Grand Valley ENT & Facial Plastic Surgeons

• NO VITAMIN E (Except in a daily multivitamin)
• Please do not take any of the following HERBAL SUPPLEMENTS: Ginkgo Biloba, Ginger, Ginseng, Garlic, St, John's Wart, Willow Bark or Fish Oil. (This does not apply to seasoning in foods.) Also please stop any homeopathic or dietary supplements.
• No alcohol, no smoking or nicotine products, if possible. This will help to reduce the amount of post-operative swelling and will increase your body's ability to heal after surgery.
• Tylenol (acetaminophen) is allowed pre-op for pain and/or fever. DO NOT take any aspirin or ibuprofen products as this can prolong your bleeding time.

• If you are taking Coumadin, Plavix, or other blood thinners, please let the nurse know at the time of your pre-operative interview. Please also let the nurse known if you suspect you could be pregnant.
• Please contact our office at 970-644-3800 if you have any questions prior to surgery.

• If you or your child receive a prescription for numbing lollipops (tetracaine) these are ONLY available at Western Colorado Compounding Pharmacy in Grand Junction. This medication is typically NOT covered by most insurances. Please contact your insurance or the pharmacy to verify coverage and or pricing for these prescriptions. Please be advised that all prescriptions will be given day of surgery except for the tetracaine lollipops which will be electronically sent over to Western Colorado Compounding Pharmacy the night before your surgery. If you are taking Coumadin, Plavix, or other blood thinners, please let the nurse know at the time of your first pre-operative interview. Please also let the nurse known if you suspect you could be pregnant.
• You will receive a confirmation call from our office and from the hospital or surgery center as well with a time for surgery. Please be aware that until this call the exact time of your surgery may change and this call will provide the final time. The staff calling may have questions they would like to confirm with you at this time as well.

• DO NOT eat or drink anything after midnight, unless directed to by a member of our staff. This will ensure that your stomach is empty for safety during the procedure and will reduce nausea and/or vomiting that sometimes occur with surgery.

• Take only your heart, blood pressure and seizure medications the morning of surgery. Use the smallest sip of water needed to take your medications. Contact your primary care physician regarding insulin dosage for the morning of your surgery.
• Do not apply lotions, perfumes, powders, body oil, or make-up the day of surgery.
• Please do not wear contact lenses on the day of surgery. Leave all valuables at home or with family members. You will be required to remove ALL jewelry prior to surgery. Wear loose, comfortable clothing.
• You must arrange for someone responsible (over the age of 18) to pick you up from the hospital and remain with you for 24-48 hours after your surgery.
• Do not sign any papers or make any important decisions for 24 hours after surgery or while still taking narcotic medication, as medications may alter your judgment.

After an adenoidectomy patients can expect the following symptoms:

Sore Throat: You may have a sore throat. This is typically from the breathing tube used during the surgery, and not from the surgery itself, and will last between one to several days. You may use over-the-counter Chloraseptic spray to help relieve discomfort if needed.

Ear Pain: You may have ear pain. This pain is typically the result of referred pain from the region of the adenoids and not from infection of the ears. It will resolve as the surgical sites heal. If the ear pain persists or if there is drainage from the ears, you should contact this office.

Activity: There is no activity restriction following an adenoidectomy. Most children require more sleep over the following 24-48 hours, with most returning to normal activity the following day.

Diet: There is no diet restrictions following an adenoidectomy. Once awake from anesthesia, we encourage clear fluids (popsicles/jello) and if tolerated well, they may increase to solid food immediately.

Fever: You may have a low grade temperature. The younger the patient, the higher the temperature may be. This may be treated with Tylenol if needed and Ibuprofen if allowed by your doctor. If the temperature exceeds 102�F, you should contact this office.

Bad Breath: You will have bad breath. This will persist for about 2 weeks during healing after surgery.

Pain medication: Tylenol may be used per package dosing if needed. Ibuprofen may also be used per the package dosing for children and 200mg every 6 hours if needed for those of adult weight. These two over-the-counter medications can be alternated every 4-6 hours as needed. Typically pain is minimal following this procedure, and is only required, if at all, for the first few days.

How you will feel - You will be drowsy and tired following surgery due to the medicines we have given you to make you comfortable. Most folks wake and doze on and off during the evening after surgery. The day following surgery, you may still feel a bit tired, but resume everyday activities as soon as you can. You may move about normally without fear of disrupting your surgery. Your energy will return more rapidly if you do.

If you have nausea - Although we give anti-nausea medicines before, during and after your surgery, it's still not unusual to have some nausea following surgery. Relax, decrease your activity and don't eat any heavy foods-just try some clear liquids. All nausea should be over 8-10 hours following surgery.

Discomfort - We've given you a pain medicine to be used as directed. Take a pain pill before going to sleep the evening of surgery (preferably after you have kept something in your stomach). Take another pain pill the morning following surgery as you may feel a bit stiff and uncomfortable when you begin to move about. After two days, extra strength Tylenol should control your discomfort well. Do not use aspirin, advil or similar medicines for two weeks before and after surgery. These medicines cause bleeding and can damage your surgical result. If you have questions about a medicine, please ask us before using it.

Severe, deeply-felt pain in or behind the eyes must be communicated to your doctor at once. It may represent bleeding within the eye and may result in permanent blindness if not immediately treated.

Swelling - You may expect some swelling and discoloration around your eyes following surgery. This swelling will increase overnight. To reduce swelling, you may gently apply an ice pack to the eyes during the first 48 hours following surgery. If possible, sleep with your head elevated on two pillows. Most of your swelling should subside over 4 to 5 days. Rarely, your eyes may swell shut for the first 24 hours following surgery. If this occurs, please notify your doctor.

