Chapter 1:
Cleft Palate Repair


Clefts of the Lip and Palate

Feeding an Infant

Surgery

Unilateral Cleft Lip Repair

Bilateral Cleft Lip 

Cleft Palate Repair

Pharyngeal Flap

Late Cleft Treatment

Pierre Robin Syndrome

 

CHAPTERS 

Introduction

Clefts of the Lip and Palate

Ear Reconstruction

Craniosynostosis

Orbital Reconstruction

Treacher Collins Syndrome

Nasal Reconstruction

Orthognathic Surgery

Trauma Reconstruction

Hemifacial Microsomia

Summary

 

The objective of cleft palate surgery is to close the palate to restore normal function to eating and drinking and to enhance the development of normal speech.

Clefts of the palate can occur as isolated deformities or in combination with a cleft of the lip. Cleft palates result from failure of fusion of the embryonic facial processes resulting in a fissure through the palate. This may be complete (extending through the hard and soft palates) or any degree of incomplete (partial cleft). The palate forms the roof of the oral cavity and the floor of the nose; thus, a cleft causes a free communication between these two cavities. As a result, treatment of palatal clefts is complex because of potential problems with feeding, speech, middle ear infections, occlusion and jaw alignment.

Surgical treatment of the cleft palate is best accomplished in one surgical procedure before the child reaches 12-14 months of age. The cleft palate is surgically closed by elevating two muscoperiosteal flaps. The levator muscles are elevated, redirected and repaired; and a three layer closure of nasal mucosa, muscle and oral mucosa accomplished. Surgery under general anesthesia usually lasts about 2 hours. Special precautions as those after the repair of the cleft lip are necessary for 2-3 weeks. We prefer that the child be weaned from the bottle and pacifier prior to the palatal repair. No hard or crunchy foods are allowed for 3 weeks post operatively.

 

Cleft Palate Repair:
Closure of cleft palate with pushback palatoplasty. A) Two mucoperiosteal flaps are outlined. B) Flaps are elevated off the hard palate. C,D) The abnormal levator muscle insertion to the hard palate is identified and cut free. E) The nasal lining is closed as a separate layer and the levator muscle reapproximated. F) The palatial mucoperiosteal flaps are closed in a V-Y fashion.

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The Tennessee Craniofacial Center, part of the Erlanger Health System, is located in Chattanooga, Tennessee. The Center, led Larry A. Sargent, M.D., specializes in the evaluation and treatment of patients of all ages with craniofacial deformities. Location: 975 East Third Street. Chattanooga, Tennessee 37403
Phone: 423-778-9192 or 800-418-3223 Fax: 423-778-8172
Internet: www.craniofacialcenter.com Copyright ©1997, 2000, Erlanger Health Systems