Following a Patient from Pre to Post-Op – by Dr. Kay O’Leary

Today, I followed one of my favorite patients, Michael, through his surgery. He is 10 and has both a cleft lip, and palate. Both he and his mom are delightful. The ORs are large rooms outfitted with two operating tables and anesthesia units. Upbeat music is playing constantly, keeping time with the beeps from the monitoring equipment.  Everybody is upbeat, excited to be involved with the procedures they know will make such a difference in the lives of these children. When I asked a hospital official about locating patients for next year’s mission via the schools, he told me that the kids with cleft lips were kept at home and did not attend public school. Now these children will be able to go to school, make friends more easily and have a better self image and a chance at a better future.
The buzz in the OR is also from the excitement of being able to work with and learn from some of the top professionals in the world. Surgeons assist each other, and they show each other different techniques that they use. Michael’s surgeons were gracious to the entire team, answering questions from observers, inviting us in for closer view of the procedure, and pausing to allow photos to be taken. It took an hour to close Michael’s palate, and another hour to change the set up and repair the lip. With two operating tables going at the same time, there is constant movement with nurses floating in and out to find necessary supplies in an unfamiliar setting. As the surgery progresses from the anesthesia prep, to the surgical prep, to the surgical procedure and the final finish/cleanup, the rhythm in the room moves from quick pace to steady, then back to quick as the patient is bundled up and rushed to the recovery room. In recovery, the patients have the undivided attention of the doctor and nurses, holding them and comforting them with soothing touches, and soft, kind words as they wake from the anesthesia.

The long job of healing is just starting. For patients with a lip repair, there is the discomfort of having stitches in the lip and nose. Once food is in the mouth, chewing will pull against the new sutures, but the adjustment goes pretty quickly. For the patients with palate repair, it is a different story. In order to get enough tissue to bridge across a large opening in the palate, the skin and muscle along the base of the teeth must be released to allow the tissue at the cleft site to be pulled together to be stitched. Special white mesh is then tucked into the area at the base of the teeth to cover the open wound. A few stitches hold it in place and the body will heal that area and cover it with new skin over time. There are stitches in the floor of the nose, the roof of the mouth and along the teeth. Eating is more difficult, so food must be processed until the patient is able to tolerate chewing and the movement of food in the mouth. It is amazing to see how tough and resilient these kids are.

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