Cincinnati Oral & Maxillofacial Surgery, Inc.
Oral Surgery
(513) 451-7300/ (812) 539-4105 (800) 272- 2978
Fractured Jaw
Fracture Surgery Post Operative Instructions
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.
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.
Remember- your jaws will be held together with elastic or wires. In the unlikely event vomiting occurs, it is most important to position yourself properly rather than take the elastics off. If you are sick, 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. You will need to have wire cutters or scissors at home with you although you will most likely not need to use them. If you feel the need to cut the elastics or wires, cut them out then give us a call so that we can arrange to replace them.
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.
Remember- your jaws will be held together with elastic or wires. In the unlikely event vomiting occurs, it is most important to position yourself properly rather than take the elastics off. If you are sick, 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. You will need to have wire cutters or scissors at home with you although you will most likely not need to use them. If you feel the need to cut the elastics or wires, cut them out then give us a call so that we can arrange to replace them.
Swelling
You will be positioned with you 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 selling to occur 48 hours after surgery and most should be gone 7-10 days. In the hospital, the bed will be flexed in the middle to prevent you from sliding to the foot of the bed. 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. The amount of 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. Ice packs will also be used. Constant use for the first 12-24 hours in most effective. The nurses will assist you with ice packs, which should be applied for 20 minute and removed for 20 minutes.
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.
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 Afrin nasal spray or equivalent can be used 2-3 time per day for the first few days after surgery. Use only as necessary. Saline nasal spray, e.g., Ocean Mist, can be used as often as you want. Cleaning of the nose with Q-tips and hydrogen peroxide may be helpful if you have dried, crusted secretions in your nostrils. If you have had upper jaw surgery, DO NOT blow your nose for the first two weeks after 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.
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 Afrin nasal spray or equivalent can be used 2-3 time per day for the first few days after surgery. Use only as necessary. Saline nasal spray, e.g., Ocean Mist, can be used as often as you want. Cleaning of the nose with Q-tips and hydrogen peroxide may be helpful if you have dried, crusted secretions in your nostrils. If you have had upper jaw surgery, DO NOT blow your nose for the first two weeks after surgery.
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, inform us immediately so that we can evaluate as soon as possible.
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 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 FLUID IS ESSENTIAL FOLLOWING SURGERY.
Medication
Several medications will be used around the time of your surgery. Antibiotics will be given during your hospital stay through the intravenous line. Upon your discharge from the hospital, these antibiotics will be given in pill form.
Pain medication will also be given after your surgery. In the hospital, following your surgery, the pain medication may be administered through intravenous methods. 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 pill or liquid form. In general, there is less pain than most would anticipate with this surgery. Due to the dysfunction of the sensory nerve in the areas of the trauma, this may minimize your ability to feel discomfort. Both the oral pain medication and antibiotics will be taken orally. Check with your physician, concerning any medications that you normally take. There may be liquid alternatives, or you may be able to crush and dissolve your normal medications.
Pain medication will also be given after your surgery. In the hospital, following your surgery, the pain medication may be administered through intravenous methods. 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 pill or liquid form. In general, there is less pain than most would anticipate with this surgery. Due to the dysfunction of the sensory nerve in the areas of the trauma, this may minimize your ability to feel discomfort. Both the oral pain medication and antibiotics will be taken orally. Check with your physician, concerning any medications that you normally take. There may be liquid alternatives, or you may be able to crush and dissolve your normal medications.
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 2-3 weeks. If the pain medication is not taking the pain away, let us know and an anti-inflammatory medication may be prescribed.
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 the intervals. Rinse with warm salt water (1 tsp salt in a warm glass of water) three times a day. Rinse with Peridex mouth rinse two times a day. 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. Do not use a waterpick! 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. A small toothbrush will help make oral hygiene less difficult.
REMEMBER: The importance of cleaning your teeth and mouth cannot be over emphasized. 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.
REMEMBER: The importance of cleaning your teeth and mouth cannot be over emphasized. 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
Adequate nourishment is important during your initial healing period, especially when your teeth are wired or banded together. Your diet will consist of milkshakes, soups, and juices. Many liquid food supplements are also available such as Ensure, Sego, Metrecal, Sustagen, Boost, Carnation Instant Breakfast and others. A blender or food processor is useful to puree solid food for intake. Dilute foods with water, broth or milk to a suitable consistency. A large plastic syringe with a rubber tip will be provided by the hospital. This may increase your ability to take adequate nutrition. After using the syringe to eat, clean it with dishwashing soap and water. Do not put it in the dishwasher as this may cause it to melt. Prior to using it again, apply butter, margarine, or olive oil to the black rubber stopper to allow it to slide smoothly. Five or six small feedings each day are usually easier than three larger ones. Your oral intake should be at least 8-10 cups of fluid each day. A general rule is to maintain a minimum of 2,000 calories per day to avoid losing weight. It is important to keep well hydrated as well.
For a period of time following surgery it is likely that your jaw will be held together with either elastics or wires. This allows the bones to heal while they are being held still. Do not attempt to force your teeth apart to eat during this time. In some cases, we use bone plates and screws to hold the bones still to assist in healing. Support may also be given by the splint and elastic traction. This allows early movement and function of the jaws during the early healing period. You may be instructed on the use of "training" elastics after surgery. It must be remembered, however, that the bones are not completely healed and are being stabilized only by the screws and plates. After your teeth have been released from tight fixation, it will be easier to take adequate nourishment but you should not attempt to chew foods until your jaws are healed (for a minimum of 6 weeks after surgery). Anything that you can eat without chewing is encouraged. Attempting to chew too early could cause the bony segments to move and not heal properly, and could require additional treatment. 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.
For a period of time following surgery it is likely that your jaw will be held together with either elastics or wires. This allows the bones to heal while they are being held still. Do not attempt to force your teeth apart to eat during this time. In some cases, we use bone plates and screws to hold the bones still to assist in healing. Support may also be given by the splint and elastic traction. This allows early movement and function of the jaws during the early healing period. You may be instructed on the use of "training" elastics after surgery. It must be remembered, however, that the bones are not completely healed and are being stabilized only by the screws and plates. After your teeth have been released from tight fixation, it will be easier to take adequate nourishment but you should not attempt to chew foods until your jaws are healed (for a minimum of 6 weeks after surgery). Anything that you can eat without chewing is encouraged. Attempting to chew too early could cause the bony segments to move and not heal properly, and could require additional treatment. 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.
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. Initially, your opening will be fairly limited. We do not recommend any specific exercises during the first 4-6 weeks after your surgery. Typically, it will take 4-6 months for jaw opening to return to normal.
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 6-8 WEEKS FOR INITIAL HEALING OF YOUR JAW OR JAWS AND 4-6 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!
REMEMBER: IT TAKES 6-8 WEEKS FOR INITIAL HEALING OF YOUR JAW OR JAWS AND 4-6 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 as soon as you feel able following your surgery. We generally request limited "Bed Rest" exercise for the first week following 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 other 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 4-6 weeks before the his area feels comfortable with exercise.
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 several 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 us at any time with questions.
Office: 513 451-7300, 812 539-4105
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 several 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 us at any time with questions.
Office: 513 451-7300, 812 539-4105