Surgery #3 & Surgery #4

Yes you read it right.

There is still a 5% opening at the back of Garretts throat. It is the reason that he has been at a stand still for 6 weeks in his speech progression. And it will not get better without further surgery.

The Childrens hospital team decided today on a sphincter pharyngoplasty repair. So in english...

• He needs to have his adenoids removed (adenoids are squishy material and in the way).
• 3 months later after the adenoid removal has completely healed. They will operate again to "stretch" some material from either side of his throat up and over (to make a "flap") to the other side. This will make the hole smaller and hopefully allow his muscles to close it fully while he speaks.

Besides the risks of the surgery, there are several side effects/concerns that will need to be addressed:

• For the 3 months in between the surgeries, Garretts speech will be negatively impacted with the removal of the adenoids - since they currently make up the "back" wall of his hole and provide a cushion to making the current hole smaller. By removing them, they will make the hole bigger and thus take away the great progress he has made on his speech since the Dec surgery :-(
• Sleep apnea. This is the biggest and most realistic long-term side effect from this surgery. It is most prominent right after surgery. I need to check into some kind of monitoring tool for this as I will never sleep post-op knowing that this is a possibility and there are known death cases as a result.
• Snoring. This too is a realistic possible side effect. Not life threatening but can have a real negative impact to the quality of his sleep for the rest of his life.
• Post-Op tear/Failure to close hole enough - 87% success at first attempt however 99% success after second attempt. I need knee pads for all the praying I need to do to hopefully avoid a Surgery #5 (second attempt).

So when???

• The ENT does the adenoid removal first......earliest open surgery slot - June 23rd which puts the earliest "3 month later" slot - Sept 23rd. One month after school starts.
• So we are going to try to schedule the Surgery #4 the first week in August. And cross our fingers that the ENT has a cancellation in the next month. We are on the top of their list to call.

For all those medical personnel in my family :-)
A sphincter pharyngoplasty raises vertical flaps of tissue from each lateral pharyngeal wall, rotates them inward to a horizontal position and inserts them into the posterior pharyngeal wall. This leaves a single (smaller) opening that is closed by the elevation of the velum.