Instructions Following Jaw (Orthognathic) Surgery

Discharged To Home

You will be discharged home once you are comfortable swallowing liquids and are able to stay comfortable with oral pain medication. All patients feel discomfort or pain after an operation, although the level of pain varies from patient to patient. Take your pain medications as directed.

When you go home, it is important that a responsible adult spends the first night with you.

You will be able to shower on the second day after surgery. Avoid hot, prolonged showers which may cause bleeding in the upper jaw if surgery is performed there.

Avoid exercises, any heavy lifting or activity that raises your blood pressure or pulse for at least one month after the surgery. The blood vessels are still healing from the surgery and any increase in activity may cause bleeding. You may begin gentle exercise (e.g. walking on a treadmill) after 2 weeks, but do not do any cardio for 4-6 weeks after the surgery.

Do not drive a vehicle or perform any task that requires coordination or judgment for at least 48 hours following your anesthetic.

Bleeding

It is common to experience minor bleeding or oozing for 7-10 days after the surgery. You can use a moist gauze to apply pressure to the bleeding site. If you have had upper jaw surgery, you may also notice bleeding or clots coming out from your nose (or post-nasally). A saline nasal spray is very helpful in keeping your nasal passages clear. DO NOT BLOW YOUR NOSE.

Please call your surgeon if there is excessive or active bleeding, or if you have any concerns.

Swelling

You can anticipate a large degree of swelling over your cheek area as well as under your jaw. The swelling is maximal at Day 4 and will slowly subside after 2 weeks. About 80% of the swelling will be gone by week 6, the remaining 20% will take about 6 months to resolve.

You should place ice on your face while you are awake for the first 3 to 4 days. The ice will also have a numbing effect that will help reduce post-operative sensitivity. You must be careful not to apply too much ice directly on the skin, alternate locations every 20 minutes. After Day 4, a warm water bottle is then recommended to help reduce swelling.

Nausea and Vomiting

It is not uncommon to have some nausea and vomiting after surgery, especially in the first 24 hours. Importantly, this is not a life-threatening situation, even if your jaws are closed with elastics.

Remain calm, and turn your head to the side so that any fluids pass freely. Rinse your mouth afterwards. Most people will usually feel better after vomiting, and find that the nausea passes. If you need to, you can cut your elastics to allow you to open your mouth. Call your surgeon immediately.

If nausea and vomiting persist, please contact your surgeon .

Medications

You will usually be prescribed an antibiotic, pain medication, and mouthrinse after surgery. Use them as instructed on the bottle.

Vitamin C: continue with the 1000mg/day supplement for 30 days post-op.

Diet

It is very important to follow a proper diet plan after surgery, as your body will be healing and will need nutrition and calories. Nevertheless, it is not unusual to lose 5-10 lbs after surgery.

A suggested diet is:

• The first 3 weeks should be liquids only. Taking adequate amounts of fluid after surgery is essential as it helps your body to heal. Suggestions include any clear fluids (water, soft drinks, Gatorade, clear soups) and milkshakes, ice cream, Soya milk drinks, yogurts, protein drinks and protein supplements as well as nutritional supplements (such as Ensure, Boost, Whey, protein powders, tofu), or anything you can drink from a blender.
• After 3 weeks, you can commence a non-chew food diet. A recommendation is to eat food that you can easily squish between your fingers and anything that does not make any noise (ie hard or crunchy foods). Examples include mashed potatoes, scrambled eggs, fish, over-boiled/soft pastas cut into pieces etc.
• After 6 weeks, you can progress to a soft-chew diet. Portions should be small and cut into pieces to avoid placing too much pressure on the jaw. Soft fish dishes are excellent.
• After 6-8 weeks, you can progress to more normal chewing. However, continue to avoid overly hard foods or placing too much pressure on the jaw. Avoid pizza, apples, tough meats etc, until at least 3 months after surgery.

It is important that you don't chew too vigorously or with very much force, and you should avoid anything at all that is hard, including tough meats, candies, popcorn, pretzels, peanuts and other nuts

Hygiene

The amount of swelling that will take place in your cheeks will make it very difficult to brush your teeth. Do not brush your teeth for 1 full week after surgery to avoid damage to the incisions and increased risk of bleeding. You should use warm saline rinses (1/2 teaspoon salt in a tumbler of warm water). You can rinse your mouth with salt water as often as you would like, even up to every 2 hours. You cannot do enough rinses. This will keep your mouth nice and clean and will also tend to shrink the incision lines inside the mouth. You may also be given a prescription for Peridex, an antibacterial mouth rinse, which you should use as instructed on the bottle.

