Cleft palate is a congenital cleft caused by a defect in the development of the palate, which may be due to viral infection of the mother during pregnancy, nutritional deficiencies, genetics and other factors, the cause of which is not well understood. It occurs mainly on the right or left side or on both sides of the palate. Cleft palate can be accompanied by cleft alveolar ridge and cleft lip.
Babies with cleft palate have problems with swallowing and articulation.
The degree of cleft palate is classified from a depression of the tissue at the midline of the soft palate (cryptic cleft) to a complete cleft of the palate to the incisal foramen (complete cleft palate) as
1.Cryptic cleft palate: depression or translucency in the midline of the soft palate during movement.
2, Uvula cleft: cleft of the uvula (commonly known as uvula).
3, I degree cleft palate: part of the soft palate at the midline cleft.
4.Second degree cleft palate: the soft palate and part of the hard palate are cleft.
5.Cleft palate degree III: full cleft of soft and hard palate.
Treatment of cleft palate.
1.Evaluation of preoperative speech and Eustachian tube function
The baby’s voice and middle ear condition are evaluated to determine if he/she has exudative otitis media as well as the more serious purulent otitis media, and treated.
2. Timing of cleft palate repair.
The overall condition of the baby with cleft lip and palate needs to be taken into consideration to determine the time of surgery (pre-operative examination).
Cleft palate: generally 6-18 months old.
Older children with cleft palate: since the optimal time for cleft palate surgery has been exceeded, early surgery is needed to close the cleft palate to reduce its impact on speech development.
3. Post-operative speech evaluation.
After the baby is 3-4 years old and its speech development is basically completed, it needs to be reviewed and have a speech evaluation to determine whether further speech training is needed and whether pharyngoplasty treatment is needed to improve the articulation.
In case of older cleft palate patients, speech evaluation and training can be performed 3 months after surgery.
4. Examination of various auxiliary instruments.
In addition to the direct speech evaluation of the cleft lip and palate baby by the speech specialist, further nasopharyngeal fiberscope, nasopharyngometer and X-ray are usually required to check the baby’s palatopharyngeal closure.
5. Pharyngoplasty.
Some cleft palate babies may still have slurred speech after cleft palate repair and still need further palatopharyngeal surgery with speech training to improve their speech. This is usually performed after preschool speech evaluation.
6. Voice training.
After cleft palate repair, not every child with cleft palate can naturally regain normal pronunciation. It requires repeated and painstaking voice training by the postoperative phonetician and parents in order to improve the baby’s pronunciation significantly, and the efforts of parents are even more important.
Pre-operative care for cleft palate
1.Feeding style.
As with cleft lip surgery, in order to reduce the impact of the baby’s sucking power on the wound after surgery, we should try to switch to using a spoon or a special cleft lip and palate bottle to feed the baby before surgery, and to switch to it about 3 days before surgery to give the baby a time to adapt to the change in feeding method.
2. Correction of bad habits.
Some babies are used to sucking fingers and biting hard objects. In order to prevent the baby’s fingers from unintentionally picking and tearing the wound after surgery, such bad habits should be corrected as much as possible before surgery.
Cleft palate postoperative care
1.Surgical incision.
Try to ensure the cleanliness of the lip incision
The first two days after surgery, there is a small amount of blood oozing from the intraoral incision and the nasal cavity on the affected side, and the blood oozing will generally decrease significantly after two days, so no special treatment is needed.
When feeding the baby, parents should feed the baby with a small mouthful of milk and wait for the baby to swallow all the milk in the mouth before breastfeeding. After the baby is full, drink some warm plain water to rinse the food residue covering the incision to promote better healing of the incision.
2. Feeding food.
Within 2 weeks after cleft palate surgery, the baby must be fed with liquid food (dregs-free food DD milk, soup and juice, etc.), and in the 3rd and 4th weeks, the baby is fed with semi-liquid food (rice porridge, rotten noodles and egg custard, etc.), and after a week, the baby is fed with normal diet.
3. Protection of the palatal incision.
Restrict the baby’s arm movement to prevent the baby’s fingers from stabbing the palatal incision; to prevent the impact on the healing of the palatal incision when eating hard objects.
4. Use of antibiotics.
To prevent infection of the baby’s palatal incision, prophylactic application of antibiotics is also required.
5.Removal of stitches.
Cleft palate surgery generally do not need to remove the sutures, if the sutures after one month still part for off, adults can be removed, and children with cleft palate do not cooperate may not need to remove the sutures, to prevent crying when the removal of the sutures pulled open palate incision.
6. Difficulty in breathing after cleft palate surgery.
The baby may snore and hold his breath during sleep after cleft palate surgery. This is due to the fact that the upper airway of the baby is very spacious due to the same mouth and nose before the cleft palate repair, but after the closure of the cleft palate after surgery, the upper airway becomes narrower, coupled with the edema of the palate tissues and the change of the breathing pattern after surgery, which leads to poor breathing.
7. Uvula shape (uvula).
The presence or absence of the uvula (small tongue) after cleft palate repair does not in fact have a significant effect on the improvement of speech, but considering the high requirements of the family for the shape of the uvula, we generally repair the shape of the uvula.
8.Palatal fistula
Some cleft palate babies develop small fistulas in the palate after cleft palate repair, mostly at the junction of the hard and soft palate, due to premature eating of hard objects, excessive crying and trauma to the palate (hard objects such as hands, chopsticks and spoons). Parents do not need to be overly nervous, as small fistulas can heal on their own, and large fistulas are repaired at the same time during alveolar ridge bone grafting or pharyngoplasty.
9. Alveolar ridge oronasal fistula
In babies with alveolar ridge fissures, the oronasal fistula at the dental bed may affect the baby’s feeding and articulation after the cleft palate repair, and the bony fissure is usually closed during bone grafting at the age of 9-11 years.