Evaluating the Safety Profile of Early Tongue Stitch Removal After Primary Palatoplasty

This study describes a protocol for tongue stitch (TS) removal following primary palatoplasty and evaluates its safety and impact on the perioperative hospitalization. A retrospective review was performed on all patients with cleft palate cared for between 2019 and 2022 at a single academic institution. Seventy-eight patients who underwent primary palate repair before 24 months of age with postoperative TS placement were included. A TS was placed in any patient undergoing palatoplasty for the indications discussed. The suture was removed in the postanesthesia care unit (PACU) if the patient met specific safety criteria. Collected data included demographics, cleft classification, operative metrics, and postoperative outcomes. Of 78 patients included, 85.9% were deemed appropriate for PACU TS removal by our protocol. No patients required reintubation, and there were no mortalities or major morbidities. Of note, patients with PACU TS removal had a faster time to feed [9.1 versus 15.4 hours ( P =0.01)], reduced morphine equivalent use [3.4 mg vs. 6 mg ( P =0.051)], and shorter hospital length of stay [1.6 days vs. 2.0 days ( P =0.22)]. Our proposed protocol for PACU TS removal demonstrates a safe protocol and, based on our results, does not lead to an increase in airway complications. In addition, we demonstrated that earlier TS removal leads to improved early postoperative patient outcomes, including decreasing time to feed and narcotic usage for pain.