When do you decide that the further rehabilitation of the short palate does not make sense and operation is necessary?
What does such operation consist of?
If after closing the cleft palate fistulas appear, could they be seen with the naked eye
and the doctor will notice them during the check-up visit?
If it can’t be seen with a naked eye how can you state that there are still gaps in the palate
and when (how fast after the first operation) should the procedure be repeated?
Not only on the length of the palate does a good speech without nasality depend. The most important in the cleft palate operation is a correct connection of the muscles made by the surgeon and as early as possible – only then the child naturally passes all the stages of speech development. If we add to that a proper rehabilitation of it, than there is an almost 100 percent chance that the child will speak correctly. If despite fulfilling all the conditions a child has the so called hypernasality, which means that the velopharyngeal sphincter does not close completely, then the surgeon should do an operation supporting the velopharyngeal sphincter. Usually procedure used in such cases is the so called pharyngeal tissue fixation. The decisions in that matter should be made in team with the participation of the surgeon, phoniatrics specialist and speech therapist. Although in case of incorrect functioning of muscles or residual holes in the palate the operation should be repeated. Otherwise we are sentenced to a Sisyphean task. First the normality has to be restored and then rehabilitation should begin. In cases, in which the operation should be repeated, the procedure has to be put on hold for at least half a year from the time of the first operation. After the operation all the wounds should be closed tightly. When it comes to the palatal tightness check the easiest way to do that is to see whether the food does not appear in the nose. In older patients we observe the so called dead fistulas and here the diagnosis should be made based on the experience of the surgeon, speech therapist and phoniatrics specialist. Such diagnosis is equal to indication for operation, because it impinges on the permeability of the nose, hearing and pronunciation.