If you have any question call our office at 970-644-3800.
In anticipation of swelling, you may be prescribed a Medrol dose pack. Please take this medicine as directed.

Fever - Fever of up to 101oF following surgery is common. Please call us should your fever reach 102oF.

Antibiotics and Infections - You received antibiotics in your IV prior to surgery, but will need to continue taking antibiotics as prescribed after surgery. Infection after eyelid surgery is very rare, but if you notice increased redness or swelling accompanied by tenderness, fever or discharge from the eyes at any time, please call us so that we may examine you.

Visual Changes - Any visual changes, whatsoever, (blurred vision, double vision, etc.) must be reported to your doctor at once.
However after fracture repair this is quite common and can persist 1-4 weeks. This is mostly temporary.

Eye & Eyelid Care - An ophthalmic antibiotic ointment should be placed along your suture line and within your eye. Place a small amount about the size of this "0" in the outside corner of each eye. Place a similar amount on a Q-tip and apply it to your incision while looking in the mirror.

Some discoloration around your incision can be expected. However, should you experience a great deal of redness and itching around your suture line, please call our office. You may have a rare allergic reaction to either the sutures used or the ointment being applied to your suture line. Again, your doctor or his nurse will be able to help.

Nylon sutures are placed to close the incisions. We will remove these sutures during your first post-operative visit. Under no circumstances should you attempt to remove these sutures yourself. Such action could truly damage the results of your surgery. Other sutures inside your lower eyelids are designed to slowly dissolve over time and will not need to be removed.

Do not lift anything over 15 lbs and do not blow your nose for 2 weeks. If you feel that you need to sneeze, open your mouth.

How you will feel - You will be drowsy and tired following surgery due to the medicines we have given you to make you comfortable. Most patients doze on and off during the evening after surgery. The next day, you may still feel a bit tired, but try to resume everyday activities as soon as you can. You may move about normally without fear of disrupting your surgery. Your energy will return more rapidly if you do.

If you have nausea - Although we give anti-nausea medicines before, during and after your surgery, it's still not unusual to experience nausea. Relax, decrease your activity and don't eat any heavy foods-just try some clear liquids. All nausea should resolve 8-10 hours following surgery.

Discomfort - We've given you a pain medicine to be used as directed. Take a pain pill before going to sleep the evening of surgery (preferably after you have kept something in your stomach). Take another pain pill the morning following surgery as you may feel a bit stiff and uncomfortable when you begin to move about. After two days, extra strength Tylenol should control your discomfort well. Do not use aspirin, advil or similar medicines for two weeks before and after surgery. These medicines cause bleeding and can damage your surgical result. If you have questions about a medicine, please ask us before using it.

Severe, deeply-felt pain in or under your surgical areas must be communicated to your doctor at once. It may represent bleeding underneath your skin and may result in permanent skin loss if not immediately treated.

Swelling - You may experience some swelling and discoloration around your eyes, face and neck following surgery. This swelling will increase overnight. To reduce swelling, you may gently apply an ice pack to the eyes during the first 48 hours following surgery. If possible, sleep with your head elevated on two pillows. Most of your swelling should subside over 4 to 5 days. In anticipation of swelling, you may be prescribed a Medrol dose pack. Please take this medicine as directed.

Fever - Fever of up to 101°F following surgery is common. Please call us should your fever ever reach 102°F.

Antibiotics and Infections - You received antibiotics in your IV prior to surgery, but will need to continue taking antibiotics as prescribed after surgery. Infection after facelift surgery is very rare, but if you notice increased redness or swelling accompanied by tenderness or fever at any time, please call us so that we may examine you.

Surgical Dressing - During the first night following your surgery, you will have a tight surgical dressing around your face and neck. Do not remove your surgical dressing unless instructed to do so by your doctor. Your dressing serves to support the area where you had surgery and promote healing. Its removal could damage your final cosmetic result.

You may also have drains coming out from under your dressing. These drains help prevent the accumulation of blood beneath your skin. Your nurse will empty your drains. Both the drains and the tight surgical dressing will be removed by your doctor the morning following surgery.

Facelift Dressing - After the tight surgical dressing and the drains have been removed, you will be fitted with a secure but comfortable facelift dressing. This dressing should be worn continuously for the first week following surgery. It should only be removed to eat and to bathe. You will be given a second facelift dressing to use in the event that your original dressing becomes soiled. These dressings may be washed and reused.

After the first week, we recommend wearing the dressing at night while asleep. You should do this for two weeks. This promotes the healing of your face and neck and reduces postoperative swelling.

Incision Care - Bacitracin antibiotic ointment should be placed along your suture line. This is best done gently with a Q-tip applicator while looking in the mirror.

Some discoloration around your suture line can be expected. However, should you experience a great deal of redness and itching around your suture line, please call our office. You may have a rare allergic reaction to either the sutures used or the ointment being applied to your suture line. Again, your doctor or his nurse will be able to help.

Sutures are placed in front of the ear and sometimes under the chin. We will remove these sutures during your first post-operative visit. Under no circumstances should you attempt to remove these sutures yourself. Such action could truly damage the results of your surgery. Other sutures behind your ears and along your hairline are designed to slowly dissolve over time and will not need to be removed.

Diet - Try to take only liquids or soft foods during the first 24 hours after surgery, and then increase your diet to normal as tolerated. Avoid very hot liquids and foods as these may cause bleeding. Also avoid alcohol for 2 weeks preceding surgery and for 2 weeks postoperatively, as it can prolong swelling and interfere with healing.

Personal Hygiene - Try to keep your facelift dressing clean and dry. Avoid taking a shower until the doctor says you may. If necessary, have someone wash your hair in the sink like they do at the hair salon.

Activity - During the evening following surgery, you should stay in bed with your head elevated on two to three pillows. You may go to the bathroom, but may need assistance.

