Surgery

Evan 2 weeks old.
Evan now. What a face! I could just eat those double dimple cheeks of his.

Well, I have spoken to Evan's ENT. It looks like Evan will have surgery. The way it was explained to me was that we will need to do the surgery in two parts. The 1st surgery will consist of lengthening his soft palate. It looks like Evan has a deep pharynx, which can then create the look of a short palate, even if it is not, because the palate and the pharynx never touch allowing air to escape out of his nose. It is possible he may need a 2nd surgery to add more skin to the back of the throat to create less of a gap. We are hoping the 1st surgery is all that is needed, because having the 2nd surgery often times causes sleep apnea. With Evan being a terrible sleeper as it is, I am praying the 1st one works for him. We scheduled the surgery for January 14th, after the holidays, and when Evan's ENT will be back in the country. Below is some more information for those of you who are interested on the medical part of it.

Deep Pharynx — This is the most difficult to recognize since the deficit is in the size of the nasopharynx and not of the soft palate. The soft palate may appear normal by oral exam. The velopharyngeal deficit can be identified only by lateral radiographs or lateral fluoroscopy. The primary features are the speech characteristics of hypernasal resonance, nasal air escape and possibly “cleft palate-like misarticulations” without obvious physical deficits. Other characteristics are nasal regurgitation as a newborn, difficulty nursing and delayed, hypernasal speech with normal language development. The speech-language pathologist is extremely important in the ultimate diagnosis and referral for appropriate evaluation and management of disorders of the deep pharynx. Speech deficits are the primary characteristics.
VPI is often not diagnosed or diagnosed late because the palate appears normal and the pharynx is not evaluated. When diagnosed after speech has begun, sparse adenoid mass may be a factor.
Hypernasality is the primary presenting factor. Hypernasality may be present from onset of speech — some children do not grow adenoids. After adenoidectomy — deep nasopharynx is unmasked (velo-pharyngeal mechanism seems able to adjust to slow involution but not the sudden increase with adenoidectomy).