Cleft Palate Surgery in Sadashiv Peth, Pune
During a baby’s early development in the womb, when the roof of the mouth doesn’t close properly, it is known as a cleft palate. The palate is made of two parts – the soft palate and the hard palate. The bony portion in front of the roof of the mouth is the hard palate whereas the soft palate is made of soft tissue and located at the back of the mouth. Babies might be born with a split in one or both parts of the palates. They might also have a cleft lip or a split in the gums.
A cleft palate is one of the most common problems in newborn babies. Every year, about one in every six hundred babies is born with a cleft.
Typically, the cause of a cleft palate is not known and it is not possible to prevent it. However, some factors that can cause a cleft palate are:
- Genetic and environmental factors - The chances of a cleft palate occurring are higher in a newborn if a parent, relative, or sibling has had the problem. Exposure to chemicals or viruses, while the fetus is developing in the womb, can also cause a cleft palate.
- Medications and drugs - Some drugs such as acne drugs, anti-seizure drugs, and methotrexate, a drug that is used for treating psoriasis, arthritis, and cancer, if taken during pregnancy, can cause a cleft palate.
- Part of other medical conditions such as van der Woude syndrome or velocardiofacial syndrome
- Cigarette smoking
- Drinking alcohol
- Deficiency of prenatal vitamins such as folic acid
A cleft palate is immediately identifiable at birth. It appears as:
- A split in the roof of the palate might affect one or both sides of the face
- A split in the roof of the mouth that doesn’t show on the face directly
- A split that extends from the lip through the upper gum and palate into the bottom of the nose
Sometimes, a cleft can occur only in the muscles of the soft palate. It may go unnoticed at birth and might not be diagnosed until later when symptoms start to show. Known as submucous cleft palate, its symptoms include:
- Chronic ear infections
- Difficulty with feedings
- Difficulty swallowing
- Liquids or foods come out of the nose
- Nasal speaking voice
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Since a cleft palate is visible at birth, it is easy to diagnose with a physical exam of the palate, nose, and mouth. A prenatal ultrasound might help determine if a cleft exists in the fetus. If diagnosed, your doctor might remove some of the amniotic fluid surrounding the baby to get it tested for other genetic abnormalities.
A cleft palate can only be repaired by surgery, wherein the opening in the roof of the child’s mouth would be closed. A team of specialists including plastic and ENT surgeons, oral surgeons, pediatricians, and orthodontists would work together in this surgery. First, the child is given anesthesia, so he or she won’t be awake during the procedure and won’t feel any pain. After this, a brace or device will be placed in the child’s mouth to keep it open through the surgery. Then, on both sides of the palate along the cleft, incisions will be made. The layer of tissue attached to the bone of the hard palate is loosened so that the tissue can be stretched. After this, a cut will be made along the gums to allow the tissue of the palate to be stretched and moved toward the middle of the roof of the mouth. Then, the inner layer of the tissue will be closed using sutures that will dissolve while the incision heals. After this, the outer layer of tissue will be closed with stitches that will dissolve. The incisions along the gums will be left open for the next few weeks, to heal. The incision would look like a “Z”.
The “Z” shape is better as it helps improve the child’s speech in the following ways:
- The muscles in the soft palate are placed into a more normal position to enable growth and healing.
- The soft palate gets lengthened with a “Z” shape as it is longer than a straight-line incision. Once the incision starts to heal, it will become shorter in length.
It is not possible to prevent a cleft palate, however, some steps can be taken to lower the risk of it, such as:
- Take prenatal vitamins regularly
- Avoid using tobacco or alcohol
- Consider genetic counseling
Children with a cleft palate face a lot of challenges such as:
- Difficulty feeding – A cleft palate makes it difficult for babies to suck, which is why breastfeeding can be difficult.
- Dental problems – If the cleft extends through the upper gum, there may be problems with tooth development.
- Ear infections – Babies with a cleft palate are at higher risk of developing middle ear fluid and hearing loss.
- Speech defects – A cleft palate can cause problems in the development of normal speech since the palate is used in forming sounds. Speech may sound too nasal.
- Social and emotional problems – Due to a cleft palate, the child’s appearance gets affected which can lead to them having social, behavioral, and emotional problems.
Repair of a cleft palate requires multiple surgeries that are performed over 18 years. The first surgery is performed when the child is between 6 to 12 months old. When the child is about 8 years old, he or she might require a bone graft. Additional surgeries might be required to improve the appearance of the nose and the lip and speech, to close the openings between the nose and the mouth, to help with breathing, and to stabilize and realign the jaw.