Abstract
We report a patient with cleft lip and palate who refused to eat after secondary palatoplasty. The patient was a 5-year-old boy with multiple congenital anomalies (including auricular deformity, micropenis, and hypoplastic corpus collosum). Cochlear implants were placed for his hearing loss. The patient also had intellectual disability, communication disorder, and autistic tendencies. For his complete right cleft lip and palate, he underwent primary lip repair (triangular flap method) at 5 months of age and primary palatoplasty (push-back method) at 1 year and 3 months of age. The patient initially refused to eat postoperatively and required a few days to begin eating again, but his postoperative course was otherwise uneventful. Thereafter, he was periodically followed up at the Department of Plastic and Reconstructive Surgery, and he was unable to speak at 5 years of age. He was followed up at another institution for his hearing loss. At that institution, he was found to have velopharyngeal incompetence (VPI) and was recommended to undergo surgery at our department. We explained to his family that his inability to speak and VPI were unrelated, but they strongly desired the surgery. Therefore, a secondary palatoplasty (re-push-back method) was performed at 5 years and 4 months of age. The patient was given a liquid diet one day postoperatively but he refused to eat. Therefore, parenteral nutritional therapy was continued via a peripheral vein. Since his body weight decreased 1 kg by the tenth postoperative day, he was transferred to the pediatric department where tube feeding was initiated. His refusal to eat was thought to be of psychogenic origin, and the administration of an anti-anxiety drug (tandospirone citrate) was initiated on the 38th postoperative day. The patient and his family became accustomed to tube feeding by the 54th postoperative day, and he was discharged from the hospital because he was considered to be manageable at home. He began eating bread 1 week after discharge (61st postoperative day), and his dietary intake was good by the 70th postoperative day. Special considerations are thought to be necessary for secondary palatoplasty in pediatric patients with intellectual disability. It is important to carefully consider surgical indications and consult with the patient's pediatrician and physiatrist to reduce psychological stress caused by intraoral surgery.
