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In cleft palate repair, your child will have general anesthesia (asleep and not feeling pain). Tissue from the roof of the mouth may be moved over to cover the soft palate. Sometimes a child will need more than 1 surgery to completely close the palate.
During these procedures, the surgeon may also need to do rhinoplasty.
Most of cleft palate patients will develop velopharyngeal competence after palate closure and the rest may require speech therapy and/or an additional surgical procedure called a pharyngeal flap. This procedure involves raising a flap of tissue from the posterior pharynx and inserting it into the soft palate. This flap is indicated when the repaired palate is too short or the muscles do not function properly, causing a persistent hypernasal speech. The procedure is performed usually after the age of 4-5 years when speech and velopharyngeal competence can be thoroughly assessed and before the child begins school.
A cleft defect can also involve the teeth and gums. A child with a cleft palate may need surgery after the initial cleft palate repair to replace missing bone in the gumline. The "alveolus" is the bony part of the gumline found in the region of the upper jaw and lower jaw that contain the teeth. The placement of bone to this area is referred to as "alveolar cleft bone grafting" (ACBG).
Pharyngeal Flap:
The pharyngeal flap, a superiorly based flap of tissue is raised from the posterior pharynx and sutured to the soft palate thereby decreasing the amount of air through the nose. Lateral ports or holes are left so that the nose will not be obstructed.
Late Cleft Treatment:
The Craniofacial Center can also help those individuals that have grown up without access to a comprehensive, coordinated team approach. For adults with speech problems, the previously mentioned pharyngeal flap, combined with an intensive regimen of speech therapy, can produce significant improvements. Orthognatic surgery is available to patients with deformities of the jaws to improve their appearance as well as to correct dental occlusion. For soft tissue revision of a severely tightened or notched upper lip, an Abbe flap is the surgical option. This procedure is usually indicated in bilateral cleft patients who have a short or deficient columella and a tightened upper lip. This operation can add fullness to the upper lip as well as lengthen the columella. A number of additional surgical therapies, similar to the ones described, are available to patients who desire further improvements.
Hearing:
Children with cleft palate have a higher incidence of hearing problems. The Eustachian tube connects the middle ear space to the back of the throat. It normally opens and shuts to relieve pressure that builds up behind the ear drum. If the Eustachian tube does not open, then the pressure increases until mucus or "fluid" accumulates behind the eardrum. The muscles responsible for opening the Eustachian tube do not function as well in children with cleft palates resulting in more frequent problems with fluid, otitis media and ear infections which can be very painful. Because of this problem, it is important to have the infant's hearing tested during the first few months. If hearing is impaired by fluid buildup or unequal pressure, it may be necessary for the otolaryngologist to place pressure equalizing (PE) tubes. Tubes are often placed at the time of the lip or palate surgery. It is crucial that children with cleft palates have regular hearing tests to monitor middle ear problems that could alter the development of normal hearing as well as speech. As the child grows, the frequency of ear infections and fluid in the ears seem to decrease.
Speech:
Speech development in children with cleft lip only should be normal. The un-repaired cleft palate causes speech to sound hypernasal because air passes through the nose while talking. Most speech sounds require the nose to be closed off from the mouth. Cleft palate surgery usually remedies the problem, but speech therapy is still recommended. Approximately 20-30 percent of cleft palate patients will have velopharyngeal incompetence or hypernasal speech after surgery and may require a pharyngeal flap to correct it around the age of 4-5 years.
Dental:
Clefts of the palate generally have an effect on dental development. In the area of the cleft, teeth often erupt in a crooked position with extra teeth or missing teeth being common in the cleft area. Radiographs are often taken to determine the exact position of the teeth. Dental problems have an effect on speech, chewing, appearance and frequently require orthodontic treatment. Early orthodontic intervention may require a palatal expansion device with further alignment of the dental arches. Later treatment after the primary teeth have erupted can begin at 10-12 years of age. Orthognathic surgery may be indicated if a malocclusion develops due to abnormal growth of the maxilla.
The cleft palate repair is done in the operating room under general anesthesia so that the child will sleep throughout the entire procedure. The average hospital stay is 5 to 7 days. Complete recovery may take up to 4 weeks. Some children continue to have speech defects after the surgery because of muscle problems in the palate. Speech therapy is then required.
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