Cleft Palate
Dr. Travis Greathouse discusses Cleft Palates, whether there's a genetic component to them, and treatment options.
Featuring:
Learn more about Travis Greathouse, MD
Travis Greathouse, MD
Travis Greathouse, MD is a Surgeon-Plastics & Reconstructive Surgery.Learn more about Travis Greathouse, MD
Transcription:
Caitlin Whyte (Host): Welcome to Right Beside You, a Reid Health podcast. I'm Caitlin Whyte. And we're talking about cleft palates today. Joining us is Dr. Travis Greathouse, a Plastics and Reconstructive Surgeon. All right to start us off Dr. Greathouse, what is a cleft palate?
Travis Greathouse, MD (Guest): So, a cleft palete is a congenital fissure between the left and right side in the soft and hard palate, kind of the roof of the mouth. It's something the child is born with. It's not something that happens to them later.
Host: Is it a cleft palate, genetic?
Dr. Greathouse: It can be, not always, but about 50% of the time, it can run in families. There are certain genetic syndromes that very strongly run in families where almost all of the people in the family will get a cleft palate, but other times, it can just happen kind of randomly, or it can be something that can occur in response to an exposure to a drug or medication during pregnancy. We also know there's a pretty good association with things like gestational diabetes and cleft lip and or palate.
Host: So, what are my treatment options and why is considering timing so important?
Dr. Greathouse: The main treatment for cleft palate is almost always surgery. We know that without surgery, these kids will almost certainly have difficulties with feeding as well as with speech. Surgery has kind of two goals in mind. The first goal is to close the gap in the roof of the mouth that separates the mouth from the nose. The other is to realign the muscles. There are sets of muscles in the soft palate in the back of the roof of the mouth that raise the soft palate and close it off with the back of the throat. That's what's important for speech. Without that closure, the child will have a very nasal speech pattern. As time goes on, they develop certain speech characteristics that become very difficult to unlearn. So, repairing the cleft palate before speech really develops, or as the child is learning to speak at about one year of age is the ideal scenario so that we can interrupt learning these bad or incorrect speech patterns.
Host: And what does surgery look like? How has the recovery time after?
Dr. Greathouse: Surgery is usually a overnight stay. It doesn't have to be, but in most instances, since this is done on a very small child, we'll do it in the operating room with them under anesthesia. They'll have to have special device to hold the mouth open and keep the tongue out of the way. There'll be a machine that will breathe for them. And the tube that breathes for them will be held out of the way by the our device. And then while we do the surgery, we repair the nasal lining that forms the top most layer of the palate, as well as the muscles. And then finally the oral lining or mucosa it'll cause a lot of swelling and that's the main reason why we want to keep them in the hospital overnight so that we can make sure they don't have any sleep apneic events or swelling in the back of the throat or breathing problems.
Most children don't have a lot of pain with it. Often just some Children's Tylenol or Children's Motrin is enough to control the pain. And then the big thing about it is trying to keep food out of that surgical repair site. Often, these are, we're at the age where we're starting to introduce some solid foods. So, we may have to be careful how we feed. We often try to avoid getting a spoon into the roof of the mouth. If they're on a bottle, we try to get them off of the bottle before doing the surgery so that the tip of the bottle doesn't poke into the roof of the mouth and disrupt that repair. And then we avoid things like hard objects, straws, et cetera.
Sometimes it's almost like, can be almost like feeding the child with like a little dropper in certain instances, but a lot of kids can just drink out of a spoutless sippy cup and do pretty fine at that point. It takes about anywhere from three to six weeks for us to know that our repair is really, really good. And that it's, that there's no problems with healing.
Host: Well, as we wrap up here, Doctor, is there anything else you'd like to share about cleft palates?
Dr. Greathouse: Well, I think, I think a great thing for people to know is that most of these kids with cleft palate are totally normal kids. This may be their only problem that they have. Sometimes whenever there's problems with speech, they get teased and made fun of, and maybe thought that they're not as intelligent, but you know, these kids are just the same. There's certain cases where it may be associated with a syndrome or where there's some developmental delay, but that's usually not the case in the vast, vast majority of these. So, I think trying to avoid that stigma is really important.
Host: Great. Well, Doctor, thank you so much for squeezing us into your busy schedule. We really appreciate your time. You can always learn more at reidhealth.org or by calling (765) 962-4872. That's (765) 962-4872. Don't forget to subscribe, rate and review this podcast and all of the other Reid Health podcasts. This has been Right Beside You, a Reid Health podcast. I'm Caitlin Whyte. Stay well.
