The goals of treating a cleft palate are to: 1) provide sufficient nutritional support until the puppy is old enough and healthy enough to survive surgery; 2) treat and resolve aspiration pneumonia or other associated respiratory disorders, if present; 3) close the anatomical defect surgically if possible; and 4) restore the dog’s ability to eat, drink and live normally, healthily and happily.
Intensive supportive care is usually necessary for any puppy with a cleft palate. The puppy’s physical inability to create enough suction to nurse normally usually requires that it be fed by hand. This involves carefully passing a flexible rubber tube down the dog’s esophagus (throat) directly into its stomach, and feeding either bitches’ milk or a milk-replacer formula through the tube, to ensure the puppy’s daily nutritional and caloric intake. This is not a particularly difficult procedure and most owners can be taught to tube feed their puppies at home. However, it is essential that the tube not be inserted down the trachea (wind pipe). Unfortunately, no matter how careful the person feeding the puppy is, puppies with cleft palates often develop aspiration pneumonia. Many of them simply do not thrive and die young.
Pneumonia must be treated and resolved before surgery is a realistic option. Antibiotic therapy may be necessary to manage secondary bacterial respiratory tract infections. Once the puppy is stable, surgical correction may be an option, especially if the palate defect is small. Reconstructive surgery is usually done at between 2 and 4 months of age, shortly after weaning. There are a number of different surgical techniques to rebuild a cleft palate, depending upon its location, but each of them is complex and should be performed only by a veterinarian experienced in the procedure. Multiple surgeries may be necessary to achieve successful correction, if that is even possible.
Medication to manage pain is extremely important after any surgical procedure to correct a cleft palate. Opioids and non-steroidal anti-inflammatory drugs (NSAIDs) are often recommended. Nutritional support post-operatively will require liquid or very soft food for up to 4 weeks or more, with no dog biscuits or hard chew toys during the recovery period.
Attempts at surgical correction of cleft palates historically have had a fairly high complication or failure rate. However, newer techniques are improving the success rate in domestic dogs. Because most cases of cleft palate are thought to have a hereditary component, there is an ethical issue surrounding keeping affected dogs intact and using them for breeding. Most authorities recommend that if a cleft palate is corrected surgically, the dog should be spayed or neutered, or at a bare minimum securely removed from any breeding program.
Euthanasia is an option that owners may need to consider for very young puppies diagnosed with a cleft palate, depending upon its location and severity. The puppy’s veterinarian is the best one to discuss all possible treatment choices with its owner.
Without surgical repair and reconstruction, the prognosis for puppies with cleft palates is poor. However, if surgery is done and post-operative management is well-handled, the prognosis for recovery is fair to good. The best chance for success is on the first attempted surgical repair procedure. If more than one surgery is necessary, the prognosis worsens. The prognosis for puppies that develop respiratory disease from aspirating milk or food because of a cleft palate is poor to grave. If there is significant soft palate involvement, especially if most of the soft palate is absent, the prognosis is also grave. With or without treatment, many affected puppies die at a young age.