What Is a Cleft Palate?
A Cleft Palate is one of the most common facial differences present at birth: a gap in the palate, the roof of the mouth. It can be complete, incomplete or submucous, and may occur with a cleft in the gum (alveolus) and a Cleft Lip.
Because the muscles of the palate are abnormal, a Cleft Palate can affect swallowing and speech. In some children it also affects the Eustachian tube, letting fluid collect in the middle ear and causing hearing problems.
How It Is Diagnosed
A Cleft Palate can often be seen on a high-quality 3D or 4D ultrasound during pregnancy, and the anomaly scan in early pregnancy usually detects it. It is sometimes missed and found only after the baby is born.
When Is the Repair Done?
Repair is usually done at 9–12 months of age, just before speech develops, once your baby is stable enough for a general anaesthetic.
What the Surgery Involves
Your baby is seen by the paediatric anaesthetist before surgery and admitted on the day of the operation, which takes about 60–90 minutes under general anaesthesia.
The gap is closed by rearranging the lining (mucosa) and repairing the palate muscle. To close the gap in the middle, tissue is moved in from the sides of the palate, which leaves small wounds there. In the same sitting the ENT surgeons usually insert ventilation tubes to clear fluid from the middle ear.
After Surgery
- Absorbable packs may be placed in the mouth, and a little oozing of blood from the mouth is normal.
- Splints on both arms stop your baby from touching the repair.
- Clear liquids from 2 hours after surgery and soft food from the next day; the speech pathologist advises on feeding technique.
- Home after 2–3 days once feeding is normal, with a wound check after 1 week. The stitches are absorbable and dissolve or fall out over the following weeks.
Speech After the Repair
Speech problems can persist despite surgery. Your child may need speech therapy through the growing years and, very rarely, Speech Surgery.
Possible Complications
Infection, bleeding, swelling and pain are the common complications. Pain in hospital is managed by the acute pain service team, and usually only a simple painkiller is needed at home. Very rarely the wound can come apart (wound dehiscence) and the repair may have to be repeated later.
Frequently Asked Questions
When is Cleft Palate surgery done?
Usually at 9–12 months of age, just before speech develops.
Why are ear tubes put in at the same time?
A Cleft Palate can stop the Eustachian tube working properly, so fluid collects in the middle ear and affects hearing. The ENT surgeons usually insert ventilation tubes during the palate repair to drain it.
Will my child need speech therapy?
Possibly. Speech problems can persist after the repair, so speech is followed through childhood; speech therapy is common and Speech Surgery is very rarely needed.
How long is the hospital stay?
Usually 2–3 days, until feeding is back to normal.
Related Cleft Lip and Palate Procedures
- Cleft Lip Repair — Lip repair at 3–6 months: the operation, feeding and scar care.
- Speech Surgery — For nasal speech that persists after therapy, usually from age 5–6.
- Alveolar Bone Grafting — Bone graft to the gum gap at 7–11 years, timed to the canine tooth.
- Jaw Surgery After Cleft — Le Fort I or Double-Jaw Surgery after 16 for a flat midface and underbite.
- Cleft Rhinoplasty — Nose and septum correction after 18 — usually the last cleft operation.
This page is general information written by Dr Vybhav Deraje for patients and families. It does not replace an individual consultation; treatment depends on clinical assessment.