title: How Prepared is Prepared Enough?
abstract: A 17-year-old female was in the final stage in treatment of right unilateral cleft lip and palate. She had undergone a number of previous surgeries. Hearing and speech were good on evaluation, and her social and family situation were deemed excellent. After preparatory orthodontics she underwent a Lefort I maxillary advancement. Surgery was successful and she was admitted into postoperative recovery. However, the lack of adequate preoperative preparation caused traumatic reaction from the patient and her parents: anxiety over appearance, crying, refusal of oral fluids and oral care, refusal of analgesia, and refusal to mobilize. The patience and persistence of hospital staff slowly overcame all adversities and the patient moved on to full and successful recovery, but this case prompted changes in preoperative procedures and involvement of patients and their families in postoperative meal selection, planing, and preparation.
authors.affiliation: Pediatric Psychologist, Advanced Surgical Institute, Center for Children at Medical City Dallas, 7777 Forest Lane, Dallas, TX 75230, USA.
authors.initials: S
authors.lastname: Porter-Levy
authors.initials: L
authors.lastname: Macleod
authors.initials: VI
authors.lastname: Rickert