123 - Cleft palate surgery

Summary

Congenital deformities of the head and neck and cleft palate surgery in particular can present surgical and long-term management challenges. Not only can cleft palate involve both the primary and secondary palate, the clefting itself may also vary in width and length. Given this range in palatal defects, the goal of surgical intervention is to provide both functional and esthetic correction of the deformity. The most immediate concern with a palatal defect involves feeding difficulties and the potential for airway compromise. Obstruction of the airway may especially occur with isolated clefts of the secondary palate. Most cases of airway compromise are mild and can be managed effectively by positioning the child in the prone position. In more severe cases, a tongue–lip adhesion may have to be performed while exceptional cases will require a tracheostomy.

Advances in surgical techniques for repair of cleft palate have greatly enhanced the functional aspect, allowing improved speech development and swallowing function, though the effects on facial growth remain controversial. Timing and technique are the two most influential factors in determining the outcome of cleft-palate repair. While the timing of repair continues to be controversial as well, it is generally not attempted before the child is 10 months of age, has 10 g of hemoglobin, and weighs at least 10 lb.

All palatal repairs are done under general anesthesia. Operative time varies according to the severity of the cleft and the surgical approach chosen. Generally, it ranges from 30 minutes to 2 hours.