[ginahage7]

[quote=King Bombo;2250063]Bombo had his surgery on the 18th of Sept at UC Davis. It was the one year anniversary of the day my first true love Yorkie died.

I am posting a little more in depth than what most need to know. But I thought that those with cleft palate puppies might be interested in knowing what is entailed in repairing a major full midline cleft--from the top of the hard palate to the back of the soft palate.

Bombo is a 10-month-old Yorkie, weighing a tad over 3 pounds. He was tube-fed every two hours the first month of life by his breeder, then kept on hard kibble and water from a lixit bottle to reduce the chances of his inhaling food into his lungs. I received him at 4 months. The breeder adored him and gave him to me, knowing I was experienced with tiny yorkies and would do all I could to keep him alive. He was a little over a pound then, quite weak, with a huge head on a tiny body. His face looked almost flat and he had a miniscule nose that was prone to congestion.

I kept up the same feeding instructions and also had him on daily azithromycin to not let infections take hold. He did have one bout of pneumonia and ongoing sinus infections, evident by greenish nasal discharge. I suctioned his nose daily with a baby bulb syringe, and by 8 months, he had no discharge from his nose and no longer needed suctioning. He had grown to be quite a strong little boy, despite his size and condition.

You might wonder why we would still opt to close his palate, even though he had done so well without a repair. The problem is, he still got into major trouble. There were numerous times when he accidentally ate or chewed something he found on the floor--a napkin, a felt chair leg pad, a piece of plastic liner he tore from his wee-wee pad, a tiny safety pin. Those things went into the cleft and nasal area and got stuck, causing choking and panic, with liquid foaming from his nose. If we had not been there to dislodge things, he could have died. Pneumonia was also a possibility, as were sinus infections.

So he survived with us gnawing our knuckles. The surgeons at UC Davis --which has an oral surgery department--were surprised that he was that vigorous, considering the size of his cleft and that he had not been on a feeding tube the whole time. So we also knew we were lucky. I think they are always happy to have a case like his: an older puppy, a major cleft, and no prior attempt to correct it, which often leads to a botched job and complications that are more difficult to repair than if nothing had been done.
Since they are a teaching hospital and have vet students rotating through their department, it affords the students a chance to see this sort of medical problem not often seen in a regular vet practice. Cleft palates are something the surgeons at UC Davis handle routinely. On one visit, I saw a cocker spaniel puppy in the examining room with a cleft that went from his nose and through his hard palate.

There was an initial surgery to remove baby teeth, as well as permanent molars on his left side. That cleared area would later allow them to take more tissue from that side once he was ready for surgery. After the extractions, he was eating, playing, and running around as soon as the anesthesia wore off.

The second surgery a month later was more elaborate. The oral surgeons were able to do the repair in a single surgery and not in stages, which is sometimes necessary with a full midline cleft. But it was more difficult than they anticipated because they discovered when surgery began that there was little bone under the tissue at the upper end of the hard palate.

The procedure involved slicing away the tissue on the the left hand side of the palate--where the molars had been removed--but leaving it attached at the center so that it created flap that could be laid over the cleft and placed against his molars on the right side. The flap was stitched in place along the molars and also through the midline, from the hard palate and through the soft. I saw the post-surgery photos and the left side was exposed bone. That was how much tissue was removed.

The surgery took about 3 hours. He did well under anesthesia, with no blood sugar drops, no swelling and not a lot of bleeding. They used pressure with fingers to stop bleeding and did not cauterize, which can cause swelling--not good in a little airway. There was some blood-tinged discharge from his nose for two days, but it is just a drip here and there every couple of hours and was easy to daub clean with a cotton ball.

The oral surgeons were able to save a tiny artery on the side they sliced away to create the flap. That took extra precision--pretty impressive. I saw the photos. That enabled a better heal. He was put on tramadol for pain, clavamox for possible infection. I was supposed to do an oral rinse with something quite thick and sticky, but he bucked so hard I was afraid to puncture his newly repaired palate with the plastic nozzle. I wound up dripping water from a bottle spout. The water was mixed with Oxyfresh, which is tasteless and has antibacterial properties and like the other rinse, is fine for open wounds in the oral area. I rubbed oxyfresh gel around his gums. That had aloe vera in it and was soothing, I think, because he allowed me to do that. He was reluctant to eat for a couple of days. He did gingerly eat his softened kibble, swallowing it in one gulp when I held it above his nose with his head tilted back.

I had to remove all toys and board out his sister at a friend's house, because she was picking fights with him around food, and he would try to fight back with barking and lunging. I did not want him to do any kind of barking that would stress his palate.

The surgeons told me that the first five days were critical. If the repair held, the chances of it holding permanently were good. Today is the 5th day. When he screamed at me this morning as I started to give him his tramadol, I could see the palate was nice and pink. The bone no longer shows. There are no loose threads or frayed tissue, which is what I was supposed to look for as problems. He does still sound congested, and he snores heavily when asleep. The oral surgeon called to get an update. And my description of his condition sounded normal to him. We'll have a check-up at UC Davis in a couple of weeks, and they may need to anesthesize him to see more thoroughly.

Even though his palate is closed by the flap , we will always have to be careful about toys and hard food like greenies or bones. Because there is no bone at the midline and never will be, the tissue closing off the oral and nasal cavities can be punctured. Also, the repair does not guarantee "functionality." Meaning, although the soft palate is closed off, food and liquid can still travel up into his airway and into his lungs. I do think, however, that he will learn to swallow in a way that will not allow that to happen. It is what he learned to do when his cleft was open.

The cost was MUCH lower than I had anticipated. $1500 for examinations, tests, prep, anesthesia, a 3+ hour surgery by two oral surgeons, anesthesiologist, nurse assistants, two nights of 24 hour care by a senior vet student, in addition to all meds. The dental extractions were about $1200. So altogether it was $2700. Amazing. I had expected to pay at least $5000 for the flap surgery alone, and more if there were complications. Then again, we are not yet out of the woods.

With great hopes, we're on our way to a better life for him. Wish us luck!