Children with a cleft of the soft palate undergo a definitive closure between 9-15 months of age. At this time, we often perform a Z-plasty of the soft palate, which is a lengthening procedure. This type of closure takes a little longer (about 2 hours) but is both more anatomic and provides additional length, allowing for fewer post-operative speech problems than traditional straight-line soft palate repair.
If a hard palate cleft is present, then a static palatal prosthesis is placed in the first 3 months of life. The goal is to make feeds easier, preventing reflux into the nose, as well as allowing the hard palate to migrate to the midline over time. This is a slow process, but by preventing the tongue from interfering during feeds and other activities the prosthesis allows the hard palate to grow towards the midline. When the prosthesis is removed we wait about 30 days before operating on the palate to allow the surrounding tissues to strengthen enough to hold suture. Patients undergo hard palate repairs between 1-3 years of age, depending on the width and severity of the cleft deformity.
After palate surgery, your child will be watched closely for any problems with breathing, and a nursing specialist will work with you to start feedings as soon as possible. Feeding is liquid or puree only for 2-3 weeks via a sippy cup or a syringe allowing time for the stitches to dissolve. Your child may also wear elbow immobilizers during this time to prevent the placement of any unwanted objects inside the mouth. The immobilizers can be taken off when your child is being held. After about 4 weeks, the palate should be healed, and we will advance the diet to regular foods.