Swelling of the lip and cheek region is expected after cleft repair. The swelling is greater on the side of the cleft. Swelling may even cause puffiness of the eye on the cleft side. The facial swelling will start to decrease after 3 days. An ice pack should be applied to the cheek(s) region during the first 48 hours after surgery. In addition, the head should be elevated on 2 pillows to help minimize swelling during the first 3 nights and during naps.
Your child will experience pain both from the cleft surgery and the iliac crest bone graft donor site. The iliac crest site is generally more uncomfortable than the cleft site. Children respond well to ibuprofen (Children’s Advil, for example). Follow the directions on the bottle for dosing information. For pain that does not respond to ibuprofen, you may use the prescription pain medication as directed on the bottle.
A small amount of bloody ooze from the mouth and/or nostril is common. Please contact me if your child experiences a sustained nose bleed that has not stopped after 10 minutes. There is a dressing on the iliac crest donor site. You may notice a small patch of blood on the dressing-this is to be expected and should cause no concern. Please contact me if the dressing becomes saturated with blood.
Only clear liquids will be offered on the evening following surgery. The diet may be advanced to full liquids on the day following surgery. Do not use a straw for 3 weeks after surgery. After returning home, and for the first 2 weeks after surgery, the diet is restricted to very soft foods that do not require chewing. Foods the consistency of mashed potatoes is appropriate during this time. Your child should not bite off solid food with the front teeth until 3 weeks after surgery.
There are sutures in the mouth. Some of these sutures will dissolve, but a couple will need to be removed approximately 10-14 days after surgery. The iliac crest donor site only has sutures under the skin. Steri-strips are in place to hold the skin edges together during healing. The steri-strips will fall off after 2-3 weeks.
The iliac donor site must be kept dry for 10 days. After 10 days your child may shower but no tub baths, swimming pools, ocean or lake swimming until 3 weeks after surgery.
Good oral hygiene is very important for adequate healing and preventing infection. Careful, supervised tooth brushing should be started on the day after surgery. The brush should only make contact with the teeth in the area of the cleft. Do not brush the sutures. You should begin brushing your childs teeth the day following surgery and after each meal. A child’s soft toothbrush can be utilized for this purpose, paying particular attention to keeping the brush in direct contact with the teeth. It is very important to keep you mouth clean as the wounds are healing. You will take home a bottle of Chlorhexidine mouth rinse from the hospital. Rinse with warm salt water (1/2 teaspoon of salt in a cup of warm water) six times a day. Continue this procedure until healing is complete. Do not use a water-pik for 2 weeks after surgery.
REMEMBER: A clean wound heals better and faster.
There is a dressing covering the iliac crest donor site that will be removed at the first clinic visit after surgery. The dressing must not get wet. If the dressing does get wet it should be removed. Do not remove the steri-strips under the dressing, even if they are wet.
Be sure to take the prescribed antibiotics as directed to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction and notify our office. Otherwise, please finish your entire course of antibiotic. Antibiotics can sometimes cause an upset stomach. If this is the case, it is advisable to take acidophilus or pro-biotic tablets along with your antibiotic. Call our office if you have any questions.
Women taking oral contraceptives: Antibiotics that you have received for your surgery may make your oral contraceptive less effective. You should use an alternate form of birth control until your normal menstrual cycle
Your child is not to use a straw for 3 weeks after surgery. No nose blowing for 3 weeks after surgery. Your child may walk with assistance the evening of surgery. No running, jumping, rough-housing, bicycles, skateboards, trampolines, sports, or PE at school for 6 weeks after surgery.
It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have any questions or concerns about your progress please call the office . We are available 24 hours a day. If your child develops a fever (>100.4), bleeding, nausea, or if swelling in the mouth prevents fluid intake, please contact our office any time of the day or night.
Thank you for trusting us with your oral and maxillofacial surgery needs.
Reproduced with permission by: Samuel J. McKenna, D.D.S., M.D., F.A.C.S
Any other use or duplication of this material by any other party requires the prior written approval of Samuel J. McKenna.