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Table of Contents
Dr. Khechoyan Introduction
- Idaho State University, Bachelor of Science, Biochemistry - Summa Cum Laude: August 1997 - June 2001
- University of Washington School of Medicine, Doctor of Medicine with Honors: August 2001 - June 2005
- Residency - Plastic and Reconstructive Surgery - University of Washington Department of Surgery: July 2005 - June 2011
- Fellowship - Pediatric Craniomaxillofacial Surgery, The Hospital for Sick Children, Toronto, ON - July 2011-June 2012
Specialty: Pediatric Craniomaxillofacial Surgery and Plastic & Reconstructive Surgery
Khechoyan’s Orthognathic Pathway
(this is preliminary and may change, but at least gives you an overview)
MEDICATIONS:
IV unasyn while in house; augmentin (high-dose, 875 mg) po BID for 2 weeks; substitute clindamycin if penicillin allergic.
Peridex mouthwash four times a day for 6 weeks.
Oxycodone for pain on discharge.
DIET:
Clear liquid diet for 48 hours in the hospital.
Then, blenderized (full liquid diet) for 2 weeks thereafter; nutrition consult in hospital.
Soft (no chew) diet after 2 weeks until 8 weeks post-op (6 weeks total). Diet restriction for a full 8 weeks.
IMAGING:
On discharge, patients will go from main hospital to Dental Center for Panorex, lateral cephalogram and PA cephalogram xrays. Maureen and Tracy/Alma will need to communicate close to day of discharge to coordinate/arrange this.
ELASTICS:
Elastics will be initiated in hospital on POD#1 based on recommendations by Dr. Lowe. Maureen will teach patients on elastics application/wear in hospital.
DENTAL HYGIENE and ORAL/LIPS CARE:
Peridex QID Full glass of water after every meal. Peridex after every meal, swish and spit. Vaseline to upper and lower lips QID. Hydrocortisone 1% cream to upper and lower lip BID while in hospital. May brush teeth with soft pediatric tooth brush twice a day starting on POD#2. Avoid brushing close to gingiva or sutures.
ACTIVITIES & RESTRICTIONS:
No sports or exercise or strenuous activity for 8 weeks post-operatively. Sleep with head of bed elevated at 45 degrees for 2 weeks post-operatively. Ice packs to face for first 72 hours: 30 minutes on/30 minutes off.
FOLLOW-UP VISITS:
1 week post-op with Dr. Lowe for dental hygiene/irrigation with dental assistant and check on healing and initiation of elastics. Weekly or every 2 weeks follow-ups with Dr. Lowe at her discretion to continue post-operative elastics care.
1 week post-op with Maureen for check on healing, oral hygiene, etc. 2-3 week post-op visit with me AND Maureen together (or sooner if there are concerns re healing or occlusion). 6-8 week follow-up visit with me AND Maureen together
Cleft Physician Preference
Cleft Lip
Antibiotics No (intraop)
Bottle yes
Restraints no
Spoon Feeding yes
Pain Medications
Tylenol yes
Motrin yes
Oxycodone yes
Lortab yes
Length of Stay 1 day typical
Incision site care
Glue no
Stiches yes
Tape NO
Nutritional Consult Yes
Follow up 1-2 weeks/then 1 month
Cleft Palate
Antibiotics intraop
Bottle
Restraints yes x 3 weeks
Spoon Feeding yes sideways
Type of feeding blenderized x 2 weeks and then soft x 2 weeks.
Pain Medications
Tylenol Yes
Motrin NO
Oxycodone Yes
Lortab NO
Length of Stay Depends on po
Incision site care
Dissolvable sutures yes
Nutritional Consult yes if able
Oxycodone yes
Lortab no
Length of Stay depends on po
Nutritional Consult pre discharge yes
When they can go back to ST 4 weeks
Follow up 1 we; 1 mo
Ear Tubes
Follow up per ENT
Antibiotics
Drops/Duration
Swimming/Ear submersion
Drainage
Automatic renewal of Drops with Drainage
Follow up audio
Pharyngeal Flap
Antibiotics home on po 7-10 days
OTC medications
Tylenol yes
Motrin Check with him case by case
Oxycodone yes
Lortab no
Diet Restrictions Blenderized x 2 and soft 2-4.
Follow up 7-10 days; then 4-6 weeks.
When to resume speech 1 month
Activity Restricitons 2 weeks for all and 1 month for contact.
? Automatic referral to VPI No
Length of stay 1-2 nights
Alveolar Bone Graft Underlined Text
BMP No
Iliac Crest Yes
Pre-op Panos/Peri apical yes w/in 3-4 mo
Post-op Panos/Peri apical yes at 3 mo
Cone Beam yes if available
Follow up 7-10 days; 4-6 weeks
Diet restrictions
OTC medications
Tylenol yes
Motrin care dependent; no if raw surfaces
Oxycodone Yes
Lortab ?
Mouth rinse (peridex) yes qid x 4-6 weeks; also rinse with H20
tooth brushing Not at surgical site for 4-6 weeks
Activity restrictions No contact 4-6 weeks
nutrition consult/teaching prior to d/c yes
?restraints for 2 or 3 weeks
Dr D prefers no motrin x 7 days
*will discuss when has more pts in this age range
Updated: 1/17/19 MSA