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This one is about: Pharyngeal Flap

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My daughter who is 21 months, will need her palate redone and very likely a pharyngeal flap, in about 6 months. I would appreciate anything you can tell me about the flap surgery. Was it very painful for him? How was the recovery period, in terms of the flap? Does he get sore throats or ear infections more frequently since the flap was done?


A response from Joanne Green:

A pharyngeal flap is a procedure that has been around for a very long time. It is done to improve nasal speech.  In this procedure, the surgeon uses the back of the throat wall to form a small ledge that closes off the extra space between the soft palate and the back of the throat, allowing the person to more easily direct the flow of air through the mouth and away from the nose during speech.

This procedure is not without its problems. The scariest problem is that is can create or exasperate sleep apnea, which could, under the worst conditions, be life threatening. Another problem is that, because it creates an unnatural ledge, it can lead to more throat infections. A third problem is that it can in fact create a problem of HYPO-nasal speech (sounds like you have a cold).

Lots of people have had it done with very good results. For some it doesn't work as well.


A response from Debbie:

My daughter Alisha had the pharyngeal flap surgery twice. (The last one was a revision to the first surgery.)

It was not as difficult as the palate repair. It is like a bad sore throat. Again, the recovery was not as difficult as the palate. Liquids for a couple of days, then soft foods, etc. She bounced back pretty quickly.

No, she did not get infections or sore throats more often after the surgery. As a matter of fact, she seemed healthier. (That may be because she was getting older?).

After the revision, her speech improved GREATLY! The only downside was just snoring when she slept. However, she has improved with that with time. At first, her snoring was really bad. She'd keep everyone awake with loud snorts. But, I have noticed she does a lot better now, unless she has a cold.


A response from Anna:

Hi! Philip has had no complications or problems with his pharyngeal flap, except that he can really saw some logs - snore I mean! His throat was very sore when he first came out of surgery and he refused to swallow liquids for a couple of hours. He finally agreed some Sprite and really winced while it was going down. After that, he started drinking juices in earnest and was not too bothered by his throat.

Frankly, we were having such fits over his nose that we weren't too concerned about the flap! He started on soft foods the next day, anything that would go through that syringe. His speech improved immediately. He came out of surgery with a whole set of consonants that he didn't have before.

We were told by a PS this past summer that there is some controversy over the flap - that it could possibly "tether the maxilla" and therefore interfere with optimal growth. The same PS also said that for some children the flap is nevertheless necessary or their speech would never be normal. I never checked out this controversy because Philip already had the flap by then and we believe that his speech needs warranted the use of the flap. His health has not been worse since the flap. He pretty much battles ear infections constantly.

Even that has gotten better lately, which I think is due more to the end of the swimming season than anything else! I'll pray that all goes well for you.


Nancy's questions on the procedure:

I have a few questions for you. How long did it take Cory to recover from his z-flap? Could he eat, drink, etc.? How long was his surgery? How long was Cory in the hospital? When our doctor asked us if we had any questions, we did not know what to ask. I have not called his office yet. I am waiting until I have all the questions I want to ask.


Michelle's reply:

Nancy -- Cory recovered so fast I was surprised. He wasn't allowed "hard" foods for 6 weeks. Things like chips and pizza, etc., were no-nos, but it really wasn't tough. He drank a lot of milkshakes, ate pudding, even sandwiches (soft ones like potted meat (yuk) or spam (double yuk). His surgery was a little over 2 hours, but they also replaced ear tubes in that time. He was discharged from the hospital the next day and did not have to have any arm restraints (at 3 1/2, he'd have taken them off anyway). The doc said we probably should stay an extra day, but Cory was so unhappy w/ the hospital setting, the doc agreed he'd do better recovering at home. He got home and only complained a few times that his throat hurt. Most of the recovery was spent on his feet :-)

I don't want to act as if everything was peachy keen. Cory came out of anesthesia abruptly. He was sleeping soundly one minute and then bolted upright the next, screamed, and yanked out his IV. Of course, that created one helluva mess and it took both my husband and I to hold him down and calm him enough to reinsert it. Eventually, it came out that evening as he was uncooperative about it. Joanne had a similar experience w/ Jessica and put it on an autoresponder (Wildcat in Recovery). Read it, it will help in case (and I stress ONLY IN CASE) the same goes for your little one. I tell you this not to frighten you because Cory's roommate was a little girl who had a fistula closed under anesthesia and she gained consciousness slowly and calmly. Cory's experience wasn't the norm, but it would have been nice to have at least been forewarned that this was possible. He caused himself no damage, just caused mom and dad to freak. Docs and nurses said it was ok, happens occasionally, but with no long term effects.

Another thing I MUST add--that very day, I repeat, that very day, Cory said, "Mom my mouth hurts," and "Daddy, I want to go home..." PERFECTLY, SUCCINCTLY, and TOTALLY understandable. The surgery appeared 100% successful right off the bat. That alone brought tears to my eyes and I wanted to share with you how happy we were with the procedure. He needed minimal pain medication after the first day. Most days, he needed none. After the 3rd day, he was finished with it altogether. Today, Cory is still in speech therapy, but the focus is not on the back of the mouth any longer. They are working on his "s" his "Ch" and "th" sounds, which are primarily tough for him due to his alveolar ridge and teeth, etc.  His closure problems are over.

Please feel free to ask anything else you would like. I will dig into the deep recesses of my brain for the experiences we had. All told, I think you will be pleased with the results.

Michelle S.

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