Cleft Palate Surgery at JHCH
An infant born with cleft lip and / or palate attends the Cleft Clinic soon after birth. At this time planning begins for repair surgery. The approximate surgical timeline followed at John Hunter Children’s Hospital is:
| 0-3 months | Pre-surgical orthodontic (wmv 12.7 M) moulding for clefts wider than 10mm |
| 3-4 months | Lip and alveolus repaired (wav 11.3M) |
| 7 months | Hearing test -> if fluid present, then grommets (wav 2.6M) will be inserted at time of palate repair Sleep study (wmv 15.2 M) -> can proceed to palate repair if sleep study results satisfactory |
| 9 months | Palate repair if sleep study satisfactory, plus grommets if indicated If sleep study indicates central or obstructive sleep apnoea, palate repair may be delayed until this has improved, usually by 12-18 months |
| 4 years – adulthood | Pharyngoplasty if required |
| 12-14 years | Alveolar bone graft (for wide clefts of the alveolus) |
| Teens | Cosmetic surgery to lip or nose if required |
| 16 yrs to early 20s | Maxillary advancement (wmv 12.8 M) if required |
Prosthetics
The prosthetics equipment commonly used at JHCH is the pre-surgical orthodontic moulding appliance. This is sometimes referred to in the literature as a "feeding plate", however, its primary purpose is to bring the edges of the alveolus closer together prior to surgical repair. Babies can be fed with or without the plate, however, its purpose is not to assist feeding.
This photo shows a four day old baby with a unlateral complete cleft lip and palate. The alveolar gap prior to orthodontic moulding was 10 mm. In the second picture, following three months of wearing the appliance, the alveolar gap had reduced to 2 mm, leaving a smaller gap to be surgically repaired.
Here is a photo of a different baby with the pre-surgical moulding appliance in place.
For clients for whom surgery is not an option, use of prosthetic appliances such as palatal lift or obturator may be considered by the tertiary team.
In the late primary school and high school years, other appliances are used for orthodontic purposes and preparation for later maxillofacial surgery. For example, maxillary expansion plates, braces.
Disclaimer
This webpage pertains to management of children by the John Hunter Children’s Hospital Cleft Palate Team. The resource information is aimed at qualified speech pathologists working within the geographical area of the Northern Child Health Network. It assumes a working knowledge of articulation and phonological processes in paediatric populations.