begin or resume self-feeding.

Cleft palate repair post-operative patient instructions (PDF)

Pain and discomfort after surgery is managed with a combination of infant strength acetaminophen (Tylenol) or prescription pain medications when something stronger is needed. Doses are based on body weight. We avoid the use of aspirin and ibuprofen (Advil, Motrin, Aleve, Nuprin) two weeks before surgery because of decreased blood clotting that can be happen with that medicine. Ibuprofen may be used after surgery. An antibiotic may be prescribed for several days after discharge.

An antibiotic ear drop may also be prescribed if the child has ear tubes placed at the same time as palate repair.

For most speech sounds, the palate blocks the flow of air into the nose during speech and directs the air out of the mouth. The speech of a person with an unrepaired cleft palate is described as “hypernasal” because the person cannot block the passage of air into the nose. Usually repair of the cleft palate in early childhood will correct this problem, but some children may still have an air leak into the nose. In a small number of children, the repaired palate is not long enough or does not work properly, and an additional surgery may be needed to help speech.

Many children with cleft palate will have some speech problems that will need speech therapy after repair. Your child will be evaluated for speech problems at each cleft team appointment.

Speech Development (PDF)

Children born with a cleft palate alone (without a cleft lip) have been shown to have up to a 40% chance of having a genetic reason for development of the cleft. If your child has additional abnormal findings (heart problems, club foot, etc.), the chance of having a genetic syndrome is even higher. Because of this, we recommend that all children born with a cleft palate alone undergo genetics evaluation.