A maxillofacial and oral surgeon

There are many different techniques and approaches to treating cleft palates, 

which must be assessed for each case, says Dr Sharan Naidoo, a maxillofacial and oral surgeon at Mediclinic Midstream. A cleft palate is a birth defect where there's an opening in the roof of the mouth (palate) due to incomplete tissue fusion.

Types of cleft palate surgeries

“Cleft configurations can vary,” explains Dr Naidoo. “They range from an isolated cleft to a complete cleft that affects both the inside of the mouth and the outside of the face. Depending on how serious the condition is, we follow a set treatment plan in stages to make sure we achieve predictable outcomes.”

He explains that the first step is to close the cleft. Follow-up procedures, which aren't always necessary, are done to improve the results of the first surgery, fix any healing issues, or help with specific problems like speech.

Timing of procedures

In children, timing of primary cleft palate surgeries is vital, Dr Naidoo says, as it should be done in infancy when it would benefit the child most. “For example, a soft palate cleft should be repaired just before the child begins to speak. This is because we want to not only close the defect but also reorient the muscles and balance the structures anatomically so there is less effect on the child’s speech development.” This is usually done when the baby is about five to seven months old, as that’s when they start to babble and make sounds.

Dr Naidoo stresses the importance of following up with cleft palate patients to track their progress and ensure they can live as normal a life as possible. “We do intense follow-ups, usually annually,” he says. “Even when the child doesn’t require surgical intervention, we need to understand where they are on the developmental curve and measure the reality against expectations. It’s important to identify problems early so we can intervene if necessary.”

Speech development is a key focus as the child grows, which is why speech therapy is an important part of the treatment alongside surgery. “If the child gets intense speech therapy both with a therapist and at home, they can overcome the need for secondary surgical procedures,” Dr Naidoo says.

Apart from surgery, patient management also comprises aftercare, like wound care and psychological support, he adds. Ultimately, a multidisciplinary approach, which includes surgeons, speech therapists, a feeding expert and audiologist, is vital.

The evolution of cleft palate surgery

Cleft palate surgery has improved a lot in recent years, from the techniques used to the care given after surgery. “We’re always learning and sharing what we’ve learned,” says Dr Naidoo, who is actively involved in teaching and as a speaker at international conferences.

“I've always been interested in developing new surgical techniques. We implement developments that we feel can improve on outcomes.” He says the biggest improvements have been in deciding the best time for surgery and finding ways to shorten hospital stays.

“Today, we do more conservative incisions, and work more meticulously, so there’s no need for nasogastric feeding for long durations postoperatively. This was previously the primary reason for longer hospital stays.”

Generally, Dr Naidoo considers early discharge if the child does not have a wide cleft and large releasing incisions aren’t needed. He says shorter hospital stays help reduce the risk of infections and other problems by lowering the chance of germs spreading.

Dr Naidoo adds that things are always evolving, so doctors need to stay up to date. But he also highlights the need for balance. “There’s a fine line between trying new methods and sticking to proven ones. By learning constantly, attending conferences, and gaining experience, you develop a good sense of when to use what.”