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. Regardless, be assured that there will be experienced and caring nurses and staff to your needs. When you wake, 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 will be held together with elastic or wires. In the unlikely even 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 our your nose. You will not choke. There is no need for you to take wire cutters home with you although you will be supplied with them. Many of these things can cause you to fell uncomfortable or even panicky. Remember to relax and listen to the staff – you are in no danger.
You will be positioned with your head up. This will help minimize swelling. This “heads up” position should be used for the first 7-10 days to help reduce swelling. Expect the peak of your swelling to occur 48 hours after surgery and most should be gone in 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. Pending 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. 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 20 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 q-tips 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.
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 fluently 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 lip 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.
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 given in pill 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 intravenous methods. You will regulate the amount of pain medication you are given. It must be emphasized that this route of administration is only used while you have the intravenous, which is approximately 24 hours. 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 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. Both the oral pain medication and antibiotics will be taken orally.
This is an important part of your surgery. This will help your bite and train your muscles to function in the new jaw position. It should work full-time except when you are eating or cleaning your mouth. It has indentations on it that fit the teeth on the top and bottom and thus will only fit one way. Generally, the splint will be worn continuously for the first 6-8 weeks following surgery. We may elect to discontinue the splint use early, especially in the upper jaw surgery alone. However, the splint should be expected to be worn for at least 8 weeks. Your orthodontist may continue to use the splint for a short period of time to assist treatment. Failure to wear the splint may cause pain or may result in significant change of the bite! The splint will also help reduce jaw joint pain.
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. 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.
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) 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! Also, brush your splint when doing your oral hygiene. 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.
For a brief 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. 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.
You can resume light physical activity 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 hip area feels comfortable with exercise.
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 that just a slow oozing, inform us immediately so that we can evaluate as soon as possible.
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.