Cleft Palate Surgery

A good palate repair has essentially three very important issues to address, these are speech, nutrition and growth of upper jaw.

Back of the palate which hangs in the mouth and is called the soft palate (see section on medical terminology) serves an important function of closing the nasal air passage from the oral passage during speech while producing certain sounds. When this movement is deficient it leads a nasal tinge to speech (see section on speech impairment). Modern day repairs thus lay a lot of emphasis on good repair of muscles which has lead to significant reduction in the incidence of speech defects.

Type of palate repair is also associated with the growth of upper jaw an effect which will become apparent as the child grows, in other words what kind of surgery we do at the age of 7 months determines the appearance of face when the child grows up. Modern day repairs cause less growth impairment as compared to older repairs

Early palate repair helps take care of nutrition in a growing child and is associated with better speech results. We prefer operating at the age of 7 months.

Speech impairment associated with repaired cleft palate is called velopharyngeal incompetence or simply VPI . This is a correctable situation and requires further surgery and/or speech therapy. (See section on speech impairment )

In patients older than 17 years if the upper jaw is smaller as compared to lower jaw this can be corrected by surgery called orthognathic surgery (see section on jaw surgery). As mentioned above modern day repairs are less likely to interfere in growth of upper jaw.

In patients older than 17 years if the upper jaw is smaller as compared to lower jaw this can be corrected by surgey called orthognathic surgery. As mentioned above modern day repairs are less likely to interfere in growth of upper jaw.

Sometimes hole develops in the palate after surgery, this is called palatal fistula and requires further surgery 6months after the palate repair

Advanced, Traditionally only outer and inner layers of palate were repaired, this is still a very common practice with many surgeons and is associated with a higher incidence of speech impairment. Modern repairs involve dissection of palate muscles taking them to the correct position and repairing them. Two repairs which address this issue well are Intravelourveloplasty (IVV) and Furlows repair (also called Double Opposing Z-plasty). Furlows repair is the most common repair practised in most developed countries and in our opinion is the best possible solution. Use of tissues from inside the cheek (buccal flap) to add to the palate repair is becoming popular these days. We practise Furlows repair in palate surgery and selectively use buccal flap when required.