Remember that the blood pressure in your face increases whenever you lower your head below the level of your heart-this may lead to nasal bleeding. Therefore, try to sleep on two or three pillows, and be very careful about bending over in the first two weeks following surgery. You may slowly advance your physical activity. Aerobic exercise should be avoided for at least two weeks following surgery. In general, sports such as running, weight-lifting, tennis, golf and swimming may be resumed in approximately two weeks following surgery. Body contact sports such as volleyball, football, basketball and wrestling are prohibited for six weeks following surgery.

When in doubt, please ask your doctor before engaging in any physical activity that could damage the results of your surgery.

Numbness - Your ears will be numb for the first several weeks following surgery. This is normal, and your sensation will return as the skin nerves regrow following surgery. Your ears will finally feel totally normal 4-6 months after surgery. Very rarely, numbness in the upper portion of the ears remains permanent.

Cosmetics - We will be able to instruct you in what kind of make-up to use to cover up any bruising or discoloration in the immediate post-operative period. Generally speaking, cosmetics may be used following the first post-operative visit. Please do not use any facial make-up in the area of your surgery until your doctor says it is okay, because you could damage the results of your surgery.

Sun Exposure - Please avoid the sun. Excessive sun exposure can result in ugly scar formation and ruin the results of your surgery. In the first six months following surgery, you must always use a good sunblock (SPF 15 or higher) before going outside. A good habit to get into is using a sunblock as your morning skin moisturizer. That way you'll always be protected.

Medicines - Please resume all your normal medicines unless specifically instructed not to by your doctor.

Day of Surgery - Arrange for someone to stay with you for the first 24 hours. Go to bed and rest lying on your back with your head elevated with 2-3 pillows. You should be lying at a 45 degree angle. You may be up and around to go to the bathroom or eat a light meal with assistance. Take medications only as directed. Use ice packs, one on top of head and one on forehead as much a possible. Some swelling and bruising is a normal occurrence especially in the frown line and lower eyelid area. This usually goes away quickly, but can last up to 2-3 weeks. If the pain or swelling is excessive, please call our office Keep the bandages and suture line dry. It the bandages loosen, secure it with more tape. The bandage and drains will be removed in our office the morning of the first post-operative visit.

Post-operative Visit - On the first and second day after surgery you may be up and around as tolerated, however expect to tire more easily than usual. Meals and activity should be kept at a minimum and continue with ice packs. On the third day you can remove all bandages and head straps in the morning. Your forehead and eyes may be swollen and discolored. This is normal. You may get into the shower and gently wash your hair with baby shampoo. Blow drying your hair is not recommended; however, a cool setting is fine. Most swelling occurs after surgery in the first 48-72 post-operative hours. It is important to use ice as much as possible during this time. Sutures and staples are removed 10-15 day post-operatively.

Long-term Care

• Rest and good nutrition are important healing factors, especially during the first 6 weeks post-surgery.
• Avoid alcohol for the first few weeks as this can prolong swelling and healing.
• Numbness, itching of the forehead and scalp tissues, and crusting and redness of the incision lines are normal occurrences. These complaints will subside gradually over several months.
• Do not color or perm your hair for 4 weeks.
• Postoperative checkups and photographs are needed as directed by your doctor.

After a hemiglossectomy patients can expect the following symptoms:

Sore Throat: You will have a sore throat. This will last between several days and one week. After that time, the pain diminishes over a few days to one week.

Ear Pain: You may have ear pain. This pain is typically the result of referred pain from the region of the throat and not from infection of the ears. It will resolve as the surgical sites heal. If the ear pain persists as the throat pain improves or if there is drainage from the ears, you should contact this office.

Tongue Numbness/Taste Change: You may have tongue numbness/taste change. This is from pressure on your tongue with instruments to access your voice box. This should resolve with time. It rarely lasts more than a few weeks.

Eating/Drinking: There are no dietary restrictions after surgery. Patients may initially prefer soft foods. This will return to normal in time. Patients should be encouraged to drink liquids frequently. Post-operative dehydration increases pain. The minimum fluid intake is enough to allow the patient to urinate a couple of times each day as normal. If the patient is unable to meet this goal, then they may require emergency room evaluation for intravenous rehydration. Typically water and clear, non-citrus, non-carbonated beverages such as pedialyte, Gatorade, and popsicles are tolerated best. Dairy products tend to thicken the saliva and can make this harder to swallow, however if tolerated by the patient these are also acceptable.

Activity after surgery: There is no activity restriction after surgery. Patients may return to work or school as they tolerate.

Bleeding after surgery: Patients may notice mild blood streaking of saliva. This generally improves with time.

Pain medication: Tylenol and Ibuprofen may be used per package dosing if needed. Do not drive or drink alcoholic beverages while taking narcotic pain medication.

! PLEASE NOTE: narcotic medication (hydrocodone, oxycodone, Percocet, Vicodin, Hycet) must be refilled by physical paper prescription only and cannot be called, faxed or e-prescribed to the pharmacy. Due to this, these medications cannot be refilled on nights, weekends, or holidays. Please plan to refill if needed during regular business hours only! Most insurance will only provide a 7 day supply and will not refill prior to 7 days. !

You probably won't have these symptoms, but call your doctor if:

• You have difficulty breathing
• You continue to spit up blood
• You have difficulty swallowing that worsens with time

How you will feel - You will be drowsy and tired following surgery due to the medicines we have given you to make you comfortable. Most patients wake and doze on and off during the evening after surgery. The day following surgery, you may still feel a bit tired, but resume everyday activities as soon as you can. You may move about normally without fear of disrupting your surgery. Your energy will return more rapidly if you do.

If you have nausea - Although we give anti-nausea medicines before, during and after your surgery, it's still not unusual to have some nausea following surgery. Relax, decrease your activity and don't eat any heavy foods-just try some clear liquids. All nausea should resolve by 8-10 hours following surgery.

