What Is a Cleft Palate?
A cleft palate is an opening or split in the roof of the mouth (palate) that occurs when the tissue forming the palate does not join completely during fetal development. The palate normally fuses between the sixth and ninth weeks of pregnancy.
The palate has two parts: the hard palate (the bony front portion) and the soft palate (the muscular back portion). A cleft can involve either or both parts. In some cases, a submucous cleft palate may be present — where the muscles of the soft palate are separated but covered by the mouth's lining, making it less visible.
Cleft palate can occur alone or in combination with cleft lip. When it occurs alone, it is more common in females. With proper surgical repair and ongoing care, children with cleft palate can achieve normal speech, hearing, and dental development.
Types of Cleft Palate
Incomplete Cleft Palate
The cleft involves only the soft palate (the back, muscular portion of the roof of the mouth). The hard palate remains intact. This type may be less visible but still affects speech and feeding.
Complete Cleft Palate
The cleft extends through both the soft and hard palate, creating an opening from the mouth into the nasal cavity. This may be unilateral (one side) or bilateral (both sides).
Submucous Cleft Palate
The muscles of the soft palate are separated beneath an intact mucosal lining. Often not detected at birth, it may be diagnosed later when the child develops nasal speech or has difficulty with feeding.
Symptoms & Complications
Cleft palate affects several important functions. Early intervention and ongoing care help minimize these challenges.
Feeding Difficulties
Babies with cleft palate often cannot create the suction needed for breastfeeding. The opening between the mouth and nose allows milk to flow into the nasal cavity. Specialized bottles and feeding techniques are essential from birth.
Speech & Language
The palate is critical for producing many speech sounds. Without repair, children develop hypernasal speech and difficulty with consonant sounds. Even after repair, some children may develop velopharyngeal insufficiency (VPI) requiring additional treatment.
Ear Infections & Hearing Loss
Children with cleft palate are prone to chronic middle ear fluid (otitis media with effusion) due to dysfunction of the Eustachian tube. This can lead to hearing loss if untreated. Ear tubes (tympanostomy tubes) are commonly placed to prevent complications.
Dental Development
Cleft palate can affect the growth of the upper jaw and the alignment of teeth. Missing, extra, or malformed teeth are common in the cleft area. Orthodontic treatment is typically needed to achieve proper alignment.
Treatment Timeline
Cleft palate treatment is a journey that spans from infancy through the teen years, with each stage building on the last.
Initial Assessment & Feeding Support
The craniofacial team evaluates the baby and provides specialized feeding support. Families receive education about the treatment plan and connect with support resources.
Primary Palate Repair (Palatoplasty)
Dr. Chaiyasate performs the palate repair using techniques such as the Furlow double-opposing Z-plasty or the two-flap palatoplasty. The goal is to close the palate, reconstruct the muscle sling of the soft palate, and create the conditions for normal speech development. Surgery typically takes 2–3 hours, with a 1–2 day hospital stay.
Ear Tube Placement
If not already placed during the palate repair, ear tubes may be inserted to drain fluid from the middle ear and prevent hearing loss. This is a brief outpatient procedure often combined with the palate surgery.
Speech Evaluation & Therapy
Regular speech assessments begin to monitor language development. If velopharyngeal insufficiency (VPI) is present — where the repaired palate does not fully close against the back of the throat during speech — additional surgery such as a pharyngeal flap or sphincter pharyngoplasty may be recommended.
VPI Surgery (If Needed)
For children with persistent hypernasal speech despite therapy, Dr. Chaiyasate may perform a pharyngeal flap procedure or sphincter pharyngoplasty to improve the seal between the mouth and nose during speech.
Alveolar Bone Graft
If the cleft extends through the gum line, a bone graft (typically from the hip) is placed into the alveolar ridge to support the eruption of permanent teeth and stabilize the dental arch. This is timed with the development of the permanent canine tooth.
Orthodontic Treatment
Comprehensive orthodontic treatment with braces to align teeth and correct bite issues. This may involve palatal expansion, braces, and other appliances to achieve optimal dental alignment.
Orthognathic Surgery & Final Refinements
After facial growth is complete, jaw surgery (orthognathic surgery) may be needed to correct any growth discrepancies of the upper jaw. Final rhinoplasty and lip revisions can also be performed at this stage.
Surgical Techniques
Dr. Chaiyasate selects the most appropriate technique based on the type and extent of the cleft, the child's anatomy, and the goals of repair.
Furlow Double-Opposing Z-Plasty
This technique repositions the muscles of the soft palate into their correct orientation, creating a functional muscle sling. It is particularly effective for achieving good speech outcomes and is Dr. Chaiyasate's preferred technique for many cleft palate repairs.
Ideal for clefts of the soft palate and narrow hard palate clefts.
Two-Flap Palatoplasty (Bardach)
Tissue flaps from both sides of the palate are raised and brought together in the midline. This technique provides reliable closure for wider clefts and allows reconstruction of the nasal lining.
Suitable for wider complete cleft palates.
Von Langenbeck Repair
One of the oldest and most reliable techniques, it uses bipedicled mucoperiosteal flaps to close the palate. It preserves the blood supply well and is effective for many types of cleft palate.
Effective for incomplete and moderate cleft palates.
Pharyngeal Flap / Sphincter Pharyngoplasty
Secondary procedures to address velopharyngeal insufficiency (VPI). A pharyngeal flap creates a tissue bridge between the palate and the back of the throat, while sphincter pharyngoplasty narrows the velopharyngeal port to improve speech.
For persistent hypernasal speech after initial palate repair.
Schedule a Consultation
Dr. Chaiyasate and his team are here to answer your questions and discuss the best treatment options for you or your child.