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Abstract: Cleft palate belongs to a group of congenital disorders and is often confused with airway choking due to breastfeeding. In this case, the child was found to be choking on milk after birth by his parents, and was later examined by an obstetrician and diagnosed as having a soft palate cleft. 1 year old to the outpatient oral surgery clinic, the soft palate cleft was clearly identified and surgical treatment was performed. Through active treatment, all indicators were normal after surgery and the child was discharged successfully.
Basic information】Female, 1 year old
Type of disease】Cleft palate
Hospital】The First Hospital of Harbin Medical University
Date of consultation】November 2021
Treatment plan】Surgical treatment (Lan’s two-flap posterior thrust operation)
Treatment Period】2 days of hospitalization and 1 month of follow-up
Results】The incision healed well after surgery
I. Initial consultation
After examination by the obstetrician and consultation with the oral surgeon, the child was diagnosed as having a soft palate cleft, which was recommended to be treated surgically when the child was about 12 months old due to its young age and incomplete development. The parents were advised to place the child in a lateral or prone position on a daily basis to avoid rapid enlargement of the cleft. When the child reaches 12 months of age, the parents bring the child back to the clinic, where the child is seen to be well developed and free of illnesses such as colds that could affect the surgical procedure. The intraoral examination showed a full cleft palate from the uvula to the posterior edge of the hard palate, with thick tissue on both sides, no tonsillar hypertrophy on pharyngeal examination, and a cleft palate voice with fair hearing. The child underwent routine preoperative examination, and the preoperative findings were normal, so he was admitted to the hospital for surgical treatment.
II. Treatment history
After admission, a cleft palate repair was proposed to close the soft palate cleft at the same time. Preoperatively, we communicated with the family and explained that the treatment option for the child’s soft palate cleft is surgery, and the current surgical methods are mainly Lang’s two-flap retropulsion, levator reconstruction and reverse double “Z” flapplasty, and Lang’s two-flap retropulsion is mostly used clinically. “Z” flap angioplasty. Since the child’s soft palate tissue is thick and the cleft is moderate, it is more suitable for the reverse two-flap posterior thrust operation, and the operation is short, simple, and the postoperative effect is exact. After communication, the family unanimously agreed to adopt Lang’s two-flap posterior thrust operation and expressed positive cooperation, so the operation was performed for the child.
III. Treatment effect
After the operation, the child suffered less pain, no fever and other systemic symptoms, and only slightly restricted breathing, but it was a normal phenomenon. After the operation, the child was given a liquid diet and the family was instructed to clean the child’s mouth after eating. The intraoral incision was observed to be free of redness, swelling, fresh bloody exudate or other secretions, and the sutures were fixed exactly. There was no special postoperative treatment, and it was recommended to go home for observation after the condition was stabilized. Therefore, the child was allowed to go home for recuperation 2 days after the operation. At the time of discharge, the child’s family was instructed to feed the child a liquid diet for 1 month, then switch to a soft food diet for 2 weeks, and then to a normal diet. In addition, the family was instructed to visit the clinic again in 1 month for a follow-up examination, which revealed that the child had recovered well from the surgical incision.
IV. Notes
We are glad that the child has recovered well from the surgery. However, since the child is still young, the family needs to take good care of him in daily life, avoiding normal diet immediately after discharge.
The sutures in the child’s mouth usually fall off on their own later, so there is no need to remove the sutures, but until the wound recovers, avoid crying to prevent the incision from opening. The overall condition of the child should be closely monitored in daily life and the child should be seen immediately in case of discomfort.
In addition, the child needs to visit the speech therapy room at the age of 3-4 years to check the articulation and assess the palatopharyngeal closure. If there is incomplete palatopharyngeal closure, the child should continue to be evaluated for pharyngoplasty. If pharyngoplasty is not required, speech therapy can be performed to help restore normal articulation.
V. Personal insight
Cleft palate is a congenital disorder and most children born with this condition will have a choking cough after birth, but the condition is usually confused with a simple choking cough from breastfeeding. Therefore, parents should take good care of their newborns after birth, and if they have a choking cough, they should not simply assume that it is caused by improper breastfeeding practices, but should promptly undergo clinical examination to make a correct diagnosis. In daily life, it is necessary to strictly control the sleeping position and breastfeeding posture of the child to prevent the cleft from developing too large and affecting the later surgery.
The surgical treatment of cleft palate should be as simple as possible, with minimal damage to the child and quick recovery, rather than mechanized treatment. In this case, the child recovered smoothly and with much less postoperative pain because he chose the more suitable option among various surgical procedures.