Cleft palate repair

Frequently Asked Questions

Q: What is cleft palate surgery?
A: The repair of the cleft palate (also known as a palatoplasty) is usually done at six to eighteen months of age. Although the child may look normal from the outside, the cleft palate can be seen by looking for a separation in the roof of the child's mouth. A cleft palate should be repaired for several reasons, namely to improve speech and to rebuild the area between the mouth and the nasal cavity. Occasionally, more than one operation may be necessary to close the cleft palate. The operation to repair the cleft palate involves making several incisions (cuts) at the edges of the palate and sewing the separated parts of the palate back together in several layers; one layer making up the nasal lining, another middle layer containing the muscles of the palate, and still another layer that makes up the lining of the roof of the mouth

Q: What should I expect after surgery?
A: Your child will spend the night in the intensive care unit. This is for observation and close monitoring. When your child first comes out of surgery they will be placed in a car seat. This will help your child to breathe and help decrease any swelling that may occur as a result of the operation. The seat is to be used as much as possible, including while your child sleeps. There will be stitches on the roof of the mouth that will dissolve on their own. You may notice a suture (stitch) in your child’s tongue after surgery. This does not hurt the child and it is taken out the next morning. This suture is used to control your child’s tongue if he/she is having trouble breathing because of repairing the palate. You may notice some clear to blood tinged drainage from the nose and/or mouth. This is expected and will stop in time. An IV (access line into the vein) will be placed during surgery and will be used to give fluids, medicine for pain, and/or nausea or antibiotics.

The nurse will frequently assess your child ‘s pain level using observation and talking to you and your child, and either using the faces pain scale (for younger children) or the verbal pain scale (for older children). She will also decide when your child can eat and/or drink. Once your child is both taking fluids and pain medicine by mouth, the IV can be taken out. Once pain is controlled with pain medicine by mouth, and your child is taking fluids well, discharge is possible. During the week or two following surgery your child can walk or play quietly but should not run, play rough or put anything sharp in their mouth.

Q: How should I feed my child after surgery?
A: Always feed your child in an upright position. Infants and young children will be using the soft tipped syringes for feeding while the older children nay use a cup. No pacifiers, nipples, utensils or straws are allowed for 10 days after surgery since they may injure the surgically repaired site. Formula and liquids are encouraged for 10 days after surgery. After that your child may begin eating soft foods. One month after the date of surgery all diet restrictions are lifted.

Q: Are elbow immobilizers necessary?
A: For infants and young children elbow immobilizers must be worn. They are necessary to prevent your child from accidentally disrupting the surgical repair by accidentally putting either their fingers or objects in their mouth. The immobilizers should be worn at all times for 10 days after surgery. However, they should be removed several times during the day to allow your child to exercise his/her arms. Skin should also be checked while the immobilizers are off. Look at the skin for any changes in color or size. If you desire, lotion may be applied at this time. While the immobilizers are off, please supervise your child and prevent him/her from putting anything in the mouth. When applying the immobilizers, be careful not to put them on too tight. Make sure the fingers and hands are pink and warm and that your child can move them.

Q: How do I care for the palate after surgery?
A: The sutures (stitches) in the mouth are dissolvable and do not need to be removed. Your child may have a cellulose pack at the time of surgery. It is placed to control bleeding and will dissolve within 10 days. On occasion you will notice it hanging from the roof of the mouth. Do not pull it off—allow it to fall off on its own. It is not harmful if swallowed. Routine oral hygiene should be performed. Softly brush your child’s teeth. Also, frequent fluids, especially water will help with cleansing.

Q: What complications/problems should I look for after surgery?
A: Please contact us if you notice any of the following: A temperature higher than 101F, drainage that looks like pus or is green/yellow appearing (clear, pink or dark red/ brown are normal), a foul odor, an increase in pain or swelling, or if the incision begins to separate.

Please remember it is important to keep your follow-up/post-operative check-ups with our surgeons. Please make every effort to keep them. If you are unable please call and reschedule as soon as possible by calling 773-385-5410. Call 773-622-5400 with any questions or concerns and ask to speak with either the plastic surgery resident or the plastic surgery nurse.