This proceedure is done after lip and palate repair if the childs palate is still too short. It takes tissue from the back of throat and loosens it on 3 sides by cutting and leaves it connected to the blood supply on one side and the tissue flap is moved and "flapped over" and connected to the end of the back of whatever palate is trying to be lengthened.
How do you know is the child needs it? First of all Dr can SEE if palate is short. Second the speech therapist can do simple manuevers to see if air is escaping out of the mouth behind the palate. Third there are some more invasive tests that can also be done to evaluate like scoping by an ENT to watch muscle movement and some other tests.
Why do all these? First of all, you don't want to have any unnecessary surgeries. Second, overcorrection of the short palate can block the back of throat too much and lead to sleep apnea and snoring which are no fun and can create more problems.
So, some kids with palate repaired need to have some sort of lengthening done to palate. That was the case with our oldest son.
Our experience:
We went in early morning for surgery and he was out after 2 hours. By noon he was in ICU. For anyone not experienced with cl/cp surgery, most stays are 1-2 nights in ICU until child can start eating and drinking enough and swelling after surgery goes down. They usually stay in ICU as a precaution so if there's any breathing or airway problems it will be noticed right away. So staying in ICU has it's own level of associated fun. There are bells and monitors going off constantly! One major plus is nurses have fewer paitients so child's needs are addressed immediately.
After any surgery with young children there's usually crying screaming and or a disoriented state. This can be a little scary for parents and kids. We always bring a familiar toy and blanket to help. Our son does not do well with Demerol yet they often insist on using it. He screams and hollers usually until it wears off. After he came to us in ICU I had them give oral liquid pain meds right away. He was awake enough to take it. They alternated a Tylenol with codeine and a regular Tylenol bc he did not like the taste of the codeine product.
He vomitted and his face was swollen and he complained of stomach ache for a while after surgery. We gave a phenergan suppository which worked great.
He took only a few sips of liquid the first night. He does not eat popscicles OR jello (never has don't know if he was traumatized by them in the past surgeries??) so his doc ordered full liquids like ice cream that evening when he came to check on him.
By the next morning he was significantly better and the swelling had gone down due to the steroids.
We went home and he has gotten slowly better each day since.
What did I not expect? Swelling was a litttle more than I thought, but resolved quickly.
He complained a lot about neck pain for about a week. Stiffness in the back of neck. In fact he was standing on our bed about a week after surgery and bounced as he sat down and he cried and caught himself in the back if the neck and said it hurt. Usually the device they use in surgery to stabilize the neck connects to their mayo instrument stand and the neck is hyperflexed. Imagine leaning your neck totally back and opening your mouth as wide as you can and leaving it absolutely still for 2 hrs. I would have some crick in MY neck!!
Also he had a bit of snoring for the first two weeks. The first 6 days he had me a little scared at times. We had him sleep in our room on a futon and he seemed as though he was stopping breathing. He also had a lot of nasal congestion and swelling due to the probing of the nose for the fistula and I think this caused him not to be able to breath out of his nose and the pflap swelling was keeping him from breathing well out of his mouth. Not sure if this is "usual" for pflap or how much nasal swelling there usually is.
The only other thing is we have Tubes in the ears and after surgery he had some drainage from one ear.
It has now been about 4
weeks since surgery and he is completely and totally back to normal.
- Amanda & Roland
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