Inquiring Minds...

I have heard this question (or a version of it) a lot, "Are the boys done with surgeries now?"

Oh, no, my friend. Oh, no.

And that question is followed up with some version of, "How many more surgeries?" or "What else needs to be fixed?"

Do we know how many or what kinds of surgeries they will need? Nope.

Sorry to be vague. It is a kind of "wait and see" process. I think we'll only know what should be the next step as we go along.

The boys just had their first surgery. We only know what is next. Samuel will have his full lip repair done in about 6 months. That means they line everything up and attach all the muscles under his lip. He doesn't look much different now from the front (you should see the roof of his mouth though :) it's very amazing and exciting), but he should after the next surgery. With David, we wait for him to grow and then the doc will attempt to close up the top of his mouth (his hard palate). How long will that take? Who knows. How about we evaluate again in 6 months. I predict that David's palate will take several surgeries to close.

I'm not being pessimistic, just being realistic. Wouldn't it be a pleasant surprise to only have one surgery to close up David's palate, eh?

I also predict one more lip revision for David. I double-checked with my crystal ball on this one :o)   I think there is still a loose muscle in there that needs to be fixed. Perhaps it was fixed this last surgery, but a flying book or no-nos rubbing on his face made it detach...

Once the lips and roofs of the mouth are closed up, and the boys are talking more clearly, we'll be able to see ~ or rather hear ~ if their soft palate is working properly. Your soft palate is the flappy part at the back of your throat that keeps you from sounding like Nasal-Nelly all the time. You need to close your soft palate to make certain sounds when you speak, especially the plosives like "b" and "p". If the boys can't seem to do this, they can be evaluated to find out the reason. I think they can put some sort of camera in their nose and take a look at what might be causing the trouble ~ whether the soft palate just isn't moving (velopharangeal incompetence) or it isn't long enough (velopharangeal insufficiency).

If their soft palate isn't closing because it is not big enough, then they will need that fixed surgically. I think there are two ways to do this. The docs can either reconstruct the soft palate or make a "speed bump" out of tissue so that the soft palate can close. I'm not sure at what age this would happen... so I'll guess around 5-6ish.

After their permanent teeth come in, they will need a bone graft in their upper teethridge (the alveolar ridge). I think the docs usually take bone from the hip to do this. All kids with clefts that go up into the roof of their mouth need this, since there is a split in their gumline. I have heard this surgery falls into the "not fun" category just like the hard palate surgery... ouch...

As they grow, we'll see if their jaw and upper teethridge are growing at the same pace. Sometimes the upper teethridge doesn't grow fully with all the stuff that's happenin' in there, so surgery is needed to line the top and bottom up. I think that happens later, maybe in the late teen years when they are at their adult size.

And all along the way we'll keep an eye on their ears in case they need new ear tubes.

And fistulas will not be our friends. Those mean more surgeries. We love our plastic surgeon, but not that much...

So that's surgery-land as I know it.

I bet I got something wrong will learn more as we go along.

I have to figure out a short and sweet answer to the question, "Are the boys done with surgeries now?"

Ask me when they are in high school and we'll have a better idea :o)

(((hugs))),
chris


Give all your worries and cares to God, for he cares about you.   1 Peter 5:7