Surgical Management of CP
· Lip repair very early: between 2-3 months following Rule of 10:
· Early palate surgery at 6-9 months
· Complete palatal cleft repair: 12-18 months
· Repair of unilateral/bilateral cleft of lip and alveolus -12-18 months
· Pharyngeal flap surgery ~4 years to correct velopharyngeal incompetence that exists in some cases following cleft repair
o Flap created by separation of a rectangular flap of tissue from posterior pharyngeal wall
o Top of flap is connected to wall, and bottom is inserted into a slit in the soft palate
o Acts as a cork preventing air escape into nasal passages as the lateral walls move in to meet the lateral edges of the flap to eliminate velopharyngeal insufficiency
o Outcome relies heavily on individual anatomy and surgical planning
· Fistula repair
· Alveolar grafting
· Craniofacial/Maxillofacial surgeries
o to correct abnormalities from misalignment of the mandible/maxilla and the orbits/forehead
o
· Orosurgery
Nonsurgical Management
· Prosthetic teeth:
· Alveolar tissue prosthesis:
· Feeding appliances: special bottles, nipples, devices designed to reduce:
· Obturators:
· Palatal lifts or speech bulbs to eliminate hypernasality by managing velopharyngeal insufficiency
Complications of Cleft Palate (treated by SLP)
1. Feeding Issues
· Infants should be fed always in upright position
· Press nipple against intact portion of palate or against cheek
· Opening of the nipple should be X shaped to facilitate milk extraction
· Slow down process of feeding
· After feeding clean out mouth/cleft with soft damp cloth
· Introduce solid food when deemed appropriate
· Oral Aversion issues
2. Speech Development/Disorders
Language
· Hearing loss negatively impacts input affects language development
· Adverse reaction to appearance/frequent hospital visits could result in poor pragmatics
Voice/Resonance
· Hypernasality velopharyngeal insufficiency
· Reduced intensity
Articulation
· Maladaptive compensatory errors
· Reduced sensation near cleft
· Hearing Loss leads to speech errors
· Malocclusion
· Palatal fistulae