Discomfort - We've prescribed a pain medicine to be used as directed. Take a pain pill before going to sleep the evening of surgery (preferably after you have kept something in your stomach). Take another pain pill the morning following surgery as you may feel a bit stiff and uncomfortable when you begin to move about. After two days, extra strength Tylenol should control your discomfort well. Do not use aspirin, advil or similar medicines for two weeks before and after surgery. These medicines cause bleeding and can damage your surgical result. If you have questions about a medicine, please ask us before using it.

Swelling - You may experience some swelling and discoloration around your eyes following surgery. This swelling will increase overnight. To reduce swelling, you may gently apply an ice pack to the eyes during the first 48 hours following surgery. If possible, sleep with your head elevated on two pillows. Most of your swelling should subside over 4 to 5 days. Rarely, your eyes may swell shut for the first 24 hours following surgery. If this occurs, please notify your doctor. In anticipation of swelling, you may be prescribed a Medrol dose pack. Please take this medicine as directed

Fever - Fever of up to 101oF following surgery is common. Please call us should your fever reach 102oF.

Nasal Discharge or Bleeding - A small amount of bleeding or nasal discharge will occur during the first 48 hours following your operation. This will gradually go away over the course of the next several days. Change the gauze drip pad under your nose as necessary (usually several times a day at first). You may remove the gauze pad while dining to make it more comfortable for you to eat.

Nasal Hemorrhaging - Heavy bleeding from the nose (hemorrhaging) is very rare and usually not serious. Should it occur, try to remain calm, keep your head elevated, and apply ice compresses to the side of the bleeding. Place a towel under your nostrils to absorb the blood, but do not insert cotton or paper into your nose as this may damage the result of your surgery.

Again, do not use aspirin-like compounds, since they can cause bleeding. Any heavy bleeding that lasts for more than ten minutes should be reported to us immediately, we may wish to see you emergently. In this case, please contact our office at 970-644-3800.

Antibiotics and Infections - You will need to take antibiotics as prescribed after surgery. Infection after nasal surgery is very rare, but if you notice increased redness or swelling accompanied by tenderness, fever or discharge, please call us so that we may examine you.

The following is a list of general instructions for your care following your Otoplasty. Please read them carefully several times as most of your questions should be answered here. Carefully following these instructions should help you get the best results from your procedure.

Daily Care - Your dressing after surgery will remain on for 5 to 7 days. It is important to relax and keep your head elevated the night after surgery. After your dressing is removed, we will review your care:

1. Go over suture lines behind the ears three times daily with hydrogen peroxide on a Q-tip. After this again with a Q-tip apply a liberal amount of Vaseline or Bacitracin ointment. The Stiches behind the ears are dissolvable and keeping them lubricated helps quicken the process.
2. A headband will be placed over the ears after dressing removal. Please try to wear it at all times the first two weeks following surgery-this is important to keeping your new ears in position. You may shower after the surgical dressing is removed. Baths are a better choice for most people. Be sure to use a gentle shampoo such as Johnson's Baby Shampoo.
3. Be sure to immediately report any of the following signs: bleeding that persist for more than ten minutes, infections, redness, fever, unusual drainage, or pain.
4. If non-absorbable stitches are used, they will be removed the seventh day after surgery.
5. Following two weeks, please wear your headband at night for another 4 weeks.

What to Expect

Swelling - Swelling will vary patient-to-patient. Swelling may actually increase the first three to four days before subsiding. Most of your swelling should resolve over the first two to three weeks. Do expect, however, to have minor fluctuations in the remaining swelling over the course of the next two to three months. Things to do to minimize this swelling include keeping your head elevated as much as possible over the first two to three weeks, avoiding bending over or heavy lifting for the first three weeks, and avoiding prolonged sun exposure for the first two to three months.

Discoloration - Bruising will vary like swelling from person to person. Most bruising and discoloration should resolve over the first two weeks. Make-up can be applied ten days to two weeks after surgery, if given permission.

Numbness - Your ears may be numb following surgery. This is normal and will subside over the coming weeks to months. Unusual sensations, pins and needles, and occasionally mild discomfort may occur as these nerves regenerate over time.

Depression - It is not uncommon for patients to go through a period of mild depression after cosmetic surgery. This typically occurs the second week after surgery while some of the swelling and bruising still persist and yet the patient is anxious to see a final result. Realize this is a temporary condition and things will improve. Focus on diligently following the wound care as well as other activities to help divert your mind.

Restrictions

1. No strenuous exercise for at least two weeks.
2. No heavy lifting for three weeks
3. No "pull-over" clothing for two weeks
4. Avoid hard chewing foods for two weeks
5. No contact sports for six weeks

Finally

The healing time for ear surgery is often less than expected and the results are worth the wait. While swelling should be completely gone after four to six weeks, your healing will continue for the entire first year. I will follow you through this entire process, but be patient.

• Tylenol (Acetaminophen): may be used per package dosing every 6 hours
• Ibuprofen: NONE!
• Hydrocodone/Acetaminophen (Hycet): may be prescribed and can replace the regular Tylenol dose in your pain management schedule as below. Not required for adenoidectomy alone.
• Tetracaine lollipops: from compounding pharmacy (western Colorado specialty pharmacy or palisade pharmacy)
• Pain medication schedule: You may be able to take some form of medication every 6 hours, a generic example of this is below:
  • Tylenol or Hydrocodone/Acetaminophen at noon
  • Tylenol or Hydrocodone/Acetaminophen at 6pm
• To start this schedule please note the time medications were given in the hospital to establish your specific schedule for taking medication if needed. You may decrease/remove doses from the schedule as you feel better.

