After Orthognathic Surgery

The following information will help you and those caring for you after your jaw surgery. Please do not hesitate to contact us if you have any questions.

RECOVERY ROOM

After the surgical procedure, you will be taken to the recovery room. You may or may not remember your stay here. When you first wake up you will become aware of certain things. First, your jaws will be held together with elastics. Sometimes this can cause some anxiety in patients, but relax. You are in no danger. Try not to open your jaws against the elastics. Secondly, you may have a tube inserted in your nose which may be slightly irritating. This is to remove anything from your stomach to reduce the incidence of nausea. We will remove this tube when the oozing has stopped. Your head will often be wrapped in a “cold ice pack”. This pack is connected to a machine that automatically pumps cold water continually into the pack around your jaws. This takes the place of the ice pack and ensures that it is always cold and doesn’t create the wet drippy mess that comes with ice packs. You will also have a face tent that has humidified oxygen coming out of it and you may have a urinary catheter in place.

You will experience some nasal stuffiness and feel like you have a sore throat for a few days. This is from the intubation and is very common.. It will resolve within a few days.

After approximately an hour, you will be discharged from the recovery room up to the hospital floor.

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IN-HOSPITAL STAY

During your stay in the hospital, you will be under the care of nurses who are very well trained and experienced in handling orthognathic surgery patients. You will be closely monitored at all times. If you or your family have any questions or concerns, please do not hesitate to contact the nursing staff.

At the hospital bedside, there will be a suction apparatus set up for you to suction out your mouth. Your head will be elevated and we will continue with the cold ice pack as described above. This will help decrease the swelling.

You will be on several medications intravenously. Pain medication is administered through what is known as Patient Controlled Analgesia machine or PCA. This is controlled with a button that you can push when you need more pain medication, so there is no need to have to contact a nurse. The machine has a “lock out” control on it to reduce the risk of accidentally overmedicating. You will also have post operative antibiotics administered through the intravenous line as well as some medication to minimize your swelling.

You can begin to drink clear fluids after we remove the nasal tube. It may be challenging because in addition to the swelling, your lips will feel numb. The nursing staff will assist you in drinking by giving you some aids to help you drink. This will consist of a long tubing with a large syringe attached to it. Draw up the fluids you want to drink in the syringe and twist the end

of the tubing onto it. Insert the tubing along side your teeth until the end reaches the back of your cheeks. Now depress the plunger on the syringe and you should feel the liquid in the back of your mouth. You will also receive fluids in a zip lock bag that has a straw attached to it. You can squeeze the bag to help delivery of the fluids at a rate which is comfortable to you. Once you have mastered the clear fluids and we can progress to a full liquid diet which will also include shakes.

It is important to try to drink early. The most common reason for delayed discharge is because the patient is not drinking adequate volume of fluid. You should aim to have about 2-3 liters of fluid intake per day.

Patients often comment that they have nasal congestion after the surgery. This is temporary and you can use nasal spray that is prescribed for you. Try not to blow your nose if you have had upper jaw surgery. The nostril can be cleaned with Q-tips and diluted hydrogen peroxide if necessary.

After the first day, you will be encouraged to not only sit up in a chair, but to actually ambulate down the hallway. Discharge is determined when the patient is adequately taking in enough fluids and the pain level is controlled with oral pain medication.

Just a final word regarding your jaw surgery and safety.  First, the elastics can be easily removed by you.  In the unlikely event vomiting occurs, it is most important to position yourself properly rather than to try to 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.  For your safety, the hospital will discharge you with wire cutters or scissors which you should carry on you at all times.

DISCHARGE TO HOME

MEDICATIONS

Prescriptions for medications post operatively will be given to you before the surgery. They will all be in liquid form except for the Medrol Dosepack which is in very small pill form.

The level of pain is surprisingly low following this surgery. In fact, we discharge patients with the same medication we use for our third molar surgery patients! Usually the pain is very well controlled with a common pain medication like liquid Vicodin or sometimes with a liquid Ibuprofen which can be obtained over the counter.

