Cleft Palate

Cleft palate is one of the most frequent birth defects in the United States that occurs without any other major defects. Cleft palate is a separation in the roof of the mouth that occurs when it fails to join, or fuse, as a child is developing before birth.

Dental, speech, feeding and hearing problems may result from this condition.

Surgery to correct a cleft palate is usually done between 9 months and 2 years of age, and may require several stages of repair.

No single cause of cleft palate has been identified. Certain risk factors may increase chances of cleft palate.

  • Genetic factors
  • Smoking during pregnancy
  • Diabetes
  • Substance abuse

Cleft palate is usually diagnosed at birth. Sometimes the condition is identified before birth on an ultrasound. If the cleft palate is hard to see, you may notice that your baby has trouble feeding.

Because of the cleft palate, babies are unable to suck or nurse effectively. You will need to use special feeding techniques and/or special bottles and cups for your baby. 

Repair of cleft palate (palatoplasty) is usually performed between 9 months and 2 years of age. Palate repair may require several stages of repair.

In preparation for the palate repair the infant must be off a bottle and pacifier and only drinking from a cup. We will schedule a special visit before your child’s surgery to help you learn how to transition them to cup feeding. You may need to wean your baby off of a bottle as early as 6 months of age. 

This is a timeline for treatment of the child with a cleft palate. This timeline provides you with a general treatment plan overview.  Each child with a cleft palate is unique and will have their own treatment plan.

Birth-2 months

Your baby will see a plastic surgeon in their first month. 

What to expect at this visit:

The team will:

  • Ask questions about your family history and your pregnancy
  • Weigh your baby
  • Take photos of your baby
  • Review the best treatment plan for your baby

If your baby needs a special appliance to help them eat, they will also need to see a pediatric dentist.

What to expect at this visit:

  • The dentist will make a model of your baby’s gumline to create a dentomaxillary appliance (this looks like a retainer)

Between 6 weeks to 2 months of age, surgery is done to insert the appliance in their mouth

  • Surgery is done with general anesthesia (sleepy medicine) and your baby stays overnight in the hospital

6 months

  • It is time to get your baby ready for their cleft palate repair.
  • Teach them to drink from a regular cup – not a sippy cup.
    • When the cleft palate is repaired, your child will have stitches in the roof of their mouth.  Using a sippy cup or pacifier (or anything that makes them use a sucking motion) can irritate the stitches.

9 months

  • The cleft palate is repaired. 
  • If your baby hasn’t had ear (PE) tubes placed, they are inserted during this surgery
  • If your baby needs further repair of a cleft lip, it is also done at this time.
  • Your baby will stay one to two nights in the hospital and need to wear arm restraints to keep them from putting anything in their mouth.
  • Your baby will go home when they are able to drink enough fluids.

3-5 years old

  • When your child begins to speak in sentences, a speech pathologist will evaluate their speech.  Speech therapy and/or surgery may be needed.
  • If surgery is needed, your child will see a plastic surgeon that will perform pharyngeal flap surgery.
  • Your child will usually stay in the hospital two to four days after surgery until they are drinking well.

5-9 years old

  • If your child has a cleft through the gumline they may need to have this area expanded in preparation for a bone graft.
  • The pediatric dentist or orthodontist does this in the office. It is like getting braces.
  • The bone graft is done in the hospital and bone is taken from the hip for this graft.
  • Typically your child stays overnight in the hospital.

11-20 years old

  • Braces (orthodontics) are usually started around this age.
  • As your child’s face changes, other revisions of the lip and/or nose may be desired. 
  • For some of the procedures it is necessary to wait until your child is finished growing.
    • Jaw surgery to bring the upper jaw forward and/or the lower jaw back
    • Septorhinoplasty – to straighten and refine the nose
    • Malar implants – to build up the mid-face (cheekbones), revision of the lip and nose
  • The plastic surgeon will discuss these options with you. 
  • The length of hospital stay depends on the type of surgery performed.

You will need to protect your child’s palate from injury while it is healing. It is hard to tell how much feeling your child has in the repaired palate. The tissue may be numb and without feeling for a period of time after surgery. If this is the case, it is possible for your child to injure the roof of their mouth without feeling any pain. You may treat your child as any other child but you must watch them closely to keep hands and objects out of their mouth.

Your baby will have elbow restraints for one to two weeks after surgery (physician dependent) to keep hands away from the surgical site. Remove the restraints to exercise the arms. Remove one restraint at a time, on a rotating basis, every hour or so to exercise and massage the arms. Make sure to watch your child closely when the elbow restraint is off.

  • You may feed your child formula from a cup only after the operation.
  • Mix baby food with fluid in a cup so it is able to be poured. For the first week, do not use a spoon to feed your child. After one week, you may then feed with a spoon.
  • Make sure food is not too hot.
  • Provide fluids from a cup only and do not use straws.
  • After the meal, give your child water to help keep the mouth clean of food.

Possible long-term problems include speech problems, crooked teeth, frequent head colds and frequent ear infections.

  • The child refuses to eat or has a decrease in wet diapers 
  • The child has a fever over 100.4°
  • You have any questions or concerns 

Last Updated 03/2016

Contact Us / Schedule an Appointment

For more information you may contact the Craniofacial Center or Plastic Surgery:

  • Craniofacial Center: 513-636-4539
  • Plastic Surgery: 513-636-7181