What to expect after surgery:
o Our goal is to open the airway enough so that your baby can breathe easier and sometimes feed easier.
o We are trying to avoid having to perform a surgical airway (tracheotomy) on the front of your baby’s neck.
o Your baby will have small incisions on each side of the neck. A small metal arm will stick out through a small hole in the skin. This metal arm is part of the distractor device that we will be turning every day to help grow new bone and move the lower jaw forward.
o We start turning the device on the day after surgery.
o As we turn the device it will look like your baby’s chin is growing or getting bigger. This is a good thing, because it means that we are moving the base of the tongue forward too.
o We will turn the device for 2-4 weeks. After the device is turned all the way we will remove the metal arms that are exiting through the skin.
o Swelling will increase for 2-3 days before it starts to go down.
o Elbow restrains (No No’s) need to be on your baby’s arms unless they are swaddled. We want to be careful that your baby doesn’t reach up and pull on the metal arms. The No no’s need to be worn for 1-2 weeks after surgery.
Diet:
o We will keep the feeding tube in the nose after surgery. It will stay in until your baby can begin feeding.
o After the breathing tube is removed, the Speech Language Pathologist and Lactation Specialists will work with you and your baby and begin bottle feeds and breastfeeding.
o The distractor device is helping move the base of the tongue forwards; it can be challenging for the baby to feed and your baby will need some time to adapt to the new position of the tongue.
Wound Care:
o The site where the distractor arm exits the skin will be kept clean with q-tips with sterile water and Dakin’s Solution Quarter Strength. A small amount of bacitracin is applied for 3 days. A small yellow gauze dressing is also wrapped around the arm.
o The incision site needs to be kept clean. It can be cleaned gently with a gentle wash cloth and patted dry.
o A small amount of bacitracin will be applied twice daily for 3 days; after 3 days a small amount of Vaseline is applied twice daily.
o After 3 weeks, if everything is healing well, you can use Vitamin E oil and cream and massage the area gently to help soften the scar.
Antibiotics:
o Your baby will be on antibiotics while they are in the hospital.
o If the metal arms are still exiting the skin when you go home, you will go home with antibiotics, as well.
o Antibiotics MUST be taken as prescribed. If your baby develops a rash or other side effects, stop the antibiotic and contact our office.
Bleeding/Bruising:
o Some oozing of blood is expected after surgery. The oozing may persist for up to 24 hours.
o Sometime there is bruising on the side of the neck and jaw.
Pain Management:
o We put long-acting numbing medicine in the area of the surgery that lasts 5-6 hours.
o Some discomfort is expected after surgery. The goal is to minimize the discomfort so that it is tolerable. It is unrealistic to expect zero pain after surgery, but we will work with you to minimize the discomfort as much as possible.
o There is some mild discomfort when the distraction device is activated. Usually, your baby will calm down after just a few minutes.
o Usually, your baby will only need over the counter children’s Tylenol.
o On occasion a stronger pain medication is given.
o Never exceed the maximum daily dose that is described in the over-the-counter instructions.
Swelling/Bruising:
o Swelling is normal after surgery. It is normal for swelling to increase for the first 2-3 days after surgery and then reach its peak and start to lessen.
o Sometimes there is bruising that can take days to weeks to resolve.
Sutures:
o Resorbable sutures placed at the surgical site will dissolve/resorb on their own after about 7-14 days. Some stitches need to be removed in the clinic if they aren’t dissolving quickly enough.
o Non-resorbable sutures will be removed about 5-7 days after surgery.