You will also be prescribed liquid antibiotics. Remember that often liquid medication is prescribed for children so you will need to take relatively more. Be sure to follow the instructions carefully.

The Medrol Dosepack is to minimize the swelling and all the inflammatory effects of the surgery. The pack is a self-limiting course of a cortico-steroid. These pills are small and we recommend crushing them up and putting them in something like apple sauce, yogurt or pudding.

DIET

IMMEDIATELY FOLLOWING SURGERY UNTIL WEEK 4:

When you first arrive home after the surgery, the swelling and the numbness will make eating/drinking difficult. During this period, it is helpful to make the food/drinks a bit thinner. We advise patients to be creative about what they eat. Put foods through a blender or a food processor. It is sometimes difficult to find foods already in the liquid form, so creating your own pureed diet is helpful. Nutritional supplements are also helpful, such as Ensure or Sustacal.

In order to get an adequate volume of fluid and nutrition daily, it is usually necessary to eat smaller meals 5-6 times per day instead of the usual 3 times per day. We advocate “grazing” throughout the day.

After the splint is removed, there will be progressive times during your recovery that the elastics are allowed to be removed. Resist the urge to chew at this point. It must be remembered, however, that the bones are not completely healed and are being stabilized only by the screws and plates.  Therefore, we discourage actual chewing and 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.

WEEKS 4-6:

Food during this period does not need to be liquid.  It can consist of soft foods that require minimal chewing.  This can consist of mashed potatoes, scrambled eggs, soft pasta that is cut into small pieces, soft rice dishes, or soft sandwiches that are cut into small pieces.  One can also eat the foods that were eaten during the initial period.  Chewing can start during this period of time.

AFTER WEEK 6:

At this point, chewing can be attempted.  The food must be initially soft, progressing into softer meats such as hamburger and soft chicken.  The portions should be small so as not to place too much force on the healing bones.  Soft fish dishes are also excellent.  You will find that your jaw will tire easily.  This will continue for the first 2-3 months until your jaw muscles have accommodated for your new jaw position.  Avoid eating food which requires chewing for prolonged periods of time.

SURGICAL SPLINT

The surgical splint is custom made for your new bite. 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 2 weeks following surgery.  Dr. Jui will remove the splint after that time. The splint will also help reduce jaw joint pain.

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 the splint is removed and we begin jaw movement. We will instruct you when it is time to begin proper jaw exercises.   We do not recommend any specific exercises during the first week or ten days after your surgery.  Simply attempting to move your jaw side to side and opening slightly when you have your elastics off may help increase your jaw movement.

HYGIENE

As with any surgical wound, it is extremely important for you to keep all areas inside your mouth clean after surgery. Often patients find it useful to purchase a WaterPik device. You should brush your teeth (use the toothettes or a small kids’ toothbrush) and rinse your mouth each time after you eat. The elastics and the wires from the braces entrap a lot of food debris, so cleaning is essential. 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) at least four times a day.  The incision sites are above the gumline so brushing your teeth will not be a problem. If you use the curved syringe we give you, put it on each and every bracket to blast food particles out. If you have a waterpik, use it on the gentlest setting.

REMEMBER: The importance of cleaning your teeth and mouth cannot be overemphasized.  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.

RETURNING TO WORK

We usually advise taking between 2-3 weeks off 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 TO 8 WEEKS FOR INITIAL HEALING OF YOUR JAW OR JAWS AND 3 TO 4 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 exercise as soon as you feel able following your 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 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 2-4 weeks before the hip area feels comfortable with exercise.

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, go immediately to the nearest emergency room and have them contact Dr. Jui.  This, by the way, is very rare. Do not blow your nose for the first 3-4 weeks following surgery.

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 week 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 our office at any time with questions that are not clarified in this pamphlet.

If you are having a life-threatening emergency, please call 911.

If any questions or problems arise during normal business hours, please call our office at Newport Office Phone Number 949-760-1661. After hours, the doctor on call (Dr. Michaelis, Dr. Jui or Dr. Kriwanek) will return your call.