Optional chart for tracking pain medication: (continue pattern below beyond chart provided if needed)

[CHART SVG HERE]

Fluid/food intake goals by age:

[CHART SVG HERE]

After a panendoscopy/direct laryngoscopy, patients can expect the following symptoms:

Sore Throat: You will have a sore throat. This will last between several days and one week. After that time, the pain diminishes over a few days to one week.

Ear Pain: You may have ear pain. This pain is typically the result of referred pain from the region of the throat and not from infection of the ears. It will resolve as the surgical sites heal. If the ear pain persists as the throat pain improves or if there is drainage from the ears, you should contact this office.

Tongue Numbness/Taste Change: You may have tongue numbness/taste change. This is from pressure on your tongue with instruments to access your voice box. This should resolve with time. It rarely lasts more than a few weeks.

Eating/Drinking: There are no dietary restrictions after surgery. Patients may initially prefer soft foods. This will return to normal in time. Patients should be encouraged to drink liquids frequently. Post-operative dehydration increases pain. The minimum fluid intake is enough to allow the patient to urinate a couple of times each day as normal. If the patient is unable to meet this goal, then they may require emergency room evaluation for intravenous rehydration. Typically water and clear, non-citrus, non-carbonated beverages such as pedialyte, Gatorade, and popsicles are tolerated best. Dairy products tend to thicken the saliva and can make this harder to swallow, however if tolerated by the patient these are also acceptable.

Activity after surgery: There is no activity restriction after surgery. Patients may return to work or school as they tolerate.

Bleeding after surgery: Patients may notice mild blood streaking of saliva. This generally improves with time.

Pain medication: Tylenol and Ibuprofen may be used per package dosing if needed. Do not drive or drink alcoholic beverages while taking narcotic pain medication.

! PLEASE NOTE: narcotic medication (hydrocodone, oxycodone, Percocet, Vicodin, Hycet) must be refilled by physical paper prescription only and cannot be called, faxed or e-prescribed to the pharmacy. Due to this, these medications cannot be refilled on nights, weekends, or holidays. Please plan to refill if needed during regular business hours only! Most insurance will only provide a 7 day supply and will not refill prior to 7 days. !

You probably won't have these symptoms, but call your doctor if:

• You have difficulty breathing
• You continue to spit up blood
• You have difficulty swallowing that worsens with time

As with other postoperative wounds, please keep all incisions moist with antibiotic ointment at all times. This is important as moist wounds heal faster than dry ones and have less change of a scar.

There is a bridge of tissue from the brow region connection to the nose. This is intentionally left in place as the blood supply for the flap is within this tissue. This will be divided or fashioned at another surgery in three weeks' time.

There is a piece of yellow Xeroform gauze, which is wrapped around the bridge of tissue. Please keep this gauze coated in antibiotic ointment as well as keep it in place. Occasionally, this gauze will need to be changed, but only do so if instructed by Dr. Baker or the on-call doctor.

It is not unusual to have swelling of the forehead, eyes, and nose. Some bleeding and oozing form the underside of the flap is also to be expected in the immediate postoperative period. Bruising often occurs after this surgery and although is unsightly, it is not harmful.

Reasons for concern following this procedure:

• Fevers greater than 102.4°F
• Rapidly expanding mass (hematoma) under the skin
• Decreasing acuity of vision or changes in vision

Activity:

• No travel for 1 week
• No bending, lifting or straining for 1 week
• No rigorous activity until permitted

Restrictions:

• DO NOT USE ANY ASPIRIN, IBUPROFEN, OR ASPIRIN-LIKE PRODUCTS UNTIL PERMITTED. If you are uncertain about the use of a medicine, please call the office.
• There are no diet restrictions following this surgery. Drink plenty of fluids.

Wound Care:

• You may shower within 24 hours after your surgery. It is important after showering that you are careful to pat the wound dry without pulling on the wound or rubbing the steri-strips or stitches as they are delicate.
• Some numbness surrounding the incision around your neck is to be expected. This will typically resolve within several months following surgery. However, some permanent numbness is to be expected. Men should be careful when shaving over the numb area to prevent trauma to the operative area.

Calcium supplementation:

• Take 1000mg of Calcium with Vitamin D (Over the counter) three times per day until your follow up appointment in the office.
• If you develop signs of low calcium such as numbness/tingling of the fingers or surrounding your mouth, muscle weakness, take one extra calcium and call the office at 970-644-3800 for further instructions.

Call the Office For:

• Development of numbness or tingling around your lips and/or fingertips
• Muscle weakness
• Temperature over 102°F
• Increased neck swelling
• Shortness of Breath
• Increasing pain or bleeding from the operative area.
• Severe or persistent diarrhea (from antibiotics)

Activity:

• No travel for 1 week
• No bending, lifting or straining for 1 week
• No rigorous activity until permitted

Restrictions:
 

• DO NOT USE ANY ASPIRIN, IBUPROFEN, OR ASPIRIN-LIKE PRODUCTS UNTIL PERMITTED. If you are uncertain about the use of a medicine, please call the office.
• There are no diet restrictions following this surgery. Drink plenty of fluids.

Wound Care:

• You may shower within 24 hours after your surgery. It is important after showering that you are careful to pat the wound dry without pulling on the wound or rubbing the steri-strips or stitches as they are delicate.
• Some numbness surrounding the incision around your neck is to be expected. This will typically resolve within several months following surgery. However, some permanent numbness is to be expected. Men should be careful when shaving over the numb area to prevent trauma to the operative area.

Calcium supplementation:

• Take 1000mg of Calcium with Vitamin D (Over the counter) three times per day until your follow up appointment in the office.
• If you develop signs of low calcium such as numbness/tingling of the fingers or surrounding your mouth, muscle weakness, take one extra calcium and call the office at 970-644-3800 for further instructions.

