Speech Surgery

What is surgery for speech?

For people born with a cleft palate, a further operation may be needed if their speech is still sounding nasal and unclear after their initial palate repair.  This is known as secondary speech surgery.

For some people not born with cleft palate, the back of the mouth does not work as it should for speech.  As a result, they may also undergo a similar type of surgery if their speech sounds nasal and unclear, to help improve their speech.

Are there different types of surgery for speech?

There are four main types of surgery that can be done to improve palate function for speech.  These are:

Palate re-repair or intravelar veloplasty

This operation involves the palate being operated on to move the muscles further back within the palate, and/or to lengthen the soft palate.  The aim is to improve the functioning of the muscles and ability of the palate to lift during speech.  The side and back walls of the throat are NOT altered during this operation.

Pharyngoplasty or pharyngeal flap

This is an operation to alter the shape of the back of the mouth/nose, also known as the nasopharynx.  The aim is to reduce the size and make it easier for you to close off the nose from your mouth with your soft palate during speech.

Buccal flap palate lengthening

This operation involves releasing strips of tissue from the inside of both cheeks, separating the hard and soft palate and placing the strips of cheek tissue between the hard and soft palate.  This means the soft palate is pushed towards the back of the mouth – ‘lengthening’ it.

Fistula closure

Sometimes a ‘hole’ in the palate (fistula) can cause leakage of air and sometimes food and drink into the nose.  If this is the case, surgery may be recommended to close the fistula.

You are having the following type(s) of surgery:

• Palate re-repair/intravelar velopasty
• Pharyngoplasty
• Buccal Flap Palate Lengthening
• Fistula closure

SPEECH AFTER SURGERY

What will my speech sound like after the surgery?

Your  speech may sound different immediately after the operation, but continued improvement is typical as it can take between 6 – 12 months for scars to heal and muscles to settle.

For some people, speech may sound better immediately after the operation and then deteriorate.  This can be due to the swelling and the effect of changes as swelling goes down.  This is normal and advice can be sought from the speech therapy team if you have any concerns.

Is there anything I can do to support progress with speech?

If you see a speech therapist to work on specific speech sounds, it is helpful to recommence therapy two weeks after surgery to use your palate to make oral pressure sounds soon after surgery.  If you have any questions once you get home, please call 0161 701 9080 for advice.

RECOVERY AFTER SURGERY

When will I be able to eat and drink?

On return from theatre! By the time of discharge you should be eating and drinking sufficiently for the nursing staff to allow you to go home.  However you will need to be eating only soft foods to start with.

How long will I need pain relief medication?

For the first few days following surgery continue to take Paracetamol and Ibuprofen regularly.  Follow the instructions on the packet carefully and do not exceed the prescribed doses within a 24 hour period.

How do I care for my palate? 

Your palate may look different and may be swollen initially; this will settle down.  It may feel different to swallow initially but this will return to normal.

After surgery, use a small toothbrush and rinse out with water after every meal to ensure food is not left in the mouth. ‘Plain’ unsweetened, sparkling water works well.

Soft diet

Following surgery you will need to have a soft diet for at least three weeks.  Ideal foods include mashed potato, pasta, beans, soup, scrambled egg, banana, porridge, softened cereals, yoghurts, custard etc.

PLEASE AVOID HARD OR SHARP FOOD (e.g. toast, pizza, chips, crisps, sweets, biscuits)

Is there anything I need to watch for at home?

If you notice any of the following, please contact your GP for advice as they may be signs of infection:

• Sore throat
• Swelling/oozing/redness of the throat or mouth
• Smell from the mouth
• Increase in pain when eating or drinking
• A rise in temperature
• A loss of appetite

When can I go back to college/work?

To reduce the risk of infection it is advisable to stay at home for at least a week after you come home from hospital.

It is a good idea to avoid activities where you are talking loudly or shouting excessively, for example, concerts or sports competitions for 10-14 days after the surgery.

You should avoid sporting activities for up to 2 weeks after surgery.

What happens next?

You will be invited to see the cleft team as part of a multidisciplinary clinic approximately 6-8 weeks after their surgery.  This is to review your progress and discuss any issues/concerns.  The cleft surgeon will examine the palate to ensure it is healing well and a speech therapist will listen to your speech.

If you attend speech therapy within your local area, we will endeavour to contact them to let them know that you have had your operation, advise a two week break from therapy and establish when you will next be seen.  

If you have any concerns after you leave hospital, please contact:

Cleft Unit: 0161 701 9091