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The hard palate is a shelf of bone covered in mucous membrane, which separates the nasal chambers from the mouth. The bony shelf is formed from two bones (left and right) fused along the centerline. Deficits most commonly arise at the natural center weak point where these bones fuse together.
An uncorrected hard palate deficit allows the passage of food and liquids from the mouth into the nasal cavity. The worst case scenario is fluid is inhaled down into the lung and sets up life-threatening aspiration pneumonia. This is especially true in young kittens, with a birth defect leading to a cleft hard palate, since they rely on milk for nutrition.
Repair may be undertaken in first opinion practice or a referral center.
Very young kittens may need to be fed via a tube until they are 10 to 12 weeks old and strong enough for an anesthetic. In cases of traumatic damage to the hard palate, the patient first needs to be stabilized against shock, pain, and blood loss.
Once stable, a full general anesthetic is given. There are a variety of techniques available, the choice being dependant on the size, position, and severity of the palatal deficit. The most commonly used techniques involve making parallel incisions in the mucous membranes either side of the deficit. The soft tissue is undermined, in order to make it more mobile. The leading edge of the deficit is cut with a scalpel blade in order to freshen it and help it to fuse together. The flaps are then mobilised to cover the gap. The aim is to place the sutures over bone rather than over the gap.
A feeding tube may need to be placed in order to provide adequate nutrition while the palate heals. Several revisional surgeries may be needed, given the high likelihood of wound breakdown.
Good surgical technique and choice of method makes a big impact on how effective the repair will be. Factors that increase efficacy include placing minimal tension on the graft flaps, keeping the suture line away from the gap of the deficit, and freshening the edges of the deficit.
Other factors such as feeding tubes also help to reduce abrasion and trauma during healing, and reduce the risk of wound breakdown.
Initially, the repair is held together by sutures and has no inherent strength of its own. It takes at least two to three weeks for the flaps to bond down in their new position and permanently repair the deficit. Unfortunately, cats are notorious for having rough, sandpaper like tongues, so constantly licking or rubbing the suture line with their tongue can cause wound breakdown, making further surgery necessary.
Tactics such as placing a feeding tube can help reduce abrasion to the hard palate and remove one complicating factor. A feeding tube may be placed at the same time as palatal surgery, and removed two to three weeks later once healing is complete.
For a young kitten, the cost of surgery may be anywhere from $300 upwards. For an adult cat involved in a trauma, there will be costs associated with stabilization. These vary depending on the severity of the injuries, but can run into thousands of dollars if intensive care is required. Typically, expect the cost of palatal surgery to be around $400 upwards.
In many cases, opting not to operate and to leave a permanent deficit means a high risk of aspiration pneumonia, which is often life-threatening. In kittens, the risk is so great that hand rearing and feeding via a tube may be needed until the kitten is large enough to withstand surgery.
It is to be expected that revisional surgery may be needed, for reasons such as wound breakdown due to rubbing by the tongue.
Cats should not be bred from those that were born with a palate deficit which was surgically corrected. This is because of the risk of it being a hereditary condition.
Other factors include trauma, such as falling from a balcony, or a traffic accident. These are largely preventable by fencing in a balcony, putting netting over windows, and keeping your cat indoors.
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