Postoperative Instructions - Major Jaw Surgery (Orthognathic, TMJ,Trauma, etc.)

The following information is provided to ensure that many of the details of postoperative care are covered prior to your surgical procedure. This ensures a smooth and uneventful recovery. It has been our experience that the more information and preparation patients have prior to their surgery, the more easily they are able to manage their postoperative care.

There are several aspects of your postoperative care which will require special attention. These areas of concern are listed below in the sequence with which you will have to manage them after your surgery. The following topics will be covered:

SWELLING

It is difficult to predict what you will remember immediately following surgery. You may remember waking up in the recovery room or you may not recall this event and only remember waking up in your room. Regardless, be assured that there will be experienced and caring nurses and staff to attend to your needs. When you awake, you may have some concerns. You will likely have a small oxygen mask lightly over your face; this is routine. If you have some fluids in your mouth or stuffiness in your nose, this will be removed with a small suction tube. Remember - your jaws may be held together with elastics or wires. Many of these things can cause you to feel uncomfortable or even panicky. Remember to relax and listen to the staff -you are in no danger. This resting of the jaw will help minimize swelling.

You will be positioned with your head up. This will help minimize swelling. This "head up" position should be used for the first 7-10 days to help reduce swelling. Expect the peak of your swelling to occur 48-72 hours after surgery and most should be gone by 7-10 days. At home, propping up your mattress at the head of the bed and under the foot of the bed will help also. Spending a lot of time in a "Lazy Boy" type chair is an excellent alternative. Remember, keeping your head above the level of your heart is what helps reduce and minimize swelling. How much swelling you will actually have varies significantly from patient to patient.

In the hospital, several additional aids will be used to help minimize your swelling. Medications will be administered to help decrease swelling. Ice packs will also be used. Constant use for the first 12 -24 hours is most effective. The nurses will assist you with ice packs which should be applied for 20 minutes and removed for 10 minutes.

Nasal swelling and stuffiness can also be a problem after upper jaw surgery. This will tend to be worse 48 hours after surgery and will then begin to decrease.

The use of nasal spray and special cleaning of the nose with Qtips and hydrogen peroxide will be reviewed with you prior to surgery. Warm packs to the face after the first 48 hours will help increase blood supply and reduce swelling, speeding the resolution of discoloration associated with bruising. If bruising occurs it will be evident 4-5 days after surgery.

Just a final word regarding your jaw surgery and safety. In the unlikely event vomiting occurs, it is most important to position yourself over a basin or toilet bowl and let the fluids pass between the spaces in your teeth and out your nose. You will not choke. The only reason to cut the wires is if you begin to choke.

DRINKING

Following jaw surgery there is frequently some numbness in the upper or lower lip, or both. When this is combined with facial swelling and soreness due to incisions inside the mouth, a task as basic as drinking may present difficulties. There are several tips which may help you:

You should be drinking a fair amount of fluid after jaw surgery. Daily amounts should be between 2 -3 liters. Fruit juices are an excellent source of fluid, especially apple juice. This is a major goal after surgery. The most frequent cause for a delay in discharge from the hospital is a lack of adequate fluid intake. Always have some fluids in front of you and drink frequently to consume 2-3 liters in 24 hours. The nurses will be encouraging you to drink early.
Attempt to drink from a cup if possible. While some fluids may be spilled when drinking in this manner, this is still the most effective way of taking fluids.
Place a small towel under your chin if necessary and place a small amount of fluid in your cup. Tip your head back slightly while pouring in the fluid slowly, a little at a time. Close the lips together and swallow. If you have difficulty with this, then try doing it in front of the bathroom mirror over the sink. You will find this gets easier the more times you drink.

REMEMBER: TAKING ADEQUATE AMOUNTS OF FLUIDS IS ESSENTIAL FOLLOWING SURGERY

MEDICATIONS

Several medications will be used around the time of your surgery. Antibiotics will be given during your hospital stay through the intravenous. Upon your discharge from the hospital, these antibiotics may be continued orally.

Pain medication will also be given after your surgery. In the first 24 hours following your surgery, the pain medication will be administered through intravenous. We always encourage you to use oral pain medication as soon as possible as this will expedite your discharge from the hospital and allow for a smoother transition. Upon your discharge from the hospital, your pain medication will be in oral form. In general, there is less pain than most would anticipate with this surgery. This is due to the dysfunction of the sensory nerve in the areas of surgery which minimizes your ability to feel discomfort.

PLASTIC SPLINT

Your surgeon may have placed a plastic splint attached to your upper jaw. This is an important part of your surgery. This will help balance your bite and train your muscles to function in the new jaw position. It has indentations on it that fit the teeth on the top and bottom and thus will only fit one way. Generally, the splint is left in place, when necessary, for the first 6-8 weeks following surgery.

JAW JOINT PAIN

It is possible to experience some pain or pressure in or around your jaw joint after jaw surgery. This may feel somewhat like an earache. This pain or pressure will usually disappear within 2 to 3 weeks. If the pain medication is not taking the pain away, let us know and an anti-inflammatory medication may be prescribed. The new position of your jaw is the cause of pressure in the jaw joint area.

JAW OPENING

Since jaw surgery causes soreness in the muscles and bones of your face, you will find some difficulty in moving your jaw normally after surgery. We do not recommend any specific exercises during the first week or ten days after your surgery. If your jaws are not wired shut, simply attempting to move your jaw side to side and opening slightly when you have your elastics off may help increase your jaw movement.

