Cleft Lip and Palate

Following these instructions and the instructions the nurses have given to you will result in fewer complications and make your recovery period easier. Failure to follow these instructions could result in unnecessary pain, delay in healing or complications which could negatively affect the outcome of your treatment.

When a bone graft is placed, a period of 6-to 8-weeks is usually required for initial bone healing.

WHAT YOU NEED FOR HOME 

1. Syringe (will be given to you) for rinsing.
2. Saline (to make your own: dissolve 1 teaspoon of salt in an 8 ounce glass of warm water).
3. Child size toothbrush/WaterPik™
4. Vaseline or lip balm
5. Blender or food processor (optional)

MEDICATION/PRESCRIPTION

A prescription for medication may be provided at the time of your discharge. Please take the medication as prescribed until it is finished.

You may be sent home with a prescription for a pain reliever. This can be administered through a syringe as you have been shown, or sipped from a spoon. If your pain reliever is in pill form you can crush it and mix it with 10 to 20 ml of water or juice to be sipped or administered through a syringe.

You may also be given a prescription for an antibiotic to prevent infection. It is important to take this medication as prescribed until it is finished. You may also be given a prescription for an antibiotic rinse. It is very important to keep your mouth clean.

 An increase in swelling and pain after the first week could indicate an infection, which may require treatment. Should this happen to you, contact your doctor.

CARE OF THE OPERATIVE AREA

Swelling: For the first 48 hours after surgery you will be given ice packs which will help to minimize swelling. Following this period you will need to use heat (hot, wet face cloth, hot water bottle, heating pad or microwaveable pack) to help reduce the remaining bruising and swelling. As it takes about 2 weeks for the majority of the swelling to disappear, continue to use heat for 30 to 45 minutes, 4 to 5 times a day for at least 1-to 2-weeks after you are discharged from hospital. A few minutes of gentle massage while using the heat also helps.

You may experience “rebound” or increased swelling 4 to 5 days after surgery due to the decreasing levels of steroid medication in the blood. This swelling usually starts to resolve in 2 or 3 days.

Bleeding: Prolonged bleeding such as nosebleeds or bleeding from the incision sites following discharge from hospital is not normal and you should contact your doctor if this occurs.

Bruising: Bruising is normal. Gravity may cause discoloration (usually a light yellow or green) to extend down to the neck and occasionally onto the chest. This will generally resolve in 2 to 3 weeks.  

CARE OF THE NOSE AND SINUSES

Avoid blowing your nose for 6 weeks if you had a bone graft to your cleft upper jaw. Some patients may experience nasal stuffiness and sinus congestion. Nasal congestion may create a feeling of not being able to breathe. If this occurs you should stay calm and breathe through your mouth. An air humidifier and propping yourself up on a pillow at night will facilitate breathing. Please do not use any nasal sprays.

Sore throat:For the first couple of days following surgery you may experience a sore throat and some nasal congestion. This is normal after anaesthesia and should  go away within a couple of days. Drinking plenty of liquids usually helps with the throat tenderness.

Lip care: Cracking of the corners of the mouth does sometimes occur following surgery. Apply Vaseline or lip balm regularly to keep these areas from becoming too dry or chapped.

Oral hygiene/Mouth care: It is important to remember to clean your teeth and rinse your mouth routinely following surgery. A prescription for antibiotic rinse will be given to you. Please follow the instructions indicated on the bottle. It is important to rinse your mouth with 10 to 15 ml of solution frequently (every 4 hours) as well as after meals. A Water-Pik™ is an excellent aid, but do not spray the solution directly into the incision site as this may result in the incision opening. You can start brushing your teeth as soon as it is not too painful (usually 48 hours following surgery). Use a child toothbrush to clean the teeth, but do not touch the gums. You must do this as thoroughly as possible. All stitches in your mouth dissolve over time.

HIP CARE 

When bone is taken from your hip you usually have moderate discomfort (muscle pain and tenderness with decreased mobility) in that area for the first 2 weeks. Mild discomfort may last anywhere from 6-to 12-weeks. Swelling at the hip site usually starts to resolve after 2 to 3 days and the majority of the swelling is gone after 2 to 3 weeks. A pressure dressing will remain on your hip for the first 48 hours. After that time period a lighter dressing and possibly Steri-strips (small band-aids) will be placed. The incision on your hip may be closed with dissolvable stitches or staples. If staples are placed you will require a 7 to 10 day follow-up appointment after your discharge from hospital for staple removal.

Limit your activities for the first 6 weeks following the removal of bone from your hip. If swelling recurs, pain increases, abdominal pain occurs, difficulties or pain with bowel movements occur following your discharge from hospital, please call your doctor.

