Open Cleft Septorhinoplasty Experience - 30th July 2007

Children and adults with cleft lip and/or palate issues

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Open Cleft Septorhinoplasty Experience - 30th July 2007

Postby liv.j.smith » Tue Aug 07, 2007 3:41 pm

Hi guys,

I thought it was time I wrote my experience up like last time with the jaw op! I had an open cleft septorhinoplasty on 30th July. It was done on the NHS at Addenbrookes hospital by Dr Ahmed. I was going to also have further lip repair done in January, but as it turns out, they did it all in one go, so hopefully no more ops for me!

THE AIMS OF THE OPEN CLEFT SEPTORHINOPLASTY:
1. Remove the 'hump' in my nose
2. Make the nostrils more symmetrical
3. Make the tip of the nose thinner
4. Make the septum straighter (my jaw op had caused the tip of my nose to be slightly bent)

This would 'open' surgery in that it would be done by making a small cut under the nose in the crease and lifting the skin upwards, (the surgery was too complex to do 'closed' (through the nostril)). I was told this would leave a small scar under my nose, but it wouldn't really be noticeable because it's done on the crease.

THE AIMS OF LIP REPAIR:
1. Redo lip scar to make it thinner and less noticeable (if you looked closely at my scar before surgery, it looked like cross hatching)
2. Make more of a pout (post jaw-op surgery, my profile was really good, but my top lip was still a little further back than my bottom lip)

For the latter, I was told that the surgeon would lift the top lip up, and make 'V' cuts in the lip underneath, and lift these cuts up ('^') so that when they healed, my top lip would be more of a pout).

PRE-OP:
I went to a pre-op appointment about a week before the surgery, where they did swabs of my nose and throat to see if I was healthy. (As it turned out, I did have some bacteria, but this didn't stop the operation from going ahead - they just told me that I would be given anti-biotics before and after surgery). They also asked me questions regarding my health and I had to sign a consent form for the anaethatist. I was admitted into hospital the day before my surgery where I was visited by the anaethatist, surgeon and nurses separately, who explained what they would be doing, and they answered any questions and worries that I had. They also give you your hospital bracelets with your details/allergies etc. It's standard procedure for them to check all patients for MRSA as well, so I had swabs taken on the day of my arrival to check whether I was a carrier. I went down to theatre at about 2pm the next day and was put to sleep fairly quickly.

POST-OP:

I woke up in recovery about 8.30pm (the op lasted about 5 hours plus recovery)...the nurse looking after me asked me to sit up slightly so she could adjust my sheet, but this made me vomit up blood twice. Obviously it wasn't a very nice experience, but that's what usually happens when you're put on a general anaesthetic. Plus you're stomach can't handle blood in it, so if any blood trickles down your throat, you probably will be the same! I felt tons better once I had been sick though. I was then wheeled back to my ward (I fell asleep on the way) and woke to see my mum and dad. I generally felt extremely tired when I woke, but I managed to open up my cards that I'd received. Like last time, I didn't realise that I had an oxygen mask on because my face was really numb, but I didn't really need it once I was fully awake. There was no pain though, just extreme discomfort because my nose was TOTALLY blocked.

Appearance from 30th July-1st August:
I was swollen and had a big plaster which went from the bottom of my forehead, down to the sides of my nose. I also had some gauze rolled up and taped under my nostrils to catch any blood. This gauze got changed when it got uncomfortable, but the day after my op, I kept asking the new nurses to change it again because it was feeling wet against my face (I must have asked about 5 times - each time they said they would, but never did). It wasn't oozing blood on my face or anything, but it was wet from the seeping. It was one of the most uncomfortable things and it was quite distressing when the nurses decided (after continually telling me they WOULD change it) that actually they wouldn't because they wanted to blood to clot. So I had to put up with it! I also had a line cut and stitching where my lip scar is (which at this point I couldn't see because of the gauze), and my top lip was swollen.

Breathing:
Before my op, I never really thought I breathed through my nose much anyway, but I found it really uncomfortable. You have no choice but to breathe through your mouth. This means that you're throat is so dry - my tongue literally felt like cardboard at times.

