Palatoplasty for a cleft of the palate

Presentation

The child presented with a cleft of the palate. Unlike the lip, this is not primarily a question of appearance: an open palate means food and air escape into the nose, and speech that develops around an incompetent palate is difficult to correct later by any operation. Timing therefore matters more here than almost anywhere else in reconstructive surgery.

Cleft of the palate with the palatal muscle inserting abnormally onto the posterior edge of the hard palate rather than meeting in the midline. Airway and feeding assessed pre-operatively; exposure obtained on a mouth gag with the child supine and the head extended.

Procedure

Exposure was obtained on a mouth gag, which in a small child is the step that determines whether the rest of the operation is possible. The cleft margins were incised and the layers closed separately, and the palatal muscle was dissected off its abnormal insertion on the hard palate and repositioned across the midline. That muscle repositioning is the part that produces a palate which functions rather than one which is merely closed: a watertight closure with the muscle left where it was gives a child who still cannot make the sounds.

1. AssessmentPalate examined; airway and feeding assessed
2. OperationPalatoplasty with repositioning of the palatal muscle
3. Follow-upSpeech review — records to be supplied

Outcome

The palate was closed with the muscle repositioned. Speech development, velopharyngeal competence and the need for secondary surgery are placeholder — those are follow-up findings and await the surgeon’s records.

Clinical images are blurred until you choose to view them. Each is labelled with its timepoint.

Sensitive clinical imageThis image may contain sensitive content.Tap to view