Call the Office For:

• Development of numbness or tingling around your lips and/or fingertips
• Muscle weakness
• Temperature over 101°F
• Increased neck swelling
• Shortness of Breath
• Increasing pain or bleeding from the operative area.
• Severe or persistent diarrhea (from antibiotics)

Activity:

• No travel for 1 week
• No bending, lifting or straining for 1 week
• No rigorous activity until permitted
• No air travel for 4 weeks

Restrictions:

• DO NOT BLOW YOUR NOSE, until given permission to do so (usually 1 week after surgery). However, you may gently sniff through your nose.
• DO NOT SUPPRESS THE NEED TO COUGH OR SNEEZE, but do so with your mouth open. This will relieve pressure on the nose.
• DO NOT USE ANY ASPIRIN OR ASPIRIN-LIKE PRODUCTS UNTIL PERMITTED. If you are uncertain about the use of a medicine, please call the office.

Wound Care:

• You may have some bleeding from your nose for several days after surgery & then after each office debridement. Do not blow your nose for the first 10 days following surgery- this may loosen crusts and cause bleeding. When you do begin blowing your nose, please blow both sides at the same time.
• Do not snort the blood in thru your nose or blow your nose; this will increase the bleeding. Heavy bleeding from the nose (hemorrhaging) is rare and usually not serious. Should it occur, try to remain calm, keep your head elevated, and apply ice compresses to the side of the bleeding. Place a towel under your nostrils to absorb the blood, but do not insert cotton or paper into your nose as this may damage the result of your surgery.
• A small amount of bleeding or nasal discharge will occur from your nose during the first 48 hours following your operation. This will gradually go away over the course of the next several days. Change the gauze drip pad under your nose as necessary (usually several times a day at first). You may remove the gauze pad while dining to make it more comfortable for you to eat.
• Again, do not use aspirin-like compounds, since they can cause bleeding. ANY HEAVY BLEEDING THAT LASTS FOR MORE THAN 10 MINUTES SHOULD BE REPORTED TO US IMMEDIATELY - WE MAY WISH TO SEE YOU EMERGENTLY.
• After 2 to 3 weeks you will have some thick brown drainage from your nose. This is mucous and old blood, and is normal, as the sinuses begin to clear themselves. It does not indicate infection.
• Keep your nostrils clean and free of drainage using Q-tips dipped in hydrogen peroxide. Reach inside the nose only as far as the length of the cotton on the Q-tip. Use saline nasal spray every hour or two while you are awake until you are instructed otherwise. Squirt 2 sprays in each nostril. This will help moisten your nose and prevent large crusts from forming in your nose and sinuses. These items are available over the counter at your local drugstore.

If You Have Nausea:

• Although we give anti-nausea medicines before, during and after your surgery, it's still not unusual to have some nausea following surgery.
• Relax, decrease your activity and don't eat any heavy foods- Just try some clear liquids. All nausea should be over 8-10 hours following surgery.

Following tongue-tie, it is important to understand that depending on your child's age and the type of tie(s) your child had, improvement may not be immediate. It can take some time for your child to learn how to use their tongue in an effective manner.

Pain relief: Most babies appear to experience only minimal discomfort for the first 24-48 hours after the procedure, and breastfeeding and skin-to-skin contact provide natural pain relief. If your baby seems uncomfortable, Tylenol (acetaminophen) can be given to help with the discomfort. Please note that ibuprofen (Motrin or Advil) should NOT be used for babies under the age of two months. Please speak to your doctor/dentist/pharmacist if you are unsure about what dose of medication to give, and remember that medication dosages should always be based on your baby's weight. Please note that products containing benzocaine (i.e. baby Orajel) should not be used due to health risks (FDA). Some babies will refuse to feed for a short period of time in the first 24 hours after the procedure. This is usually due to discomfort and resolves with adequate pain management. There is usually no need for supplementation, but if you are concerned then please contact your lactation consultation or doctor.

Note: You may notice some dark streaks of blood in your baby's diaper in the 24 hours after the procedure. This is from the small amount of blood that your baby may swallow during the procedure and it is not a cause for concern. If you are noticing blood in your baby's diaper and it persists for more than 24 hours after the procedure, or you are concerned, then contact your doctor. If a laser or electrocautery tool was used for the procedure, you may notice small burns on your child's lips or tongue (small white areas). Although every effort is made to ensure that this does not happen, the potential for these small burns is unavoidable since babies do not understand the need to stay still during the procedure. These burns heal quickly and do not cause any lasting damage.

Stretching exercises: Stretching exercises appear to be important after the procedure to make sure that the area that was released does not heal back together. Doing the exercises as instructed appears to reduce the risk of needing to have the procedure done a second time, and allows for proper healing. Before starting the exercises, make sure that your hands are clean and your fingernails are short. We recommend that the stretching exercises be done five times a day starting at the 2nd feeding after the procedure. It is not necessary to wake your baby to do the stretching, however doing the stretches at least once during the night seems to help prevent reattachment. Continue the exercises for 7-10 days after the procedure. For some babies, healing may take a little longer, so if you stop the stretching exercises and breastfeeding becomes uncomfortable again, resume the stretching exercises for another few days. Your baby may cry or fuss during the exercises but should calm down quickly after the stretches are done. Stretching can be done before or between feedings, depending on what works for your baby.

To do tongue-tie exercises, lay your baby on his back with his head towards you, and feet pointing away from you. Place your index fingers under your baby's tongue on either side of the incision. Lift your baby's tongue so that you can see the diamond-shaped area where the release was made. You can also pull your fingers apart slightly to stretch the opening in all directions. Stretching should be done quickly and only needs to be held for 3-5 seconds. There may be a few drops of blood as the area stretches but this is normal. If bleeding is more than a few drops, or you are concerned, then contact your health care provider. To do the lip-tie exercises, grasp the lip and pull out and up (or down if it is the bottom lip), holding the stretch for 3-5 seconds.

