General information regarding all cleft surgery

Please find general advice for both adults and children having surgery under the care of the cleft team.

Smoking, vaping and recreational drug use

Smoking is not advised and patients who smoke will need to refrain from smoking, vaping and other substance misuse, before being listed for surgery.

Smoking can seriously affect the outcome of Cleft surgery and increases the risk of infection post- surgery. Smoking also has a potential to impact on the anaesthetic and therefore patients will not be listed for surgery, unless they have abstained from smoking for at least 3 months. You may be required to undertake testing for Nicotine use.

Parents who smoke will also be asked to consider their Nicotine use, as this can also impact of their child’s recovery from surgery, increase respiratory issues post operatively and increases the risk of respiratory disease such as Asthma, COPD, and lung disease in later life.

Advice and support on giving up smoking, vaping and drug misuse can be found by calling the free National Smokefree Helpline on 0300 123 1044

Smoking cessation services via your local GP or Pharmacy

For additional support with Drug and alcohol services – please see your GP who will be able to refer you for additional support. For information please see the below:

NHS Livewell - addiction support (opens in a new tab)

Turning Point (opens in a new tab)

Mind Charity (opens in a new tab)

Talk to Frank (opens in a new tab)

Please feel free to discuss with one of our Clinical Psychologists or one of our Clinical Nurse Specialist if you need support with accessing services on 01223 596272 – We are always happy to help!

Fitness for surgery

Babies, Children and adults having surgery all need to be well for 6 weeks prior to their surgery date

This is to optimise the healing process, and reduce complications post operatively.

Parents and other household members also ideally need to be well.

However should any household member become positive to Covid, regardless of whether the child / adult is affected, surgery will need to be postponed for 6 weeks in line with Our Trust policy!

Again this is to ensure optimal healing at the time of surgery and reduce the potential for infection.

If you as an adult patient or the child undergoing surgery develop any symptoms of a cold, cough temperature etc. or any other illness including tummy bugs and other childhood illnesses, in the lead up to your surgery date, you should contact the Clinical Nurse Specialist on 01223 596272 as soon as possible who will advise – we may need to re-schedule and swap patients around to avoid delays in re-booking.

If you are deemed unwell on the day of surgery, surgery will be cancelled and rescheduled.

Please let us know as soon as possible so that we can minimise delays, optimise our lists and ensure patient safety and wellbeing.

Vaccinations

We encourage children to receive their normal childhood immunisations as expected.

Often children will develop a slight temperature following vaccination and this is to be expected and can be treated with Calpol (Please follow the recommendations from your health care provider and as per the instruction on the bottle). To ensure that this does not mask other symptoms of a cough, cold etc., we would advise that vaccinations are not administered in the 2 weeks before surgery.

Flu vaccines which are administered nasally are safe to use for children with a cleft lip and / or Palate.

If you need further advice please discuss with your Clinical Nurse Specialist.

Pain management

Managing your pain or your child’s pain is an important part of the healing process. Good pain management will enable the patient to be able to eat and drink. A Good diet is essential to optimise healing. Research shows that pain management is a key element in post op recovery.

Please ensure you have sufficient supply at home to manage your pain and discomfort!

For Children

Calpol/soluble paracetamol should be given regularly for the first week post-surgery, every 6 hours (no more than 4 doses in a 24 hour period)

Liquid Ibuprofen should be given every 8 hours ideally with food (no more than 3 times in 24 hours)

It may necessitate waking your child at night to maintain optimum pain control for the first few days

Please speak to the clinical nurse specialist if you need support 01223 596272 option 1

Adults

Paracetamol no more than 4 times a day (Every 6 Hours) and Ibuprofen 3 times a day (every 8 hours) can be taken according to the instructions on the packet. Soluble options are available and can be purchased over the counter from your pharmacy. Stronger analgesia can also be taken.

Some stronger pain relief medication may contains paracetamol, and therefore you should not take additional paracetamol with these types of medication - Please read the instructions carefully and seek advice from the GP, pharmacist or your Clinical nurse specialist for further advice if you are unsure.

Please do not exceed the recommended daily dose advised for each medication!

If you believe you have taken more than the recommended daily dose – please seek immediate medical attention!

School / college / university and work attendance

We advise that children and Young people stay away from school for 2 weeks post-surgery – this is to prevent the risk of developing secondary infections, cough colds and viral infections which could affect the healing process.

If you are an adult and having Rhinoplasty or Septorhinoplasty surgery you will need to be away from school/college/university/work for longer – please discuss with your surgeon or the clinical nurse specialist. Sick certificates can be provided by the GP, and we can provide letters for educational and work place environments.

Going on holiday following cleft surgery

Here at Cleft Net East we advise that you do not travel abroad for 4-6 weeks post-surgery. This would include Lip and palate repair for children, bone grafting, buccal flaps and Hynes pharyngoplasties (fat patch to the back of the mouth), and re-repairs

Adults having lip revisions, palate revisions, Rhinoplasties and septorhinoplasties or secondary speech surgery should also not fly for 4-6 weeks.

This is largely due to the inability of many countries, not being able to provide specialist cleft services to support post op management, should you require medical attention.

If you are travelling abroad please be mindful that you may not be entitled to any medical treatment without incurring a cost, and some medical insurances may not include costs for any treatment following cleft surgery in the UK – Please check with your insurance provider before travelling.

Swimming

We recommend that you do not swim (use a public swimming pool) for 4-6 weeks following any cleft surgery – this is to reduce the risk of infection.

Sport and social activity

Normal sporting activity can be resumed after 2 weeks, except for those patients having rhinoplasties or septorhinoplasties.

The nose will be very fragile and as such you should refrain from any contact sports, sports where there is an increased risk of facial injury, dancing, and environments where there is a risk of being bumped into E.g. Busy night clubs and pubs.

Further information

If there is anything else you wish to ask in relation to your surgery please contact the Clinical Nurse Specialist for Cleft lip and Palate on 01223 596272 option 1 who will be happy to answer your questions and / or signpost you to the relevant clinician for further support.

Your feedback is welcomed and important to us. If you would like to suggest additions to this information please feel free to contact us on 01223 596272 or email us.