On morning rounds, the two boys from yesterday had normal voices for the first time in their lives and were praising God. One older teenager was subject to frequent bullying at school. After surgery, the chairman of plastic surgery said that their voices were as normal is if they had never had a cleft. Thankfully, they had also slept well, because the posterior flap palatoplasty causes sleep apnea in up to 39% of patients for several weeks. Both were discharged home with minimal discomfort.
I spent the morning teaching plastic surgery in the pediatric wing. The first patient was a 20 year old girl who needed revision of a bilateral cleft lip. We removed the large scar under her nose and properly reattached the muscles of the lip. The second patient was a teenager with a soft palate cleft that had never been repaired. We performed a Furlow palatoplasty to redirect the muscles across the palate so that he can speak clearly and eat without food going up his nose. The third child was 4 months old and has a bilateral cleft lip and palate. The middle portion of the jaw and lip projects too far in front of the face. Unfortunately, the pediatric hospital did not have the necessary equipment to secure a difficult airway in a young child, and we aborted the surgery after 45 minutes of anesthesia.
I spent the evening with Jesus. We performed a septoplasty with the endoscope for the resident’s benefit, and exchanged ideas about technique. Dr. Jesus Aguilar is always interested in learning and attended the AAOHNS meeting in Vancouver. Coincidentally, he stayed a day after and had lunch on top of Grouse Mountain, the same restaurant where I ate that day. Our second case was an inverted papilloma tumor of the maxillary sinus. With persistence, we were able to remove all of it endoscopically. By the time I returned to the hotel for dinner, it was 10:00 p.m.