Caitlin Whyte (Host): Welcome to Right Beside You, a Reid Health podcast. I'm Caitlin Whyte. And we're talking about cleft palates today. Joining us is Dr. Travis Greathouse, a Plastics and Reconstructive Surgeon. All right to start us off Dr. Greathouse, what is a cleft palate?
Travis Greathouse, MD (Guest): So, a cleft palete is a congenital fissure between the left and right side in the soft and hard palate, kind of the roof of the mouth. It's something the child is born with. It's not something that happens to them later.
Host: Is it a cleft palate, genetic?
Dr. Greathouse: It can be, not always, but about 50% of the time, it can run in families. There are certain genetic syndromes that very strongly run in families where almost all of the people in the family will get a cleft palate, but other times, it can just happen kind of randomly, or it can be something that can occur in response to an exposure to a drug or medication during pregnancy. We also know there's a pretty good association with things like gestational diabetes and cleft lip and or palate.
Host: So, what are my treatment options and why is considering timing so important?
Dr. Greathouse: The main treatment for cleft palate is almost always surgery. We know that without surgery, these kids will almost certainly have difficulties with feeding as well as with speech. Surgery has kind of two goals in mind. The first goal is to close the gap in the roof of the mouth that separates the mouth from the nose. The other is to realign the muscles. There are sets of muscles in the soft palate in the back of the roof of the mouth that raise the soft palate and close it off with the back of the throat. That's what's important for speech. Without that closure, the child will have a very nasal speech pattern. As time goes on, they develop certain speech characteristics that become very difficult to unlearn. So, repairing the cleft palate before speech really develops, or as the child is learning to speak at about one year of age is the ideal scenario so that we can interrupt learning these bad or incorrect speech patterns.
Host: And what does surgery look like? How has the recovery time after?
Dr. Greathouse: Surgery is usually a overnight stay. It doesn't have to be, but in most instances, since this is done on a very small child, we'll do it in the operating room with them under anesthesia. They'll have to have special device to hold the mouth open and keep the tongue out of the way. There'll be a machine that will breathe for them. And the tube that breathes for them will be held out of the way by the our device. And then while we do the surgery, we repair the nasal lining that forms the top most layer of the palate, as well as the muscles. And then finally the oral lining or mucosa it'll cause a lot of swelling and that's the main reason why we want to keep them in the hospital overnight so that we can make sure they don't have any sleep apneic events or swelling in the back of the throat or breathing problems.
Most children don't have a lot of pain with it. Often just some Children's Tylenol or Children's Motrin is enough to control the pain. And then the big thing about it is trying to keep food out of that surgical repair site. Often, these are, we're at the age where we're starting to introduce some solid foods. So, we may have to be careful how we feed. We often try to avoid getting a spoon into the roof of the mouth. If they're on a bottle, we try to get them off of the bottle before doing the surgery so that the tip of the bottle doesn't poke into the roof of the mouth and disrupt that repair. And then we avoid things like hard objects, straws, et cetera.
Sometimes it's almost like, can be almost like feeding the child with like a little dropper in certain instances, but a lot of kids can just drink out of a spoutless sippy cup and do pretty fine at that point. It takes about anywhere from three to six weeks for us to know that our repair is really, really good. And that it's, that there's no problems with healing.
Host: Well, as we wrap up here, Doctor, is there anything else you'd like to share about cleft palates?
Dr. Greathouse: Well, I think, I think a great thing for people to know is that most of these kids with cleft palate are totally normal kids. This may be their only problem that they have. Sometimes whenever there's problems with speech, they get teased and made fun of, and maybe thought that they're not as intelligent, but you know, these kids are just the same. There's certain cases where it may be associated with a syndrome or where there's some developmental delay, but that's usually not the case in the vast, vast majority of these. So, I think trying to avoid that stigma is really important.
Host: Great. Well, Doctor, thank you so much for squeezing us into your busy schedule. We really appreciate your time. You can always learn more at reidhealth.org or by calling (765) 962-4872. That's (765) 962-4872. Don't forget to subscribe, rate and review this podcast and all of the other Reid Health podcasts. This has been Right Beside You, a Reid Health podcast. I'm Caitlin Whyte. Stay well.