 Following bone removal from the hip, do not soak in a tub (i.e. bath) for 2 weeks. Please have showers only and make sure to cover the incision site with band-aids or tape. After 2 weeks you can have a bath and the tape will lift off your hip easily when wet.

DIET 

Since you had surgery on your cleft lip and/or palate, you will require what is called a balanced fluid diet (Blenderized). It is essential that your body receive adequate fluids and nourishment in order to maintain your nutritional status and promote healing.

You will be limited to a strictly liquid diet for 3 weeks. During this period, you will become creative with your menu choices. It is especially important to drink adequate amounts of fluids, 2 to 4 litres per day. You can purchase liquid nutritional supplements (such as Ensure™ or Boost™) in a grocery store or a drug store.

You can use a syringe for feeding or a spoon. Do not use a straw for eating or drinking as it may irritate the surgery site through contact or negative pressure. A nutritious dietary intake is important in promoting healing and decreasing the possibility of infection. Following the 3-week liquid diet you can proceed to a soft diet (eggs, potatoes, fish, pasta, etc.).

 If you had a bilateral cleft bone graft, do not chew with the premaxilla or front teeth for a period of 6 weeks.

 Here are some tips to creating a personal menu:

• You may eat anything that can be thinned into liquid form. Meals may be blenderized until smooth. If food is still lumpy, use a strainer.
• Cold whole milk can be used to thin puddings, yogurt, cereal, sandwiches, ice cream and cakes.
• Warm whole milk can be used to thin cheese, eggs, toast, hot cereal, muffins, pasta, hot main dishes and casseroles.
• Vegetable/tomato juice can be used to thin meats and vegetables.
• Fruit juice can be used to thin fruit, yogurt and ice cream.

 It is important to eat a variety of foods and to take into consideration Canada’s Food Guide when choosing meals. Weight loss is a common result of a liquid diet. If you are experiencing weight loss, try snacking between meals and adding whole milk cheese or skim milk powder to meals to boost caloric intake.

 Constipation may result from the low fibre content in liquid diets or may be a side effect of some pain medications. To avoid this, try to include a lot of fruit and vegetables in your diet and add prune juice to your daily menu.

 Alcohol and smoking can delay wound healing and promote infection. Alcohol and smoking should be avoided until your surgical sites are completely healed (approximately 12 weeks).

NAUSEA: Avoid alcohol or foods that may cause your stomach to become upset. Should you experience nausea, you can use “over the counter” Gravol™ (liquid or suppository) as directed on the bottle. If the nausea persists please contact your doctor.

WARNING SIGNS OF COMPLICATIONS 

The Following symptoms may be a sign of infection or other complications; therefore, you should follow up immediately with your doctor if they occur.

• Redness
• Increased swelling
• Increased or excessive pain
• Foul odor from the mouth
• Fever and/or chills
• Bleeding inside of the mouth (wires may need to be adjusted)
• Bone pieces coming out of the incision site

PHYSICAL ACTIVITY

Physical activity should be kept to a minimum for at least 6 to 12 weeks after surgery. It is very important that you realize that you just had a significant operation that requires a well rested recovery period. Excessive activity (running, exercising, swimming, heavy lifting, house cleaning, contact sports, going up and down stairs quickly, etc.) can cause bleeding, muscle pain and /or dizziness. Excessive fatigue can also slow the healing process as well as increase the chance of infection by reducing your resistance. A gradual increase back to normal activity is the most sensible approach. Contact or other sports where direct physical contact or injury are possible should be avoided for 2-to 3-months to minimize the risk of trauma to your jaw surgery site. If you have any specific activities you wish to perform following your surgery, please discuss this with your doctor.

FOLLOW-UP WITH YOUR DOCTOR 

A follow-up appointment should be arranged with your Doctor’s office prior to discharge. If an appointment has not been made, please call your Doctor’s office during regular business hours to arrange a follow-up appointment.

 If you have any questions or problems, do not hesitate to call our office at Edmonton Office Phone Number 780-454-6565 or 1-800-379-9474. If your call is not answered by the answering service, hang up and call again in five minutes. We apologize for this inconvenience as the lines may be occupied by other callers. There is an Oral and Maxillofacial Surgeon on-call ALL HOURS OF THE DAY.

WE PREFER THAT YOU CALL OUR OFFICE FIRST RATHER THAN YOUR OWN DENTIST OR FAMILY DOCTOR. However, if you are experiencing severe bleeding or breathing problems requiring IMMEDIATE ATTENTION, please proceed to the nearest Emergency Department or Dial 911.