Disease Description (Causes and Symptoms)
- Definition: Cleft palate is a congenital condition in which the palate is open, allowing communication between the nose and mouth; it sometimes includes forms extending to the gums (alveolus) or nose (cleft palate).
- Causes and pathophysiology: It occurs when the fusion process of the fetal lips and palate during early pregnancy is disrupted by a combination of various genetic predispositions and environmental factors. It may be associated with maternal infections (e.g., rubella), medication exposure, nutritional status, smoking, and other factors, but no single cause has been clearly identified. Because of defects in the palatal muscles and structures, normal separation of the oral and nasal cavities does not occur, and velopharyngeal insufficiency can cause difficulties with breathing, speech, and middle-ear ventilation.
- Main symptoms: Feeding difficulties (weak sucking), frequent otitis media and hearing loss, hypernasal speech, speech disorders (velopharyngeal insufficiency), abnormalities of the teeth and alveolar cleft, and abnormal growth of the facial skeleton.
Treatment Methods
- General principles: A multidisciplinary team approach (plastic surgery, otolaryngology, pediatric dentistry and orthodontics, speech-language therapy, genetic counseling, etc.) is standard.
- Surgical treatment
- Cheiloplasty: Usually performed at approximately 2–4 months of age (according to the traditional “10-10-10 rule” or institution-specific guidelines) to restore lip function and appearance.
- Palatoplasty: Usually performed at 9–12 months of age to improve feeding and speech function and reduce the risk of otitis media.
- Middle-ear ventilation (tympanostomy) tube insertion: Performed together with palatoplasty or separately when otitis media and hearing loss occur frequently or the condition of the eardrum is poor.
- Alveolar bone grafting: Performed during the mixed-dentition period (when the roots of the permanent canines are developing, usually around 8–11 years of age) to restore the alveolar defect and support for the permanent teeth.
- Correction of craniofacial growth (after growth is complete): In cases of severe maxillary retrusion or jaw imbalance, orthognathic surgery and other reconstructive procedures, such as rhinoplasty, may be performed after childhood and adolescence.
- Surgery to correct velopharyngeal insufficiency (palatal lengthening, pharyngoplasty, etc.): Performed for persistent speech disorders, such as hypernasal speech.
- Non-surgical treatment
- Feeding assistance: Support nutritional intake with special nipples (cross-cut or squeeze-type bottles), feeding-position management, and feeding-time management.
- Speech-language therapy: Pre- and postoperative assessment of speech and language development and long-term speech-language therapy.
- Hearing management: Hearing tests and, when necessary, hearing aids or tube treatment.
- Dental and orthodontic treatment: Long-term follow-up beginning in infancy, with orthodontic and prosthetic treatment timed to the development of the permanent teeth.
- Medication
- Antibiotics for infection prevention before and after surgery may be used depending on the situation.
- Pain control (pediatric analgesics) and management of postoperative inflammation.
- Precautions (self-care and postoperative precautions)
- Immediately after surgery, avoid touching the surgical site with the hands, and oral cleansing after meals (rinsing with water) is recommended.
- If fever, difficulty breathing, excessive bleeding, or other symptoms occur, visit a medical institution immediately.
- Long-term follow-up (hearing, speech, dental, and facial-growth assessments) is necessary, and multiple treatments may be required.
Outpatient Visit Checklist (Including Preparation Items and Example Questions)
- Preparation items (what to bring)
- List of currently used medications and supplements
- Birth and neonatal records (including surgery and hospitalization history)
- Copies of recent hearing tests, imaging (ultrasound, CT/MRI, etc.), and medical records, if available
- Vaccination records and history of allergies and anesthesia
- Feeding observation records (feeding time, formula volume, choking or coughing) and notes or recordings related to speech and language development, when possible
- Items to check during the outpatient visit
- Current feeding and weight-gain status, breathing or sleep problems, and recurrent otitis media
- Previous problems related to anesthesia or surgery and drug allergies
- Environmental information, such as the home environment and smoking status
- Example questions to prepare (sample questions to ask the doctor directly)
- "Why do you recommend this surgery, and what effects are expected?"
- "What are the risks related to the timing of the surgery and anesthesia?"
- "What should we be careful about when returning to daily life after surgery, and what will the rehabilitation (speech-language therapy) schedule be?"
Examples of General Questions to Ask the Doctor
- What are the common side effects of this medication (or treatment), and how should we respond if a problem occurs?
- To what extent can speech and hearing be expected to improve with surgery, and what is the prognosis?
- How likely is it that several more surgeries or treatments will be needed in the future?
- How should the schedule for dental and orthodontic treatment be planned during growth?
- What should we be careful about in daily life (feeding, play, and school life)?
Examples of Condition-Specific Questions
- In our child’s case, is there a particular reason you recommend performing palatoplasty now (e.g., weight, cold symptoms, or otitis media status)?
- Otitis media occurs frequently. Do you recommend inserting tympanostomy tubes at the same time as this surgery? To what extent is hearing expected to improve after insertion?