Instructions after Speech Surgery
(Posterior Pharyngeal Flap Surgery, Sphincter Pharyngoplasty, Palatal Lengthening)
Important information about speech surgery:
The surgery will reduce the amount of air that escapes out through the nose during speech and will improve the nasal sounding quality to your child’s voice. The surgery helps the muscles of the palate and throat direct the air flow correctly during speech.
During posterior pharyngeal flap surgery, a piece of tissue from the back wall of the throat is attached to the soft palate. This will form a new bridge of tissue, which helps reduce airflow through the nose during speech. Openings are left on both sides of this bridge of tissue. These openings allow mucous to drain from the nose when your child has a cold and allow your child to breathe through the nose.
During sphincter pharyngoplasty, the muscles that run from the soft palate to the back of the throat (pharynx) are repositioned. This surgery redirects airflow during speech and can reduce the amount of air that escapes from the nose during speech.
During palatal lengthening surgery, tissue from the inside of the cheeks is placed in between the hard and soft palate to lengthen the palate. This can allow the palate to work better and reduce airflow through the nose.
Patient instructions following speech surgery:
Some children will need to be in the ICU for 1-2 days after surgery. Your child may need to have a small rubber breathing tube in their nose to help protect the surgical area and ensure they are breathing easily.
Drinking and eating
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Your child will have an intravenous line (IV) after surgery. An IV is a small needle inserted into a vein that lets us give your child medicines and fluids. It will stay in place until your child is drinking well.
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Your child will begin with a clear liquid diet taken from a cup on the day of surgery. They can also have very soft foods like apple sauce, Jell-o®, milkshakes, and water ice.
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The day after surgery your child will be allowed to start eating soft foods. These can be ordered from the hospital room service menu and includes foods such as well-cooked pastas, macaroni and cheese, finely ground beef, blenderized foods, pancakes, soft bread, scrambled eggs, cottage cheese, tuna or egg salad (finely chopped). Your child needs to stay on the soft diet for 3 weeks after surgery. Your surgeon will discuss further diet changes at the first post-operative appointment.
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Do not use straws for three weeks after surgery.
Activity
Your child may not participate in gym, swimming, or sports for one month after surgery.
Speech and language therapy
Children should defer speech and language therapy until cleared by their surgeon. Most children will need speech therapy after surgery to continue to help improve their speech. Rarely, additional surgery may be needed to give your child the best result.
Pain management
Your child may be in pain after surgery, but most pain can be well controlled. Sometimes we cannot help a child to be completely pain free, but we will help your child to be as comfortable as possible. During surgery, long-acting pain medicine will be placed in the surgical sites to make these areas less painful after surgery. This medicine lasts 6 to 12 hours after surgery. Your child may have numbness and tingling at the surgical sites because of this medicine.
If at any time your child’s pain is not relieved with ibuprofen:
If at any time your child’s pain is not controlled by either ibuprofen or acetaminophen alone:
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You can alternate doses of acetaminophen and ibuprofen every three hours. For example, if you give your child acetaminophen at noon, you can give ibuprofen at 3 p.m. and then acetaminophen again at 6 p.m. and ibuprofen again at 9 p.m. It is very important that you read and understand the dosing instructions of both medicines. You may not give more than 4 doses of ibuprofen in 24 hours. You may not give more than 6 doses of acetaminophen in 24 hours.
If at any time you child’s pain is not controlled with alternate doses of acetaminophen and ibuprofen:
Discharge
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Your child may go home when they are drinking, breathing easily, and feeling comfortable. This usually happens in one to two days.
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Schedule a follow-up appointment with the plastic surgeon 2-3 weeks after surgery.
Complications
As in any surgery, rare problems can occur which include bleeding, infections, breakdown of the repair, and reactions to medicine. These problems are uncommon, and most of the time these surgeries have good results.
Contact your CHOP surgical team with questions, concerns or if your child:
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Has signs of dehydration such as urinating less often, dry mucous membranes or few or no tears when crying
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Will not drink. We expect children to drink a bit less than usual on the day of surgery, but they typically return to their normal pattern within 24-48 hours of surgery.
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Is difficult to soothe or appears weak
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Has difficulty breathing or has long pauses of breathing when sleeping
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Has pain that does not get better after taking acetaminophen, ibuprofen and oxycodone
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Has signs of infection such as drainage from the incision, swelling, and/or redness.
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Has a temperature 101ºF (38.3° C) or higher under the arm or 102ºF (38.8° C) or higher rectally
Monday through Friday, 8 AM -5 PM
215-590-2208
Evenings, weekends, and holiday, call 215-590-1000 and ask to speak with the plastic surgery resident or fellow on call
Reviewed December 2023 by Kelsey Reilly, CRNP