After Orthognathic sx or Repair of Jaw Fractures.

Definition:

Orthognathic surgery is a surgical correction of the skeletal anomalies or malformations involving the mandible (lower jaw) or the maxilla (upper jaw). These malformations may be present at birth or they become evident as the patient grows and develops.

Due to orthognathic surgery or a jaw fracture, your jaw may be immobilized to heal properly. In order to do this, your teeth may be wired or have elastic bands placed on them to hold your jaw/bite in place. Chewing foods will create mobility between the bones that will prevent them from healing leading to infections and other serious problems which may require additional surgery, so even if your jaws aren’t wired together you will generally be on a liquid diet for 4-6 weeks.

Items to purchase prior to Surgery:

  • Protein shake powder or supplements
  • Liquid multi-vitamin supplement
  • Blender
  • Small, child size soft toothbrushes
  • Small suction bulb such as those used for infants.
  • Mouthwash without Alcohol (Biotene)
  • Small Dry-erase board and pens.
  • Afrin Nasal spray.
  • Saline nasal spray (Ocean spray)
  • Lip Balm
  • Small facial Humidifier. (optional)
  • Small Tweezers or surgical clamps
  • Liquid stool softener or laxative.

Wound Care:

  • Oral hygiene is very important while your jaws are wired or banded. Keeping your mouth and teeth clean will help you heal better and reduce the chances of developing infections or cavities.
  • After each meal, brush your teeth with a soft bristled toothbrush (child size works well). Stand over the sink with your head tilted down and use a circular motion and angle the brush at 45 degrees toward the gum line. Use Peridex or a mouth wash without alcohol such as Biotene instead of toothpaste. Brush to the best of your ability and take your time. You may not be able to brush the inside of your teeth.
  • Rinse your mouth with a solution of warm salt water (1 teaspoon salt in one 8 oz glass of warm water). Oral rinsing should be done after every meal.
  • A moistened Q-tip or cotton swab may be used to wipe over the gums and tooth surfaces when brushing is impossible. You may follow brushing with a mild fluoride mouthwash to leave your breath and tongue feeling refreshed. Avoid use of products such as lemon glycerin swabs and commercial mouthwashes containing alcohol (these products can have a drying or irritation effect on the mucous membranes in the mouth(.
  • Use an oral water-pik ONLY if ordered by your surgeon.
  • Avoid dry cracked lips by using Aquaphor, Blistex, Carmex, Vitamin E or Vaseline.
  • For protruding wires that are irritating in the mouth, warmed bees wax or orthodontic wax may be applied to the end of the wires (wax should be removed before eating and brushing teeth).
  • If any skin incisions were made, clean them with 50% peroxide-water solution, remove scabs and apply neosporin.
  • Keep your facial skin clean and moisturized
  • Do not smoke (smoking also dries and irritates oral mucosa). Avoid alcohol which can cause nausea and dehydration.
  • Sleep with your head elevated on two pillows or in a comfortable recliner chair for the first week following surgery.
  • Numbness in the lower jaw and chin will occur after lower jaw fracture or surgery and in the upper jaw and along the nose and lip following an upper jaw fracture or surgery. Avoid excessive heat, cold or sharp items to prevent injury to the area.
  • If your jaws are wired together, have the wire cutters on your person at all times.

Pain

Most patients undergoing orthognathic procedures by our doctors are surprised at the lack of significant discomfort following surgery. Adult patients with moderate pain may take 600-800mg of liquid ibuprofen every three to four hours. Most patients are comfortable with this regimen. Please contact our office for instructions or if you have any questions prior to taking any medications.

For severe pain, take the medication prescribed as directed. The prescribed pain medicine will make you sleepy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, or at any time you feel the level of pain is not managed with the above medications you should call the office. Narcotic pain medications may cause constipation please alert your doctor if your are faced with this minor problem.

Do not wait for severe pain to take medication. As soon as you feel any beginning of discomfort start with the above regimen. Severe breakthrough pain is very difficult to overcome.

