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Cleft Palate (surgery)

My son with CdLS, who is 9 months old, weighs 10 pounds - 7 ounces, has a cleft of the soft palate. When is the best time to have surgery?

Clefting of the soft palate only (no lip nor hard palate involvement) does not have very much affect upon the dentition. The timing of the surgery should not be influenced by orthodontic concerns. Speech and feeding concerns are the major areas of focus that would influence surgical timing. The quicker the palatal structures are habilitated, the quicker proper speech sounds and oral air flow can be established. If feeding and growth are not up to par--closure may be emergent. The speech therapist will tell you that infants and toddlers go through various stages in speech development (the "la la" stage, the "ba ba"

stage, etc.). Each one of these sounds involves various oral, pharyngeal and
facial muscles that build up stepping stones to actual words and fluid speech. Children do not start to learn to talk at 2 1/2 yrs. old--they start from day one. Each step along the way is important. The concern over lisping is not related to the cleft. Lisping can be influenced more by the extended presence of a pacifier or prolonged thumb sucking than anything else.

The soft palate is closed at various times, depending upon the plastic surgeon's preference. Each surgeon has a slightly different preference due to where and when they trained, etc. The usual time for closure of a soft palate cleft would be from 12 months to 18 months. The infant's weight and facial growth would influence the timing. The bigger the child, the safer the anesthetic experience (10 pounds being a minimum weight for electing to schedule for non-emergency surgery).

I would turn to the plastic surgeon or facial plastic reconstructive surgeon for guidance as to when he or she prefers to perform the surgery. I strongly urge you to make sure that the plastic surgeon does a great number of cleft palate surgeries. "Tummy tucks" and lipo suction cases do not make one an outstanding cleft palate surgeon. How many cleft palate surgeries did the surgeon do last week? Sorry to be so picky, but there are differences within medical and dental specialties related to one's experience with specific problems.

I would definitely return to the plastic surgeon's office at 11 months of age. Don't forget to see your ear, nose and throat doctor at the same time. Many times, children with cleft palates will also have frequent ear infections and may require ventilation tubes in the ears to help prevent problems with hearing and infections. The two doctors can combine their efforts for one anesthetic experience and hospitalization, rather than two separate surgery times and experiences.

A hospital that has a cleft palate team of specialists may want you to see the Cleft lip and palate or Craniofacial TEAM before any surgery is scheduled. It is always a good idea to get as much information as possible; that helps in making well-informed decisions regarding your child's care.

RM/ TK 7-13-10



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