The second surgery!!!
This is always a nice one to be finished with because it’s a major milestone for the baby! The main issues involved with cleft lip & palate are resolved at this point. Up until now, the baby is unable to suck or nurse effectively. 
Special feeding cups are used to help the baby eat. Prior to the surgery being done, baby must be off of a bottle and drinking only from the special feeding cups.
It is a difficult surgery to go through because the baby is not used to not having an opening in the roof of the mouth. And also, a baby with stitches in the roof of the mouth can be rather difficult. 
In today’s post, we will discuss the surgery and what’s involved, as well as post-op care. A lot of you have asked:
What’s normal, and what’s not?
So we will dive into that too.
If the NAM appliance has been used, the surgical repair is much less than if it was not used.
This is because the palatal segments will be closer together after the use of the NAM appliance.
Cleft Palate repair is usually around 9-18 months of age
When the cleft palate involves only the back of the palate, this is where the soft palate is. It is called an incomplete soft palate. When the cleft runs the whole length of the palate from front to back, it is called a complete cleft palate. It is possible to only have a cleft lip, only have a cleft palate, or have both. 
The surgery is done before speech development occurs so that the child can learn to speak with an intact palate. It is also done after cleft lip repair has been completed. It is performed under general anesthesia, just like the cleft lip repair surgery. It takes between 2 and 6 hours to complete.
The palate is closed in a 3-layer technique.
- First the inner layer towards the nose is closed,
- Then, the muscles of the palate are closed,
- Finally, the tissues in the mouth are closed.
By aligning and closing the muscles of the palate, speech, eating, swallowing, and hearing are improved. 
Why is this surgery important?
Prior to surgery, there is a communication between the mouth and the nose via the roof of the mouth. This surgery helps to close that communication.
The reason this is important is because it:
- Allows for formation of a watertight and airtight valve, which is necessary for normal speech
- Preserves facial growth
- Allows for appropriate dental development!
Tubes for the ears can also be inserted at this appointment.
It is important to remember!
A portion in the front of the palate will be left open to allow the jaw to grow. This will be repaired with the secondary alveolar bone graft. 
What’s normal:
- More discomfort than cleft lip repair surgery
- Nasal congestion
- Staying in the hospital for 1-3 days
- Stitches on palate that will dissolve over the next 2 weeks
- Bloody drainage from nose & mouth
- Swelling, bruising
- Arm restraints for 2 weeks to make sure baby won’t disturb the site!
Diet after repair: 
- Only a cup can be used after the operation
- A suction via a sippy cup or bottle can disturb the stitches in the mouth due to pressure
- Mix baby food with fluid in the cup so it can be poured into the mouth
- NO spoon for a week after surgery (varies from surgeon to surgeon)
- After eating, always make sure to give child water to rid the mouth of debris
What’s not normal
- The baby refuses to eat
- Fever over 100.4º F
- Skin color changes
- Excessive bleeding or foul-smelling odor from palate
For information on what to bring to the hospital for this surgery, see this post HERE. 
I hope you found this helpful. These are life-changing procedures for your little one, so while it may seem scary, it is so beneficial and helpful for them!
Thanks for visiting!
*photos courtesy of UCLA School of Dentistry