DO NOT TAKE ANY IBUPROFEN, ASPRIN, NSAID, ALEVE, OR SIMILAR PRODUCT UNTIL CLEARED BY DOCTOR!

DO NOT TAKE VITAMINS OR SUPPLEMENTS UNTIL SEEN IN OFFICE.

FOR QUESTIONS CALL 970-644-3800.

Sore Throat: You will have a sore throat. This will last between several days and two weeks. Most patients who had a tonsillectomy experience a worsening of the sore throat between four and seven days after surgery. After that time, the pain diminishes over a few days to one week.

Appearance: The back of the throat will have a thick, white or gray film for 7-10 days. This is the normal appearance of a scab in the throat. The Uvula may be red, swollen and may also have a white film. If it is swollen, consuming cold products such as slushies/popsicles can decrease swelling.

Fever: You may have a low grade temperature. The younger the patient, the higher the temperature may be. This may be treated with Tylenol if needed, if the temperature exceeds 102°F, you should contact this office.

Ear Pain: You may have ear pain. This pain is typically the result of referred pain from the region of the tonsils and not from infection of the ears. It will resolve as the surgical sites heal. If the ear pain persists as the throat pain improves or if there is drainage from the ears, you should contact this office.

Bad Breath: You will have bad breath. This will persist for about 2 weeks during healing after surgery.

Eating/Drinking: Although there are no dietary restrictions after surgery, patients may initially refuse to eat solid foods. This will return to normal in time. Patients should be encouraged to drink liquids frequently. Post-operative dehydration increases pain. The minimum fluid intake is enough to allow the patient to urinate a couple of times each day as normal. If the patient is unable to meet this goal, then they may require emergency room evaluation for intravenous rehydration. Typically water and clear, non-citrus, non-carbonated beverages such as pedialyte, Gatorade, and popsicles are tolerated best. Dairy products tend to thicken the saliva and can make this harder to swallow, however if tolerated by the patient these are also acceptable. During the first few days after surgery it may be helpful to take a dose of Tylenol or hycet 20 to 30 minutes before attempting to drink liquids.

Activity after surgery: There is no activity restriction after surgery under 10years of age. For those over 10 years old, no physical activity including gym class/lifting over 10lbs for 2 weeks. Patients may return to work or school as they tolerate. Most patients after adenoidectomy will need 1-2 days of recuperation prior to normal activities and most patients after tonsillectomy require 1-2 weeks, possibly more.

Bleeding after surgery: Between about 7-10 days after tonsillectomy, the scab in the back of the throat will come off. This does not occur with adenoidectomy. Although this typically occurs unnoticed, it may be accompanied by some blood streaking of the saliva. This is normal and should clear quickly. However, if this bleeding persists and is greater than 1 tablespoon in amount, the patient should be seen by his physician promptly. Rarely, this bleeding will not stop spontaneously and the patient may have to return to the operating room to stop it. If more than 1 tablespoon of bleeding is noted from the mouth please call the office.

Pain medication after tonsillectomy surgery: Tylenol may be used per package dosing if needed. NO IBUPROFEN USE! You may be given a prescription for narcotic pain medication prior to leaving the hospital for pain not controlled by Tylenol. Do not drive or drink alcoholic beverages while taking narcotic pain medication.

! PLEASE NOTE: narcotic medication (hydrocodone, oxycodone, Percocet, Vicodin, Hycet) must be refilled by physical paper prescription only and cannot be called, faxed or e-prescribed to the pharmacy. Due to this, these medications cannot be refilled on nights, weekends, or holidays. Please plan to refill if needed during regular business hours only! Most insurance will only provide a 7 day supply and will not refill prior to 7 days. !

Ear drops/pain medication:

• Use of prescription ear drops is often recommended after surgery and this will be three times per day for 5 days following surgery, most often the first dose is placed during surgery.
• Different ear drops can be used during surgery than these prescribed for home. If so, this is planned and safe for your child.
• Tylenol and Ibuprofen may be used per package dosing if needed for pain or fever.

Follow-up visit:

• 3-6 weeks after the surgery, your child's surgeon will want to examine your child. This follow-up visit ensures that the tubes are still in place and that your child's ears are healing. Hearing is commonly rechecked at this appointment.
• After the initial follow-up, the healthcare provider may want to see your child every six months.
• Most tubes stay in place for about a year. Some last longer, some last a shorter time. The life of the tube often depends your child's growth. Most tubes fall out on their own. In rare cases, tubes need to be removed by the surgeon if it does not fall out on its own.

Fewer problems:

• Even with tubes, your child may still get ear infections. Discolored ear drainage is the sign that you should be calling your child's PCP or surgeon's office. But as long as the tubes are working, you can expect fewer problems and a quicker recovery.
• If an infection does happen, it will likely respond to antibiotic ear drops. For more severe infections, oral antibiotics may be added. Always make sure your child finishes the entire prescription, even if the symptoms go away. Otherwise, the medicine may not work. Use only ear drops prescribed by your child's provider.

Ear care/activity:

• Your child will need to wear earplugs during swimming and bathing if their head goes under more than three feet of water. If water exposure is less than 3 feet deep earplugs are not needed.
• Don't use any ear drops in your child's ears unless prescribed by the surgeon or another provider.
• Don't use cotton swabs to clean the ears. These can clog tubes with wax or even damage the eardrum.
• There are no activity restrictions outside of for water exposure or above.

When to call your child's healthcare provider:

• Bloody drainage from the ears longer than the first 2-3 days after surgery, or if a large amount.
• Drainage from the ears that does not stop.
• Fever greater than 102°F that does not improve with Tylenol or Ibuprofen (young children may have low grade fevers for 1-2 days post-surgery due to surgery itself, then will improve)
• Trouble hearing.
• Problems with balance.

