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Cleft Palate Repair & Problems After Repair

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There are many types of cleft palate repair, and the best option will be discussed by your surgeon based on the individual cleft of the palate.

Almost all operations for cleft palate involve these three main components:

  1. Freeing up the existing palate tissue from the sides of the palate and moving it so that it meets in the middle. Often, but not always, this means leaving gaps on both sides of the palate at the end of the operation, but these tend to heal quickly and without problems.
  2. Making a lining for the nose side of the palate allows the palate to be repaired in two layers rather than one, with the aim of reducing the chance of developing a hole (fistula) in the repaired palate between the mouth and the nose
  3. Creating a good muscle sling within the soft palate so that the palate can move well to form an effective “valve” and block airflow into the nose to give good speech, as described above.Your surgeon will advise on which operation is the best choice, whether to repair the entire palate in one operation or to split the repair between two operations. You will also learn whether to expect the scar in the palate to be a straight line from front to back or whether to expect it to be Z-shape.

Your surgeon will advise on which operation is the best choice, whether to repair the entire palate in one operation or to split the repair between two operations. You will also learn whether to expect the scar in the palate to be a straight line from front to back or whether to expect it to be Z-shape.

Problems After Cleft Palate Repair

There are risks of problems after any operation. Cleft palate repair, or palatoplasty, is an effective and reliable operation in a large majority of children, but there are two main risks.

The first is the risk of fistula, or a hole in the repaired palate. This can be a problem as foods and drinks can escape through the hole and leak out through the nose. If the fistula is large enough, it can affect speech. Not all fistulas need to be repaired, but if there are any problems due to the hole, surgical repair is usually recommended.

The second is the risk of velopharyngeal dysfunction. This is a term to describe that the soft palate is not acting well as a valve to block air from traveling into the back of the nose and redirecting it into the mouth. As a result, there are problems with forming speech sounds. Depending on the severity of the velopharyngeal dysfunction, this can range from soft speech or speech with added noise from air leaking through the nose, all the way to speech that is impossible to understand, even by close family.

This is discussed in more detail in the speech section. If velopharyngeal dysfunction is suspected, then it is investigated using specialized tests, and surgery may be recommended.

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