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Speech surgery / secondary surgery

Who is speech surgery for?

This kind of operation may be offered if your child’s speech has a nasal tone, which is caused by unwanted air escaping into the nose if the palate does not work well.

Speech surgery can be beneficial for those who have a history of cleft palate. Some people without a cleft palate can have palatal problems too (for example, if their palate is not long enough or does not move quickly enough). People with palate problems unrelated to a cleft can also benefit from these operations.

The decision to have this kind of operation is made jointly be the child / parent, speech therapist and surgeon.

How do these operations help?

All speech surgery operations aim to improve palate function and stop unwanted air escaping through the nose. Depending on the type of operation, this may be by helping the palate move more effectively or by changing the space at the back of the throat.

What does the operation involve?

There are different kinds of “speech surgeries”.

Some operations move the muscles in the palate (cleft palate re-repair) or make the palate longer using tissue from the cheek (buccinator flap operation). Others change the space at the back of the throat (pharyngoplasty).

The surgeons will explain the type of procedure which best suits you / your child.

For any of these operations, your child will be put to sleep (with a general anaesthetic). They will come to the hospital on the day of the operation and will need to stay on the ward for at least one night.

Their throat / mouth may feel sore, and they will need to eat a soft diet for one to two weeks. Advice will be given regarding this at the time of surgery..

Are there any risks/ side effects?

As with all surgical procedures there are risks involved:

  • Very rarely bleeding may occur following the operation requiring urgent return to theatre.  This occurs in fewer than 1 in 100 patients.
  • There is also a small risk (less than 1 in 10 patients) of the wound breaking down as a result of infection.  This may heal by itself.  If not, another operation might be needed, usually several months later.
  • Breathing through the nose may also be affected at first.  This is because of the re-arranged muscles and the swelling caused by the operation.  If this happens, a small tube (known as a naso-pharyngeal airway) is put down the nose to help breathing for the first 24 to 48 hours after the operation. Fewer than 1 in 20 patients will require this.
  • Some operations, particularly a pharyngoplasty, may cause snoring and / or sleep apnoea. If this is a possibility, we will request a sleep study to assess the risk.

The surgeon will discuss these risks with you before the operation and answer any questions you might have.

What will happen next?

Speech may sound worse immediately after the operation. Over the following year speech should improve and become better than it was before the operation.  If the operation is not successful, another surgical procedure may be available.

A review appointment will be offered at one of our clinics 4-6 weeks after surgery (usually at a children’s clinic or teens and adults clinic).

A formal speech assessment will be carried out six months after surgery  This will be with one of the speech and language therapists.

Sometimes speech therapy is needed after the operation to help learn a new, clearer way of speaking.  Your speech and language therapist will discuss this with you.