Dr. Hisham Burezq, BSc MD FRCSC FAAP
Consultant Plastic & Reconstructive Surgeon
Consultant Pediatric Plastic Surgeon
Canadian Board and fellowship in plastic surgery
When we speak, we release air through the mouth, and depending on the position of the tongue, lips and teeth, letters and words are formed.
When there is a defect in the throat (pharynx) or palate muscles, part of the air leaks into the nose, and the person may suffer from a nasal voice.
The causes include the following:
- Presence of a cleft palate.
- Presence of a congenital defect in the palate muscles.
- After a tonsillectomy is performed.
- Some diseases and conditions that affect the nervous system and the brain.
- Presence of an opening in the roof of the mouth after palate repair (oronasal fistula)
Symptoms and Signs:
- Nasality when talking.
- The air comes out from the nose while talking.
- Lack of clarity in some letters; thus having difficulty in communicating with other children.
Diagnosis
The child will be assessed by a Speech and Hearing Specialist and an endoscope will be conducted at the age of 4-5 years old, through which the movement of the palate will be evaluated.
Treatment:
These are some of the cases that have a major impact on the child’s life, prevent him from communicating with other children, and delay his educational achievement at school.
- Many cases are treated conservatively through special exercises performed by the Speech and Hearing Specialist in frequent and regular sessions.
- Some cases (30%) require surgical intervention between the ages of 5 and 8 years old. The surgery is performed under general anesthesia, in which the surrounding tissues are moved to treat the deficiencies. There are several surgeries designed to treat these conditions and the method is chosen based on the anatomy and movement of the soft palate and pharynx (throat).
Before going to the Hospital:
- Visiting the Anesthesiologist a week before the surgery is important to make sure that the child is ready for surgery.
- The child usually hospitalized for 2-4 days, and in some cases needs to spend his first night in the ICU; to monitor their breathing closely.
- The child should refrain from eating for 8 hours before the surgery.
Surgery:
- It takes approximately 2.5-3 hours under general anesthesia.
- The child will be given painkillers after the surgery while in hospital.
After the Surgery:
- It is important for the child to sleep on his stomach to get rid of any secretions or blood after the surgery.
- Lifting the child’s head after the surgery using a pillow starting from the second day and for 24-48 hours is useful for relieving the swelling resulting from the surgery.
- Small amounts of blood comes out of the mouth and nose in the first two days following the surgery, which is expected and not a cause for concern.
- The child may start snoring for a long time.
- Your child will be discharged home when they are able to drink plenty of fluids and are comfortable and pain free at day1-2 after surgery.
- How the child should eat after the surgery:
- The child will drink light liquids (interspersed with light) in the first two days, such as water and apple juice gently using a syringe.
- The child will then be allowed to drink any type of liquids.
- Afterwards, the child will start eating soft food and stays away from eating anything solid for a month after the surgery.
After your child is discharged from the hospital, return to the emergency room if they show the following:
- Stops eating and drinking.
- Suffers from a fever.
- Suffers from a severe bleeding from the mouth.
- Clear unpleasant smell from the mouth.
When does the child's speech improve after the surgery?
- The success rate of these surgeries is generally high.
- The improvement rate depends on the case; as some cases improve within a few days or weeks, while other cases may need speech and hearing therapy for 6-12 months
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