What is surgery for speech?

For children 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 children not born with cleft palate, the back of the mouth does not work as it should for speech.  As a result, these children 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:

Intravelar veloplasty +/- Furlow style lengthening (muscle repositioning +/- soft palate lengthening)

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 the child to close off the nose from the mouth with their 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

RECOVERY AFTER SURGERY

When will my child be able to eat and drink?

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

How long will my child need pain relief medication?

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

How do I care for my child’s palate? 

Your child’s palate may look different and may be swollen initially; this will settle down.  It may feel different to swallow for your child, so they will need reassurance that 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

Soft Food Diet

If you are having speech surgery or jaw moving surgery you will be told that you need to stick to a soft diet for a while after the surgery. We’ve put together a rough guide of the types of food you can eat:

• Mashed potato
• Pasta
• Beans
• Soup
• Scrambled egg
• Porridge
• Softened cereals
• Yoghurt
• Custard
• Hotdog sausages (skinless)
• Milkshakes
• Soft white fish
• Well-cooked veg such as broccoli and carrots

Handy Hint: Most foods can be soft foods if you cook them for long enough – but try to avoid crunchy or ‘sharp’ foods like crisps and biscuits!

If you are unsure about what you can and can’t eat let a member of the Cleft Team know and we will be able to offer you further guidance.

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

SPEECH AFTER SURGERY

What will my child’s speech sound like after the surgery?

Your child’s 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 children, 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.

A speech therapist from the cleft team will try to visit you on the ward post-operatively to offer specific advice, however if you have any questions once you get home, please call 0161 701 9080 for advice.

Is there anything I can do to support my child’s progress with speech?

If your child has difficulty making certain speech sounds, there are lots of helpful things you can do to support speech following surgery.  It will be helpful to encourage speech sounds which involve the movement of the palate muscles, these are known as ‘oral pressure sounds’.  Oral pressure sounds include:

p, b, t, d, f, k, g, s, sh and ch

For younger children the following can be helpful:

• Bubbles – Have fun with bubbles and use words in play that encourage oral pressure sounds, e.g. “pop, bubble, up”
• Hide and seek – Enjoy playing hide and seek and use the words “boo, bye bye” and “peepo”
• Pretend play with dolls and teddies using words such as “baby, bath, bed, book, ball”
• Cars – If your child enjoys playing with cars, target words may include “beep beep, bye bye”
• Television characters – Talk about favourite characters such as ‘Peppa Pig, Postman Pat, Baby Jake, Paw Patrol’
• Encourage your child to listen to these sounds/words and try to say them.

For older children:

• If your child sees a speech therapist to work on specific speech sounds, it is helpful to recommence therapy two weeks after their surgery to encourage them to use their palate to make oral pressure sounds soon after surgery.

When can my child go back to school/nursery?

To reduce the risk of infection it is advisable to look after your child at home for at least a week after they come home from hospital.

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

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

What happens next?

Your child 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 their 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 child’s speech.

If your child is known to speech therapy within your local area, we will endeavour to contact them to let them know that your child has had their operation, advise a two week break from therapy and establish when they will next be seen.  

 Please let your local speech and language therapist know that your child has had their surgery.