As with the formation of a top lip, the palate within a baby's mouth is formed within the first three months of pregnancy. During this time the left and right plates come together and fuse, forming the ridge that we can feel running from the front of our mouth to the soft palate.  If these parts fail to fuse, a cleft is formed. A cleft may affect the hard palate, the soft palate or both hard and soft palate. It may affect only one side, or both sides. 

With a cleft palate a child's uvula may also be split.  There is no repair for this in most cases as it does not affect the child's speech or throat function.

How much of the palate or face is affected?

Each cleft is different, and each child's needs will be different. In some cases the hard palate is affected whilst in others, both soft and hard palates are split (the image above shows only a soft palate cleft).  At the other end of the spectrum there are very difficult clefts, ones that go right through the cheekbones, almost up to the eye sockets. 

Will they repair the palate?

This is the tricky part.  South Australia differs from the other states in the management of a cleft palate.  In other states there is basically only one school of thought in regard to the repair of a palate but here in SA there are two diametrically opposed views on how to manage a palate.

I have come to learn that it had been referred to in other states as the 'river' system.  Depending upon which side of the river (Torrens, that is) you had your baby was how your baby was treated for cleft repair.  I'm not too sure if this is wholly realistic, but if you know something about that theory please let me know.

In very simplistic terms, I set out the systems for you below:

One system advocates for the early repair of the hard palate to avoid the use of (in their term 'messy') plates and to assist in the process of feeding and in speech development.

It is dismissed by this school of thought that early repair causes the upper palate to grow more slowly than the lower jaw, thereby creating a 'flat' area around the nose and upper lip. 

If the repaired palate should 'break' as they are known to do in some children, they do not always go back in a repair the break or hole.  Instead, they simply fix this with (you guessed it) a fitted plate!

This compares to the other school of thought because:

The other system advocates that the palate should remain unrepaired until the child is of a mature age, with his upper jaw-line fully formed.

To assist in feeding and speech, they fit plates to the shape of the fissure and as the child ages the plates are replaced. 

They claim this allows the upper jaw to grow at the same rate as the lower jaw, thereby removing the 'flat area' around the nose and upper lip. 

They claim that plates are a better solution to the natural palate, and overlook the embarrassment and awkwardness that having to remove plates and clean them after each meal, or remove them at night for bed, or that all important 'first kiss' might bring on. 

Basically, there is no easy answer.

Depending upon which hospital you go through, you may not even know about the alternate options available to you.  You should know, however, and you should have the freedom to explore all of your options, weigh them up and form your own opinion.

Take your time and speak to the Cranio-facial Unit at the Women's and Children's Hospital, and also talk to the Cleft Clinic at Flinders Medical Centre.  See how they differ.  Weigh up your thoughts.

Make your own informed decision for your child. 

See also What about Teeth?