Cleft palate surgery is crucial for the proper development of speech and effective swallowing. To make the postoperative recovery smoother, some preparations can be made in advance. Below are practical guidelines for parents to follow before and after the surgery.
Timing and Duration of Surgery
Children with a cleft palate are typically operated on between the ages of 9 to 18 months. The surgery usually lasts between 1.5 to 2.5 hours, depending on the severity of the defect.
Preoperative Preparations
Before surgery, it is essential that the child does not use a pacifier or a bottle with a nipple. This is because, after the surgery, children should avoid sucking or creating any pressure inside the mouth. If the child uses a pacifier to fall asleep, we recommend that they are weaned from it before hospital admission. It is also helpful to teach children to drink from a regular cup and use a soft spoon. We advise that parents bring their child’s regular spoon to the hospital for consistency.
The Day of Surgery
On the day of the operation, the child will receive only intravenous fluids (nutrition through a tube into the vein). After the surgery, children are usually sedated and given pain medications. Most children will rest during the day following the surgery. Mild bleeding from the palate and bloody saliva is common immediately after surgery. If the bleeding is excessive, additional measures and medications may be necessary.
Postoperative Feeding
If there are no complications, the child will begin feeding through a nasogastric tube (a tube inserted through the nose into the stomach), which is placed during the surgery. Additionally, depending on the child’s condition, fluids may begin to be offered orally using a soft spoon or syringe. Bottles with nipples or straw bottles should not be used.
The following day after surgery, the long stitch placed in the child’s tongue (to hold it in place during surgery) is removed. Over the next 10 to 14 days, the child will be on a strictly pureed diet (all foods must be blended into a smooth consistency). During this period, the use of a pacifier is still prohibited. If the palate heals well, after two weeks, the child can start gradually transitioning to a soft diet, and after about another two weeks, to normal food for their age. Hard foods should be avoided for at least 6 weeks post-surgery.
Postoperative Care
After every meal, it is essential to rinse the mouth thoroughly to remove any food remnants. Ideally, this should be done with water or lukewarm herbal tea.
Two weeks after the operation, when cooperation from the child allows, oral hygiene can begin. Teeth can be brushed on the lower jaw and on the upper jaw on the facial side (avoiding the side of the palate that was operated on). This should be done with maximum care to prevent injury to the operated area.
Avoiding Injury to the Palate
During the healing process, it is essential to prevent the child from inserting fingers or objects into their mouth. To help with this, splints should be used to restrict the bending of the child’s elbows for at least 3 weeks. Most children tolerate these splints very well. The hospital provides a pair of splints for each child, which the child will take home upon discharge. If one pair is not sufficient, parents are advised to create additional splints, which is easy and inexpensive.
Discharge and Follow-up Care
The child is typically discharged 6 to 7 days after surgery. Feeding continues as outlined above.
The first outpatient follow-up appointment is usually scheduled 3 weeks after the surgery, and it will be noted in the discharge report.
In some cases, palate massages are recommended, starting no earlier than the 28th postoperative day. Here is a brief guide:
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For the first 7 days, use your finger to gently rub over the incision on the palate in a back-and-forth motion. Apply only light pressure until you trigger the gag reflex.
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The goal is to stimulate the muscles of the palate in their new position.
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Perform these massages twice a day before meals to prevent the child from vomiting. Move the finger along the incision approximately 15 times in each direction.
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After about a week, you can increase the pressure applied to the incision.
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Continue these massages for a minimum of 6 weeks or until otherwise advised by the doctor.
By following these guidelines, you can help your child recover smoothly after cleft palate surgery and ensure proper healing and development.