The email included a montage of photos of adorable Bengal kittens. Who could resist such cuteness? Then another picture. A closeup of the roof of the mouth of one particular kitten named Star Zulu. Star for short. At two months old, Star was eating, drinking, and playful, but had a little hole in her hard palate. My client wanted to know if she should adopt Star? Could this small birth defect lead to more serious consequences?
First, a brief anatomy lesson. Touch the roof of your mouth with your tongue. That’s your hard palate. It separates the front portion of your mouth from your nasal passages so when you drink milk or eat a sandwich, stuff moves to the back of your throat instead of going up into your nose. Now you probably can’t reach with your tongue but farther back in your mouth that divider continues with a long flat muscle called the soft palate, which continues channeling food and liquids toward the esophagus and stomach and away from nose, windpipe, and lungs.
Cleft palate is a defect, usually congenital, that occurs anywhere from the lip back through the soft palate when the two sides do not fuse correctly during development. Usually an inherited defect, but it can also be the result of various influences on the mother cat during pregnancy such as nutritional imbalances, viral infections, or administration of certain drugs. Human babies get cleft palates. Puppies get them. Kittens get them. Inky got one. Purebred cats, especially Siamese, are known to have a higher incidence, and females are more prone than males.
The impact of cleft palate on an affected individual depends upon the location and severity of the defect, and how much it compromises the ability to feed. Star’s defect looked tiny, a barely visible hole at the front of her mouth. She had nursed successfully, and appeared to be eating without difficulty, although she was unusually petite for her age. I responded to the email saying the cleft was so minute it did not look likely to cause serious problems, though I couldn’t make any guarantees. My client decided to take a chance and brought Star home.
At Star’s first visit, I was concerned by her diminutive size, barely topping two pounds, but as I examined her, I learned she was small but mighty. I couldn’t see very far back in that little mouth, but from what I could see, all looked well. We vaccinated her, discussed her diet, and sent her off. Two weeks later, she returned with a sudden onset of high fever, sneezing, and lethargy. Now, it is not uncommon for kittens coming from large catteries or shelters to carry upper respiratory viruses and exhibit symptoms with the stress of moving to new homes. I treated accordingly with antiviral medication plus antibiotics, since she appeared to also have a secondary bacterial infection.
Star’s condition improved at first but then she relapsed, at which time she was seen at another veterinary practice that was covering for me when I was unavailable. Good thing. They got a much better look down her throat than I had previously. There they found a second far more significant defect — a big V-shaped hole way back in her soft palate, which affected her ability to swallow properly. The defect allowed bits of food and fluid to pass into her nasal passages and into the area in the back of the throat called the nasopharynx. This was leading to repeated bouts of nasal inflammation and infection and, more seriously, aspiration pneumonia.
A cleft palate of this nature requires surgical repair, otherwise the animal is at constant risk for serious infections, and unable to nourish itself properly. It is a challenging surgery with high rates of post-operative complications and recurrences. It is sometimes advised to wait until a kitten is close to full-grown before attempting repair, but at this point Star was five months old, a whopping five pounds, and having recurrent serious infections. Her owner and I both did our homework, exploring options for surgeons, getting estimates, evaluating the prognosis. Her best bet would be in the hands of a top-notch surgical specialist. We agreed on referring her to Dr. Michael Pavletic, Director of Surgical services at Angell Animal Medical Center in Boston.
When he examined Star, Dr. Pavletic concurred the small hole in her hard palate was not cause for concern and did not require intervention. The larger V-shaped defect in her soft palate was another story. It definitely needed surgery. He cautioned that the prognosis was guarded to fair, with the primary potential complication being dehiscence of the repair, but it was necessary to try. Surgery went well. At first we were hopeful that Star was in the clear, but two weeks post-operatively, part of the soft palate began to open again. Not as bad as the original cleft, but still problematic. She was showing mild respiratory problems again and I could see an area where the tissue was pulling apart. Star went back to Boston for a second surgery after which she stayed in the hospital for a full week to maximize her healing by minimizing her activity.
Star Zulu is now a month out from that second surgery. She is happy, playful, and continuing to grow. She let me look in her mouth last week. As far as I can see, the repair appears to be holding, but she did come down with a mild case of nasal congestion recently. Dr. Pavletic had us administer antibiotics. Star will return to Angell for her spay later this year, as I think that is the safest place for her whenever she needs anesthesia. At that time they will be able to visualize the soft palate more fully when she is anesthetized and better assess the success of the repair. We are all keeping our fingers and toes crossed. What a lucky little tiger to have owners who are willing to take such good care of her!