Why Is Speech Surgery Needed?
Children with a cleft often have speech difficulties. A Cleft Lip and alveolus can cause articulation problems, and a Cleft Palate can cause a nasal twang (hypernasal speech) because the palate muscles do not work normally. These need continuous speech therapy, and occasionally surgery.
When Is It Done?
Usually after 5–6 years of age, when speech therapy has not given the result hoped for. Your surgeon and speech pathologist decide on the need and timing of surgery after a detailed discussion with you.
Tests Before Surgery
Your child has periodic speech assessments and, depending on progress, a nasal endoscopy and fluoroscopy. In nasal endoscopy a thin tube is passed through the nose to look at the back of the throat and the palate and find the cause of the speech problem; fluoroscopy is a real-time X-ray that shows how the speech structures move. If a specific problem is found, surgery is planned.
What the Surgery Involves
Your child 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.
Tissues in the throat and palate are rearranged to change the shape and size of the opening at the back of the throat, depending on the speech problem. The palate may be lengthened in the same operation, and a remaining hole in the palate (palatal fistula) can be repaired. All wounds are closed with absorbable stitches.
After Surgery
- A little oozing of blood from the mouth is normal; regular mouthwashes keep the mouth clean.
- Home after 1–2 days, with a wound check after 1 week. The stitches are absorbable.
- Speech is assessed again 6 weeks after the wound has healed.
Possible Complications
Infection, bleeding, swelling and pain are the common complications. Pain in hospital is managed by the acute pain service team. How much speech improves is hard to predict, and in some children the improvement may be small.
Frequently Asked Questions
At what age is Speech Surgery done?
Usually after 5–6 years, when speech therapy alone has not given the result hoped for.
What tests are needed first?
Regular speech assessments and, depending on progress, a nasal endoscopy and fluoroscopy to see how the palate and throat move during speech.
Will surgery fix my child's speech completely?
Not always. The degree of improvement is hard to predict, and speech is reassessed 6 weeks after healing.
Related Cleft Lip and Palate Procedures
- Cleft Lip Repair — Lip repair at 3–6 months: the operation, feeding and scar care.
- Cleft Palate Repair — Palate repair at 9–12 months, with speech and hearing follow-up.
- 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.