Swelling

The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is very common. This is the bodys normal reaction to surgery and eventual repair. The swelling will not become apparent until 1-2 days following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 48 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of gentle moist heat to the sides of the face is beneficial in reducing the swelling and stiffness. Sleep with your head elevated on two pillows for the first week.

Diet:

Maintaining a healthy diet following your surgery is your primary responsibility. You must continuously feed yourself during the day in order to achieve appropriate protein and caloric intake. Feeding must be done continuously due to feeding difficulties you will experience immediately following these type of procedures.

You can reduce the risk of dehydration and keep secretions thin by drinking at least ten 8 oz glasses of fluids a day. Follow a high protein, high calorie blenderized liquid diet. Calorie and protein supplements can be used and are encouraged. Products such as Ensure, Carnation and Boost are recommended. Protein powders are more affordable and just as effective as premade caned supplements such as those mentioned above. Protein powders can be purchased at health-food stores and most supermarkets. Increased protein intake after surgery is vital for maintaining the body’s protective systems and for building healthy new tissue. You will lose between five and ten pounds during the first couple of weeks as your body adjusts to the diet change. You may eat anything blenderized that has a pourable consistency. Our office also will supply you with written diet instructions prior to surgery.

Remember snacks! Juices, smoothies, puddings, yogurt etc.

Activity:

For the first 3-4 days following surgery please limit your activity. It is important that you not confine yourself to bed. Try to spend most of the day sitting in a comfortable chair and taking short walks around the house. You should limit your visiting hours to 1-2 hours. Although you may feel well, you have had a major procedure and your body needs to recover. Uninterrupted rest is very important in your healing period. Do not participate in sports or strenuous activities, or return to work until permitted by your surgeon. Driving any motorized machinery or vehicle or signing any legal documents while taking pain medications is not recommended. The pain medications may cause alterations of visual perception and impair judgment.

Exercises

Most often following these type of procedures, teeth must be kept together with wires or elastics after surgery. This allows the jaw bones to be held still while healing. Most of the time, however, small bone screws and plates are used to hold the bone segments together during the healing period. With the use of these screws and plates the jaws can still move slightly during the post-operative period. It must be remembered that the bones are not healed and are simply held together by the screws and plates. Therefore, we encourage a gradual progression of movement and use of the jaws, keeping in mind that complete healing process does not take place for approximately two to three months after surgery.

  1. Immediately following surgery: Since surgery causes soreness in the muscles and bones of your jaw, movement will be difficult initially. We do not recommend any specific exercises during the first week to ten day after surgery.
  2. 10-14 days following surgery: Stand in front of a mirror and attempt to open and close your mouth. At ten days you should be able to get at least 1 finger between your teeth. This will increase gradually in the next several weeks. Simply move your jaw open and closed then side to side. Moist heat to the side of your face prior to these exercises can be beneficial. Do not use your fingers to force open your jaw.
  3. 4-8 weeks after surgery: At this time you should be able to get 2 fingers between your teeth comfortably and can begin using gentle finger pressure to stretch your jaw muscles. By week 8 you should be able to get 3 fingers between your teeth. Again, stretch the muscles open and closed as well as side to side.

Breathing difficulty:

Following your procedure you will develop difficulty breathing through your nose. This is a transient problem that peaks at about day 3-4. Although this period can be frustrating for the patient, the instructions below will be helpful.

  • You may feel that your airway passage is being blocked by the swelling but be assured that there is plenty of airway patent to breathe through. If concerned please remain calm and call our office.
  • Limit your activity to reduce post-operative swelling and bleeding.
  • Dried blood in the nasal passages is best cleaned by spraying of saline spray and gentle suction with the bulb. Repeat this process as needed until nasal passages are free of dried blood.
  • You may use a facial humidifier or steam in the shower to help loosen nasal secretions prior to suctioning.
  • DO NOT blow your nose following surgery for a minimum of two weeks.
  • Use Afrin nasal spray as directed by your surgeon.
  • Sleep with your head elevated on two pillows for the first week.

If, after your procedure, you have any questions or concerns please feel free to contact us at: Ventura Office Phone Number 805-648-5121 or Ojai Office Phone Number 805-646-2944.