TEN DAYS TO FOUR WEEKS AFTER SURGERY
During the ten day to four week period after surgery, stand in front of the mirror and open and close your jaw 3-4 times a day when your elastics are off. A good time to do this is after you have eaten and cleaned your mouth. At this point you should be able to get one finger in between your teeth. By four weeks after surgery you should be able to get two fingers in between your teeth. DO NOT USE FINGER PRESSURE ON YOUR TEETH TO HELP STRETCH YOUR JAW OPENING AT THIS TIME. Your jaw is weakest ten days following your surgery. Simply move your jaw forward and backward, and side to side, and open and close, while attempting to stretch your jaw muscles. Moist heat placed on the side of your face before and during these exercises may make them more comfortable and effective.
FOUR TO EIGHT WEEKS AFTER SURGERY
During the fourth to eight weeks after surgery, you should be able to get two fingers between your front teeth very comfortably. Near the eighth week, you should be able to approach placing three fingers between the front teeth. At the sixth week you can begin using GENTLE finger pressure between the front teeth on each side to help gently stretch your jaw muscles, increasing your opening.

HYGIENE

As with any surgical wound, 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 each time after you eat. 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. Rinse with warm salt water (1 tsp salt in a warm glass of water) four times a day. Rinse with 1/2 warm salt water and 1/2 hydrogen peroxide once a day to help clean the wounds. Brush your teeth as usual, although it may be necessary to brush more frequently initially. The incision sites are above the gumline so brushing your teeth will not be a problem.

During the first week after surgery, be careful to make sure that while brushing your teeth the bristles of the brush stay 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 inside of your teeth. This probably will improve with time and you should be able to accomplish this without difficulty within the first week to ten days after surgery. A small toothbrush will help make oral hygiene less difficult.

REMEMBER: The importance of cleaning your teeth and mouth cannot be overemphasized. This must be done several times each day to keep the mouth and incision sites clean. This will help the wounds heal quickly without getting an infection.

EATING

In the past, and occasionally at the present time, teeth are wired together after jaw surgery. This allows the bones to heal while they are being held still. In the majority of cases today, we use small bone plates and screws to hold the bones still to assist in healing. Support is also given by the splint and elastic traction. This allows the jaw to move and function during the healing period of 8-12 weeks. It must be remembered, however, that the bones are not completely healed and are being stabilized only by the screws and plates. Therefore, we encourage a gradual progression of movement and use of the jaws, keeping in mind that adequate healing does not take place until approximately 8-12 weeks. REMEMBER: Your jaws are weakest at 10 days.

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. The following guidelines may be of help to you:

IMMEDIATELY FOLLOWING SURGERY TO DAY 10:
During this period the diet should be essentially non-chewing. This will minimize the stress on the plates and screws. This may consist of either blenderized food or fluids that don't require chewing. This can include soups, milkshakes, baby food, or any blenderized food. Some sort of diet supplement such as Ensure, Boost or a similar substitute may be used once or twice a day to increase calorie intake. Plenty of clear fluids, water, etc. will help clean the thicker fluids from your mouth and throat. REMEMBER: It is very important to eat as much as possible to help your wounds heal properly.
DAY 10 TO DAY 28 AFTER SURGERY:
Food during this period does not need to be liquid. It can consist of soft foods that require minimal chewing. This can consist of mashed potatoes, scrambled eggs, soft pasta that is cut into small pieces, soft rice dishes, or soft sandwiches that are cut into small pieces. One can also eat the foods that were eaten during the initial period. Light chewing can start during this period of time.
4 WEEKS TO 8 WEEKS AFTER SURGERY
At this point, chewing can be attempted. The food must be initially soft, progressing into softer meats such as hamburger and soft chicken. The portions should be small so as not to place too much force on the healing bones. Soft fish dishes are also excellent. You will find that your jaw will tire easily. This will continue for the first 2-3 months until your jaw muscles have accommodated for your new jaw position. Avoid eating food which requires chewing for prolonged periods of time.

RETURNING TO WORK

It will typically take 7-10 days of recovery before returning to work or school. This period may be shorter or longer in certain cases. You feel somewhat tired after your jaw surgery initially, but with good nutrition your energy level will soon return to normal. REMEMBER: IT TAKES 6 TO 8 WEEKS FOR INITIAL HEALING OF YOUR JAW OR JAWS AND 3 TO 4 MONTHS FOR A FULL BODY HEALING. If the jaw is hit or bumped early after your surgery, this may cause some shifting in the jaw and bite, SO BE CAREFUL!

PHYSICAL EXERCISE

You can resume light physical exercise as soon as you feel able following your surgery. The plastic splint should be worn at all times during exercise for the first 4-6 weeks after your jaw surgery. You should NOT participate in any exercise or sports that may involve hitting your jaw. These will include ALL CONTACT SPORTS, ANY SPORT INVOLVING A BALL, OR OTHER AGGRESSIVE SPORTS. You can resume light aerobic exercise, swimming, or running, as soon as you are able. Do not clench or stress your jaw muscles with heavy lifting or activity.

If you have had a bone graft from your hip area then you should resume any physical activity slowly and carefully. It may take 2-4 weeks before the hip area feels comfortable with exercise

BLEEDING

It is normal to experience some bleeding from the mouth for the first 7-10 days after jaw surgery. This should not, however, be excessive. It will usually stop within a few minutes. With upper jaw surgery you may experience some old blood from the nose for the first week after surgery. This will usually happen as you stand or bend over. If bleeding is more than just a slow oozing, contact your surgeon immediately. This, by the way, is very rare.

X-RAYS

X-rays will be required after your surgery. These will be typically done within the first few days after your surgery, then at three months, six months, and one year.

We hope that these postoperative instructions have been helpful for you. We encourage all patients to read these instructions at least once prior to surgery and keep them on hand for reference during the first week after their surgical procedure. We would also encourage family and friends who are involved in your care to read these instructions as this will help them make educated decisions regarding your care. Please contact our office at any time with questions.