Orthognathic surgery is a surgical correction of skeletal anomalies or malformations involving the mandible (lower jaw) or the maxilla (upper jaw). These malformations may be present at birth or they may become evident as the patient grows and develops.
After orthognathic surgery or a jaw fracture, your jaw may be immobilized so it can 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 that 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:
Unfortunately, most oral surgery is accompanied by some degree of discomfort. Acute pain management should always start with over-the-counter pain medications, such as acetaminophen (Tylenol®) or ibuprofen (Motrin®, Advil®). If your surgeon approves these medications for you, you should take them as directed on the pill bottles, or by your surgeon. If you take the first pill before the anesthetic has worn off, you will be able to manage any discomfort better. Precede each pain pill with a small amount of food, and chances for nausea will be reduced.
The effects of pain medications vary widely among individuals. For severe pain, you may take your prescription opioid (narcotic). Do not take more opioid pills, or more often, than prescribed by your surgeon. If prescribed, Vicodin® / Norco® may be taken every 4-6 hours for pain. DO NOT USE TYLENOL. If you notice that the pain medication is not providing comfort for long enough, alternate the Vicodin / Norco and Ibuprofen throughout the day (ex: take 1 Vicodin, then 2 hours later, take ibuprofen…2 hours later another Vicodin / Norco). If you are unable to achieve a comfortable state, please call us for further advice. Do not drive or drink alcohol while you are taking opioids. Do not use opioids with benzodiazepines, sleeping medications, or other depressants. If you have any questions, ask your surgeon or any pharmacist before using these medications together as they can increase your risk of an accidental overdose.
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 body’s normal reaction to surgery. 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 side 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.
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 difficulties you will experience immediately following these types of procedures.
You can reduce the risk of dehydration and keep secretions thin by drinking at least ten 8 oz glasses of fluid a day. Follow a high protein, high calorie 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 canned 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 will also supply you with written diet instructions prior to surgery.Remember snacks! Juices, smoothies, puddings, yogurt, etc.
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 time 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.
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 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 screws and plates. Therefore, we encourage a gradual progression of movement and use of the jaws, keeping in mind that complete healing does not take place for approximately two to three months after surgery.
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, the instructions below will be helpful.
Give us a call with any questions or concerns at 805-648-5121.