After Orthognathic or Jaw Corrective Surgery
After you have undergone a surgical procedure to correct the position of your upper jaw, lower jaw, or both, attention must be given to several aspects of postoperative care in order to help make the recovery as quick and easy as possible. Since surgery produces soreness in the muscles and bones of the jaw as well as the lips, nose and other areas of the face, some difficulty is encountered in performing such tasks as eating, drinking and cleaning your teeth. However, each of these things must be done continuously and carefully to avoid postoperative problems. This is a list of instructions which should help you in your postoperative recovery.
You may be given several types of prescriptions.
Pain medication : Should be taken only during the time that you feel significant discomfort. If the pain is severe the prescription medication can be used. However, if only mild discomfort is experienced, try to use a less potent, over the counter medication. Ibuprofen is recommended to aid with inflammation. A dose of 800 mg (4 tablets of Motrin® or Advil®) can be taken every 4-6 hours as needed. Ibuprofen can also be used to supplement the prescription pain medication, especially on the third day after surgery when the discomfort is the worst. The prescription pain medication and the Ibuprofen can be alternated every 3 hours, so that each medication is spaced out 6 hours. This will keep you comfortable longer on the third day.
Antibiotics : You may be given a prescription for an antibiotic such as Duricef, Penicillin, Cleocin, etc. This medicine should be taken at the appropriate interval as described on the bottle. Be sure not to miss any doses and take the medicine until it is gone. Note: Some types of antibiotics can reduce the contraceptive effects of birth control pills. Please contact your gynecologist if you have concerns.
Decongestants : Following orthognathic surgery, especially upper jaw surgery, there isconsiderable stuffiness of the nose and sinuses. If a decongestant such as Sudafed® is recommended take the medicine as indicated on the bottle for seven to ten days or as needed for congestion.
Nasal spray : (Afrin, Neosynephrine or equivalent) can be used at six to eight hour intervals to help improve breathing through your nose. In order to prevent overuse of the nasal spray, this can be alternated with plain saline (salt water or ocean spray) nasal spray. These can be purchased from your pharmacy.
Lip ointment : You will be given a tube of lip ointment at the hospital. Use this for the first two days. Keep enough ointment on the lips to keep them looking wet. After two days stop using the ointment and use plain Vaseline®.
In the first few days after surgery you may have some difficulty sleeping : If this becomes a problem, call the office and discuss this with the office staff or the doctor. We may prescribe medicine to help you sleep better. Usually you only need to take this medicine for two or three nights to help reestablish a good sleeping pattern.
Taking in adequate amounts of fluid is essential following surgery. You need about 2 to 2.5 quarts per day .
Following jaw surgery there is frequently some numbness in the upper lip, lower lip, or both lips. When combined with facial swelling, a sore throat from the anesthesia, and soreness due to the incisions inside the mouth, a task as basic as drinking may seem somewhat difficult. Here are several tips which may help you:
Initially after surgery you will be given a syringeand small tube to help you begin taking liquid by mouth. Do not use a straw for the first day or two since this can create more bleeding and may be difficult due to numbness in your lips.
Attempt to drink from a cup as soon as possible. While some fluid may spill when drinking, a cup is still the most effective way for taking fluids. The use of a “sippy cup” like those used by toddlers may be helpful for the first few days.Place a towel under your chin and pour a small amount of liquid into the cup. Tip your head back slightly and attempt to open your mouth a tiny bit while pouring the fluid into your mouth. Pour slowly and take in a small amount of fluid. Take the cup away from your mouth. If necessary use slight finger pressure to place your lips together and attempt to swallow. This will be difficult at first, but you will find that it will become much easier in a day or two.
If drinking from a cup seems to be impossible, continue using the syringe with the tubing attached. Another alternative is to obtain a squeeze bottle to squirt fluid into your mouth. This type of device can be obtained at most department stores, sporting goods, or bicycle shops.
Do not drink cold milk products for two days after surgery . Cold milk adheres the incision areas and may promote infections. Processed milk products such as canned milk based drinks
Initially, it will be difficult to eat adequate amounts of food in only three meals per day. Try to eat five or six times a day, eating smaller portions each time. Remove the elastic bands during eating.Use the following guidelines for progressing from a liquid/blenderized diet to firmer foods.
During this time the diet should be a pureed or blenderized diet. While this can include soups, and food with baby food consistency, this type of diet does not necessarily mean foods that are of liquid consistency. You can also eat foods such as mashed potatoes, applesauce, oatmeal and pudding. It may be difficult to open your mouth wide enough to get a spoon inside. A small baby sized spoon may be helpful. Some sort of diet supplement such as Boost®, Ensure®. Sustacal, or similar substitutes may be used once or twice a day to increase calorie intake.
During this period your diet should include foods that are extremely soft in consistency and require only minimal chewing such as, very soft scrambled eggs and small pieces of pasta (for example, Franco-American SpaghettiOs®), refried beans, soft casseroles, pancakes and waffles.
WEEKS 3-6 :
At this point gentle chewing can be attempted but initially the food should continue to be of a soft consistency. We suggest food such as very soft ground meat cut into small pieces, soft flaky fish or shredded chicken. Avoid eating anything which requires a lot of pressure between your teeth or that you must chew for prolonged periods of time.
At this time the splint has usually been removed and you will find it is much easier to eat. However, remember that it will be a few more weeks until the jaw is completed the initial phase of healing and common sense dictates that food still be somewhat soft and cut into small pieces. Foods such as pizza, apples, tough meat, etc. should be avoided until at least 10 weeks after surgery . Changes in your diet as well as the use of pain medicine may cause constipation. If you have not had a bowel movement within 2 or 3 days after surgery you should begin to add fiber to your diet. Start by taking Metamucil® (1 teaspoon mixed with 8 ounces of water 3 times per day). If this does not help within a day or two, call our office and we can suggest other medications.