Pain:
There was no pain at all until the splints were removed two days after the surgery - you're constantly supplied with drugs (first intravenous, and then when you're a bit stronger, tablets). The splints are inside your nostrils, and the best way I can describe them is like tampons! They pulled them out one at a time, and it was horrible. The worst feeling - it was as if thick rope was being pulled from right down from my eyes, under my nose - ugh. It was very painful, but once they were out, the pain went - so it's not too bad.

Energy:
I was so tired for the days I was in hospital, I mainly slept. There's not really much more to say on that! I came home on the 1st and slept the rest of the day. The next day I had a few naps, but since I haven't needed to!

Speech:
My speech itself was strong from the moment I woke, even if it was nasally. It's like having a really awful cold for a while, so I was really pleased as my speech was one of my main worries last time. It's now the 4th of August (6 days since I woke up in surgery) and my speech is still nasally, but I'm still blocked up, so that's no surprise. When my nose clears up, my speech should too. To be honest, I was far too tired to make much effort to speak, so it was usually one word answers!

Hearing:
My hearing was fine - the only thing was that every now and then, it felt like I'd got some more of hearing back (like when you get off a plane), but I could hear everything all the time.

Sight:
I normally wear glasses/contact lenses, but you can't wear glasses when you've had this op as they can't sit on the bridge of your nose. I read somewhere that you could tape them to your forehead, but I didn't bother, and I probably would have felt like an idiot! There wasn't much point in me putting in my contact lenses either - I usually fell asleep every now and then, so when I was awake, I had the PatientLine TV up close to me, and made do with half vision! If I was in Bupa though (where the TV is far away) I probably would have used contacts, but you'd have to make sure that you took them out when you go for a nap as it's not a good idea to fall asleep with them in! I put my contacts in the day after I came home, and am wearing them most of the day.

Braces:
As I'd had lip repair done as well - my top lip was swollen, so putting in my retainers has been a no no! I rang the orthodontist yesterday as I was a bit worried that they wouldn't fit (haven't worn them since my op) and they told me that they probably wouldn't have moved much. I took the risk to try them though, and they fitted alright, so that's not a problem anymore. I'm still not going to wear them for a few days now because I found that they made me salivate loads more, and it was just too uncomfortable. Mind you, I only have to wear my retainers at night (I've had them a while), so my teeth were less likely to move again anyway - it might be different if you're fairly new to having them, especially if you're still on the day and night routine of wearing them.

Teeth:
I'm finding it really hard to brush my top front teeth because of my swollen top lip - so I've been using a mouthwash as well. (Ask the hospital, they'll give you a bottle for free).

Food and drink:
Drinking was hard. When you swallow, it's almost like you're blocking your nose even more! But you have to drink because the dryness in the mouth is awful!
As for food - I found it really difficult because of my lip. I couldn't bite into food because my lip was swollen against my teeth. It's easier now, but for the first few days, I was basically tipping food into my mouth! Now I can bite, but I'm careful to cut things up smaller and take my time. My hunger levels have dropped - for the first few days it was just really tiring to eat, so I couldn't be bothered to waste the energy!

Sickness:
As I mentioned, when I woke up I was sick twice. This happened again on the 31st in the night, but as soon as I was sick, I felt loads better. When I came home on the 1st, I ate some chips (took me like an hour) and then was sick. It obviously wasn't very nice again, but I think it got the last of the general anaesthetic up and I haven't been sick since!

Bleeding:
Since the gauze came off 3 days after my op, my nose has been bleeding and oozing. It's not been like gushing or anything like that. But it does need frequent dabbing (blowing isn't allowed) and can be quite annoying!

Other things to add:
1. I was sent home with 5 lots of tablets to take for 4 days
2. Stitches are dissolvable
3. By keeping the head elavated as much as possible, you can reduce the swelling
4. You can't get the plaster wet, so be careful when washing your hair/having a shower

Appearance from 1st August - 4th August:
Slight bruising came out on my eyes the day after I came home, it's now gone from a bright green to a lovely yellow. The swelling is getting better as well. My nostrils look the same size, and the tip looks smaller, so as far as I can tell, it's looking good! Obviously I'll be able to see more when plaster is taken off early next week.

So to sum up...SO FAR SO GOOD.

Hope this has helped, sorry if I've gone on and on! xx
liv.j.smith
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