Please complete these steps two to three times a day until seen in the office for follow up. If there are steri-strips covering your incision then you do not need to complete these steps.

1. Please get a standard bottle of H202 (Hydrogen Peroxide) Solution. This is an over the counter medicine and can be obtained at any pharmacy. You can buy any brand including the generic brand (CVS, Rite Aid, etc.).
2. You will need to make a half strength solutions....this is easy to do. Pour out one half of the hydrogen peroxide bottle and refill it to the top with tap water. This will dilute the hydrogen peroxide by one half. This is the solution you will use to clean all incisions.
3. Take a cotton swab or gauze and saturate it with the hydrogen peroxide solution. Gently clean all incisions being careful to not traumatize or pull the incision apart. It is very important to do this gently by only dabbing and never rubbing the incision. This step will help clean the wound by breaking down any dried blood and/or crusts that have formed. You may see the solution fizz and bubble when applied, this is normal.
4. Carefully dry the area by patting with a clean/dry gauze or swab.
5. Take a small amount of the antibiotic ointment (Bacitracin, Erythromycin ointment, etc.) and cover the incision line. If you haven't been given a prescription for this ointment then you should use an over the counter double antibiotic ointment.
6. Please call the office with any questions at 970-644-3800.

Nasal Endoscopy

Nasal endoscopy is an office based procedure to evaluate the internal anatomy of the nose and assess for common abnormalities such as infection, polyps, deviated nasal septum, and turbinate hypertrophy. This is completed using a small camera after numbing medication has been applied to the nose.

Laryngoscopy & Stroboscopy
Laryngoscopy is an office based procedure to evaluate the internal anatomy of the throat and voice box. Complaints such as hoarseness and trouble swallowing are common complaints that may benefit from this type of evaluation. This is completed using a small camera after numbing medication has been applied to the nose and throat.

Skin biopsy
Lesions of the skin can at times require a biopsy for full evaluation and to test for malignancy. To accomplish this, numbing medication is applied and a small area of the lesion is removed to send for testing. Additional treatment can be determined by these results if needed.

Hearing testing
Hearing loss can occur at any age and the first step in evaluation for this condition is obtaining a hearing testing (audiogram). This determines specific characteristics including the type and degree of hearing loss which helps identify different treatment options.

Mini facelift
Facial rejuvenation procedures can be performed in the Surgical Prodecure room in the office. There is a wide variance of procedures and we encourage you to obtain a consultation.

Otoplasty
An otoplasty is a procedure to change the shape of the ear. Often Prominauris or "Cup Ear" is corrected as an in office procedure.

Tonsillectomy and adenoidectomy
Tonsillectomy and adenoidectomy is a surgery to remove the small glands on each side of the throat (tonsils) and at the top of the throat behind the nose (adenoids) most commonly completed to help with recurrent infection or enlarged tonsils.

Tubes
Ear tubes (tympanostomy tubes, ventilation tubes, pressure equalization tubes) are tiny, hollow cylinders, usually made of plastic or metal, that are surgically inserted into the eardrum. An ear tube creates an airway that ventilates the middle ear and prevents the accumulation of fluid/infection behind the eardrum.

Sinus Surgery/Septoplasty
Sinus surgery is a procedure to open the pathways of the sinuses and clear blockages. This is an option for people with ongoing and recurrent sinus infections, for people with abnormal sinus structure, or abnormal growths in the sinuses. Septoplasty is a surgical procedure to straighten a deviated septum.

Head and neck cancer
Cancer can arise within the skin and soft tissues of the head and neck. Treatment of such areas begins with a biopsy for diagnosis and involves our multi-specialty head and neck cancer team. This team tailors the treatment approach with use of surgery, radiation therapy and chemotherapy to the specific needs of each patient.

Parotidectomy
Parotidectomy is the surgical removal of the parotid salivary gland located in the cheek. This procedure is completed to remove benign or malignant lesions of this gland.

Parathyroidectomy
Parathyroidectomy is the surgical removal of one or more parathyroid glands. This procedure is used to remove primary tumors or hyperplasia of the glands, especially when they produce excessive parathyroid hormone (hyperparathyroidism).

Thyroidectomy
Thyroidectomy is the surgical removal of all or part of the thyroid gland. This procedure is used to remove areas confirmed to have or suspicious for malignancy, areas causing compression of the airway or affecting swallowing, or failed medical management of hyperthyroidism.

Reconstruction after MOHS surgery
Mohs, is microscopically controlled surgery used to treat common types of skin cancer. After this type of surgery there is a defect in the skin/soft tissues that requires reconstruction. This can be completed in the office or in the operating room setting depending on the size of the defect.

Reconstruction of the head and neck
Reconstruction of the head and neck can be required for defects of soft tissue/bone following trauma or cancer. This can include using local flap or free tissue transfer depending on the specific requirements of each defect.

Lesion Removal (benign and malignant)
Lesions of the skin/soft tissue, whether malignant or benign, can at times require excision. A biopsy is commonly completed prior to excision to help determine the cause of the lesion and test for the presence of a malignancy. Removal of can be completed in the office or operating room setting depending on the size and location.

Rhinoplasty
Rhinoplasty, also commonly known as a nose job, is a plastic surgery procedure for correcting and reconstructing the form, restoring the functions, and aesthetically enhancing the nose, by resolving factors associated with nasal trauma (blunt, penetrating, blast), congenital defect, respiratory impediment, or a failed primary rhinoplasty.

Blepharoplasty
Blepharoplasty is the plastic surgery operation for correcting defects, deformities, and disfigurations of the eyelids; and for aesthetically modifying the eye region of the face.