Usually some types of elastics (small rubber bands) are used during the time immediately after surgery. These rubber bands are placed around small hooks on the braces or arch wires. The purpose of these small elastics is to help train you to bite into the new jaw position and to limit jaw function. Generally there is a plastic splint wired either to the upper or lower jaw. This splint has small indentations for each tooth to bite into. With the elastics in place and your teeth together, you should see that the teeth fit together into the grooves in the splint.
- The elastics should be worn at all times except when eating . They should be placed in the manner shown to you during your last appointment.
- The elastics should be removed during eating, but should be replaced immediately after you clean your teeth.
- Elastics should be changed to new ones once or twice each day as they will become stretched after being worn.
It is extremely important for you to keep all areas inside your mouth clean after surgery. You should brush your teeth and rinse your mouth after eating. Since you will most likely be eating small meals five or six times a day you will need to clean your teeth at each of these intervals.
During the first week after surgery be careful while brushing your teeth to keep the bristles of the brush on or very near the teeth and braces. You may have some soreness and difficulty opening your mouth which may prevent you from brushing the tongue side of your teeth. However, this will improve in time, and you should be able to accomplish this without difficulty within the first week to ten days after surgery.
Each time you brush your teeth place a small amount of toothpaste on the toothbrush and brush all areas of the braces on top and bottom. Also brush all around the splint as best as you can.
Rinse your mouth thoroughly with warm salt water (8 oz. water to 1/4 tsp. salt) for 5-7 days after surgery. Do not use a water pik or electric toothbrush inside your mouth for the first week after surgery.
At seven days after your surgery you can beginusing a water pik if you have one. The importance of cleaning your teeth cannot be overemphasized. This must be done thoroughly, several times each day.
In many cases there will be some type of pressure dressing or bandages that will be applied to help reduce swelling and bleeding.
- Elastic facial dressing (jaw bra) : This elastic bandage should be kept in place as much as possible for the first 24 hours. After the first day this bandage is not essential but may help reduce swelling more quickly. Wearing this dressing at night will also help reduce swelling that may occur when lying down. Note: Keeping the head elevated on an extra pillow or two during the first several days will help prevent further swelling.
- Sutures : If you had lower jaw surgery one suture may be placed on each side of your face. These will be replaced with a steri strip during your first visit to the office. These can be removed two or three days after surgery.
- Tape : If you had chin surgery you may have some tape over the chin area. This can be removed three or four days after surgery.
- Ice : Ice can be used for the first 24-48 hours after surgery to reduce swelling. To apply ice to the upper jaw (across cheeks and bridge of nose), you may find it is easier to use a frozen bag of peas or corn as it will mold to the face. For the lower jaw, ice packs can be applied 20 minutes on, 20 minutes off as needed
- On the third to fourth day after surgery: These are most often considered the worst days for discomfort. From this point on, warm moist heat and massage should be used as needed. Warm, moist compresses or towels can be used around the face with light, circular pressure or massage.
Following surgery you will find that your energy level is much lower. This will take some time to return to normal. When you attempt to return to normal physical activity start slowly and work up to your normal level. Physical exercise such as walking or running can begin 2 or 3 weeks after surgery. Begin by going shorter distances and at a slower pace than usual to be sure you feel up to the exercise. As your endurance and confidence increase gradually increase the level of exercise within a level of comfort.
In the past, and occasionally at the present time, teeth must be wired together after surgery. This allows the jaw bones to be held still while healing. Most of the time, however, small bone screws and plates are used to hold the bones together during the healing period. With the use of these screws and plates the jaws can be moved slightly during the postoperative period. It must be remembered that the bones are not healed and are simply being held together by the screws and plates. Therefore, we encourage a gradual progression of movement and use of the jaws, keeping in mind that complete healing does not take place until approximately two to three months after surgery.
- Immediately following surgery: Since surgery causes soreness in the muscles and bones of your jaw, movement may be difficult initially. We do not recommend any specific exercises during the first week to ten days after surgery. However, simply attempting to open your mouth and move your jaw side to side several times a day may help increase movement.
- Ten days to four weeks after surgery: Stand in front of a mirror and attempt to open and close your jaw as much as possible. At ten days after surgery you should be able to get one finger in between your teeth, and this should increase to two fingers by four weeks. Simply move your jaw forward and backward, side to side, and open and close, attempting to increase your mouth opening with your jaw muscles only. Moist heat placed on the side of your face before and during these exercises may make them more comfortable and more effective. Do not use finger pressure on your teeth to help stretch your jaw opening at this time.
- Four to eight weeks after surgery: During the fourth to eighth week after surgery you should be able to get two fingers in between your front teeth very comfortably and can begin using very gentle finger pressure between the back teeth on each side of your mouth to help gently stretch your jaw muscles. Again, doing these stretching exercises as well as moving your jaw side to side and forward and backward will help. Moist heat can also be used at this time. Use of a millimeter ruler to help measure jaw opening will help you monitor your progress and improvement. By the eighth week you should be able to place three fingers between your front teeth. It is also very important to move the muscles used for facial expressions.
As you can see, recovery from surgery requires a lot of effort on your part. We will be happy to answer any questions regarding diet, hygiene, elastics, exercise, or any problem which may be of concern to you. Remember, postsurgical progress is sometimes uncomfortable and may occur slowly. However, with some determination and attention to these instructions, you can maximize your healing process.
If you have any questions regarding your postoperative recovery, please do not hesitate to call us.