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 my experience that the more information and preparation patients have prior to their surgery, the more easily they are able to manage their postoperative care.
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 are awake, you may have some concerns. You will likely have a small oxygen mask lightly over your face, and ice packs on your cheeks; 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. Some of these things may 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.
If you have had upper jaw surgery, you may have a small tube placed in the nose, which goes down into the stomach. This is in place to remove any blood from the stomach in the immediate postoperative period, which helps to minimize nausea after surgery. This tube may be removed the evening of surgery, or the following morning, depending on the amount of fluid which the tube is removing. This tube is usually easily tolerated, and its removal is very quick and easy.
You will be positioned lying in bed 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 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, cycling like this continuously. You may use the ice packs as long as is comfortable, but it does not have any beneficial effect on swelling after 3 days.
Nasal swelling and stuffiness can also be a problem after upper jaw surgery. This will tend to be worse 72 hours after surgery and will then begin to decrease. The use of nasal spray (Dristan or Otrivin Spray, 2 puffs each nostril twice per day for 5 days maximum; and Nasal Saline Spray, as much as desired for as long as desired) and special cleaning of the nose with Qtips and hydrogen peroxide will be reviewed with you prior to surgery. The Q-Tip is lightly moistened and used on the inside of the nostril to remove any blood clots, which will dramatically improve breathing through the nose. If bruising occurs it will be evident 4-5 days after surgery, and usually resolve within 2 weeks..
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. The only reason to cut the wires or elastics is if you begin to choke.
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:
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 will be continued orally in a liquid form.
Pain medication will also be given after your surgery. In the first 24 hours following your surgery, the pain medication will be administered through an intravenous. The nurses will encourage you to use oral pain medication early postoperatively as this will allow for a smoother discharge from the hospital. Upon your discharge from the hospital, your pain medication will be in an oral liquid form. In general, there is less pain than most would anticipate with this surgery. This is due to the numbness of the sensory nerve in the areas of surgery which minimizes your ability to feel discomfort.
You will also be given a steroid in the hospital to reduce swelling. You will receive an injection of a long-acting steroid at the time of discharge. This steroid will last approximately 36 hours, to help reduce your swelling. Some people may experience some mild depression/weepiness for 1-2 days once the effects of the steroid wear off. This is completely normal, and simply the effect of the medication wearing off.
The pain medication which has been prescribed to you likely has a narcotic component to it (We.e. Codeine, Oxycodone, etc.). While these medications are safe, they can cause constipation. Therefore, patients taking these medications should also be taking a combination of things to prevent and treat constipation (We.e. a Bowel Regimen). Some very effective suggestions including drinking prune juice, and taking over the counter medications such as Colace, Senekot or Lactulose. These are very safe to take with your pain medication, and should be taken as needed.
You may have 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 weeks following surgery. The splint is then easily removed in the office at that time – usually no local anesthesia is ever required, as it is a simple process to remove the splint – simply cutting some wires.
Most patients experience some numbness of the operated jaw immediately postoperatively. This is due to mild swelling of the sensory nerves with the respective jaw. In the upper jaw, this can include numbness of the roof of the mouth, gum tissue, teeth, upper lip and side of the nose. In the lower jaw, it can involve the teeth, gum tissue, lips and chin. This is actually beneficial postoperatively, as this limits the amount of discomfort which people experience with surgery. The overall length of potential numbness is mainly determined by the patient’s age, with higher risks being in middle-aged and elderly patients. This will be discussed by Dr. Butterfield with yourself preoperatively.
In general, most patients do not have elastics on their teeth immediately following their surgery. This is done for comfort, as some patients find it claustrophobic to have their teeth held together while awakening from anesthesia. The first week following surgery is usually without elastics on your teeth. At the first week visit following surgery, Dr. Butterfield will usually hold the teeth together (upper and lower) with elastics tightly to fine tune your bite. This is usually for 1 week only. Following this, you will usually need to only use the elastics at night to hold your teeth tightly together, and can usually only have 1 elastic on either side during the day; this facilitates eating and brushing.
If you had surgery on your lower jaw, you will have 2 very small neck incisions (each measuring 5mm) with sutures that will need to be removed in the office in 1 week. The dressing that is in place may be removed on the first postoperative day. The wound should be cleaned with ½ strength hydrogen peroxide and water, and a topical antibiotic placed (We.e. polysporin or neosporin). The wound does not need to be covered following the first postoperative day.
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.
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 held together with elastics, simply attempting to move your jaw side to side and opening slightly when you have your elastics off may help increase your jaw movement.
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 (1/2 tsp salt in a warm glass of water) six times a day. Rinse with 1/2 warm salt water and 1/2 hydrogen peroxide once a day to help clean the wounds for the first week postoperatively.
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. The incision sites are above the gumline so brushing your teeth will not be a problem.. You may have some soreness and difficulty opening your mouth, which may prevent you from brushing the inside of your teeth. This 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 6 times each day to keep the mouth and incision sites clean. This will help the wounds heal quickly lowering the risk of an infection.
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 sometimes by a splint and elastics on the teeth.. 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 postoperatively.
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:
You may shower during the first week, but should sit on a stool during the shower. This will lessen the likelihood of getting lightheaded in the shower. Alternatively, you may take a bath without restriction, unless you have had a bone graft taken from the hip (please see specific instructions in next section). The water should be luke-warm; the combination of narcotic-based pain medication, surgical stress, and hot water can drop your blood pressure, and you can get lightheaded or pass out. You should always have someone close-by while bathing for the first week.
If you have had a hip graft done, please note that the sutures will be placed under the skin, and will dissolve by themselves. The dressing may be removed the morning following the surgery, and should be left exposed to air from them on. The SteriStrips (small bandaids on the wound) will be removed in the office at your 1 week postoperative visit. Keep the wound fully dry for the first week following surgery. You may take a shower with the wound protected by a plastic bag and tape, but do not immerse the wound for 1 week.
You will need to begin walking on the first postoperative day, and should be walking at least a small amount every hour while you are awake for the first week – this activity will speed up your recovery. Anticipate not being able to return to normal physical activity for 3-4 weeks after surgery.
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, and may require several naps during the first postoperative week – this is completely normal. With good nutrition your energy level will soon return to normal.
You can resume light physical exercise no sooner than 1 week following your 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. If the jaw is hit or bumped early after your surgery, this may cause some shifting in the jaw and bite. Do not clench or stress your jaw muscles with heavy lifting or activity for 6-8 weeks after the surgery.
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, and is usually the result of old blood which is being mobilized out of your sinus cavities. If bleeding is more than just a slow oozing, or is bright red in colour, contact Dr. Butterfield immediately at the office during the weekday business hours, or on his cell phone at 613-852-4775 during evenings and weekends. This type of bleeding is very rare.
X-rays will be required after your surgery. These will be typically done in the office during the first postoperative visit, and intermittently thereafter as needed.
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 weeks 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.