Swelling begins to lessen after about 1 week, and you will have easier access inside your mouth. Purchase a new baby toothbrush and, using a small amount of toothpaste, concentrate on brushing the metal braces. You should gently but thoroughly clean your braces, wires, teeth, and any plastic splint that is on your teeth. Be careful not to injure the wounds with the head of the toothbrush. If you do hit the wounds, there may be a little bleeding, but this is normal and should not cause any worry. Also continue to rinse your mouth with salt water regularly. Avoid showering for the 2 days after surgery, although taking a bath is fine provided you do not get your facial incisions wet. After 2 days, feel free to shower, provided that the water is not too hot, as this may encourage bleeding following upper jaw surgery.

Bruising

Bruising is also quite normal after jaw surgery. Depending on which jaw was operated on, you may have bruising in the area of your upper cheek and eyes as well as your lower cheeks and down into your neck. It is not unusual to have some bruising extend all the way onto your chest. The bruising is unsightly and disconcerting, but you must understand it is perfectly normal and should not be of any concern. It will go away after about 2 weeks.

Nasal Congestion

Nasal congestion is normal after surgery, especially if you have had upper jaw surgery. DO NOT BLOW YOUR NOSE FOR 2 WEEKS AFTER SURGERY.

Use a saline nasal spray to loosen things up. Any nasal secretions that become crusty can be removed with a moist wipe, or with a Q-tip soaked in a 1 part hydrogen peroxide to 1 part water mix. Avoid placing anything into your nose to clean it, as damage can occur, especially following upper jaw surgery.

Jaws Closed with Elastics

If your jaws are held shut with elastics after surgery, you will be provided with scissors to cut the elastics in the case of an emergency (eg car accident). You will be taught which elastics need to be removed, and how to remove them in the case of an emergency.

During the course of healing, some of the elastics around your teeth or jaws may loosen or break. This is not an emergency, but should be replaced as soon as possible. Call the office.

Jaw Opening

It is normal to have decreased opening after jaw surgery. Do not attempt to force your jaws open with your fingers.

After 2 weeks, you can begin to do simple jaw exercises. 3-4 times per day, simply try to open/close your jaw, move it side to side, and forward and back. This will be difficult at first, but will improve with time.

Other Findings

Most patients will have a numb sensation of the lips, cheeks, teeth, and jaws, depending on whether upper or lower (or both) jaw surgery was performed. This is normal, and will usually resolve over the course of a few weeks to months with healing. The numbness does not affect the movement of your face.

You may have some altered sensation to your hearing due to some of the swelling extending into the area of the ear. This numbness or muffled sound is not unusual and you should expect some of it. You may also experience some joint noises on the right and left hand side. Your joints need to get accustomed to their new position.

It may be difficult to speak after the surgery, or to be clearly understood. This will improve with time.

Activity

You should maintain minimal activity within the first week. You are able to walk and move about but you should not do any exercises, jogging or weight lifting, regardless of how well you feel. You will have lost some blood during the operation and you may be feeling weak or faint. This is not the time to try to get back into shape. It will take one month before you fully recover from the amount of blood loss and strength due to your surgery.

Avoid exercises, any heavy lifting or activity that raises your blood pressure or pulse for at least one month after the surgery. The blood vessels are still healing from the surgery and any increase in activity may cause bleeding. You may begin gentle exercise (eg walking on a treadmill) after 2 weeks, but do not do any cardio for 4-6 weeks after the surgery. Avoid any contact sport, any sport with a ball, or any aggressive sports.

Return to work or school

You may return to work or school when you feel able. However, most people usually take 1-2 weeks to recover from jaw surgery.

You will feel tired after surgery, but with good nutrition and rest your energy level should return to normal.

Follow-up

You will need to call the office for a follow-up visit between 4 and 7 days post-op.

EMERGENCIES: Life-threatening - CALL 911

If you have any other concerns, please call your doctor, or make an appointment to be seen in the office.