After Orthognatic Surgery
Orthognathic (jaw) surgery is done to move your jaws into a better position so that your teeth come together correctly. Post-operative care following jaw surgery is very important. Unnecessary pain and the complications of infection and swelling may be minimized if the instructions are followed carefully. Sometimes the after effects of surgery are quite minimal, so not all these instructions may apply. Common sense will often dictate what you should do. However, when in doubt, follow these guidelines or call our office any time for clarification.
Immediately Following Surgery:
- The gauze pad placed over the surgical area should be kept in place for 30 minutes and changed at regular intervals until the bleeding subsides. Usually within 45 minutes to an hour, the bleeding will subside to a trickle. After the subsidence of bleeding, you can quit using the gauze.
- Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged. Gentle rinsing is encouraged BEGINNING THE DAY AFTER SURGERY. Peridex (chlorhexidine), which was provided, should be used at least 3 times a day. Put the Peridex in your mouth and rinse gently for 2 minutes. Warm water rinses are fine or ½ teaspoon of salt in 8 oz of warm water can also be used in addition to the Peridex.
- Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
- Restrict your activities the day of surgery and several days after the surgery. It is not unusual to require 10 to 14 days before you are feeling back to normal. No strenuous physical activity should be done for 6 weeks following the surgery. Also, a soft diet with very little chewing in important for 2 weeks.
- Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for further explanation.
- Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing. Stand up slowly to provide time to steady yourself. If you feel dizzy when you sit or stand, you should lie back down immediately to minimize the possibility of fainting.
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon up to 72 hours after surgery. Excessive bleeding may be controlled by first wiping any old clots from your mouth if present, then placing a gauze pad over the area and biting firmly for 30 minutes. If the gauze needs to be changed, the new gauze should be moistened with cold water, with excess squeezed out until the gauze is slightly damp, then placed in the mouth. Dry gauze will absorb any forming clot and will stimulate bleeding. As the bleeding subsides, each change of the gauze should be whiter and less red. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. Avoid bending over and lifting anything greater than 3 pounds. Smoking, forceful spitting, and use of a straw can cause the bleeding to start again. Do not hesitate to call our office if you have any concerns about bleeding.
The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes, neck, and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until the day 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, ice packs, or small bags of frozen corn or peas should be applied to the sides of the face where surgery was performed. The ice packs should be used for 20 minutes on, 20 minutes off for the 1st 48 hours following surgery while awake. After the 48 hours, either ice or heat is permitted. Drinking plenty of cold fluids with crushed ice is also advantageous. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Forty eight hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling. Please note that it is important to keep your head elevated for 2-3 days following surgery to minimize swelling. A reclining chair works well to keep your head elevated.
For mild pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours. For moderate pain, take the Ibuprofen 800mg as prescribed. As a substitution for the prescription ibuprofen, you can use over the counter ibuprofen (Motrin or Advil) by taking two to four 200 mg tablets every 3-4 hours. You should not take more than 2400 mg of ibuprofen in any one 24 hour period which equates to three 800 mg tablets or 12 of the 200 mg tablets.
For severe pain, take the narcotic pain medication as directed. This prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages as they will enhance the effect of the narcotic. This is a dangerous combination. Pain or discomfort following surgery should begin to subside after the first four or five days. If pain persists, it may require attention and you should call the office. Do not routinely take Tylenol with prescription pain medications. Many prescription pain medications already contain Tylenol.
After general anesthesia, clear liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft but try to avoid chewing directly over the surgical sites. High calorie, high protein intake is very important. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Keeping well hydrated also prevents nausea and vomiting. Try not to miss a single meal. You will feel better, have more strength, less discomfort, and heal faster if you continue to eat. We recommend caloric supplements such as Ensure or an equivalent product. Two to three cans per day will help keep your strength and promote healing. Blenderizing the Ensure type products over ice usually makes them tastier, and the ice is usually soothing to the tissues. Remember to remove the gauze before eating. It is also advisable to avoid very hot foods or drink because you may have some numbness following the surgery. You can burn yourself and not know it. Please use the following guidelines for progressing your diet:
- IMMEDIATELY FOLLOWING SURGERY TO DAY TEN:
During this period, the diet should be essentially non chewing. This may consist of either blenderized food or very soft foods that don’t require much chewing. This can include soups, milkshakes, baby food, or any blenderized food. Some sort of diet supplement such as Ensure, or similar substitute may be used once or twice a day to increase calorie intake.
REMINDER: It is very important to eat a normal amount of food to help your wounds heal properly.
- DAY 10 TO DAY 21 (3 WEEKS) AFTER SURGERY
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, but you still need to be careful.
- THREE WEEKS TO SIX WEEKS AFTER SURGERY
At this point, an increased amount of chewing can be attempted. The food must be initially soft and progressing into softer meats such as hamburger or 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 to 3 months until your jaw muscles have accommodated to your new jaw position. Avoid eating food which requires chewing for prolonged periods of time on a single piece of food.
- AFTER SIX WEEKS
Chewing can now commence on a more normal basis. However, remember that it will be a few more weeks until the jaw is completely healed and common sense dictates that food still be somewhat soft. Foods such as pizza, apples, tough meat, etc… should be avoided until at least three months after surgery.
Keep the mouth clean
No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but do not rinse with any force. Gently place the water in your mouth and let it swirl around and drip out into the sink. Do not spit as this may dislodge the blood clot that has formed. The day after surgery you should begin rinsing gently at least 5-6 times a day especially after eating with eight ounces of warm water mixed with one-half teaspoon of salt. Peridex (chlorhexidine) should also be used at least 3 times a day for approximately 2 weeks. The important thing is to keep the surgical areas as clean as possible. Following one week, vigorous rinsing should be done to keep the surgical sites very clean. The use of a WaterPik is generally avoided in the surgical area for several weeks.
In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. In some patients, this is a normal occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration. In younger patients, bruising is rare and sometimes is represented as a slight yellow discoloration. In older patients, especially the elderly, bruising can be quite significant and is represented as black and blue discoloration. This can cover a larger area sometimes even involving the neck and upper part of the chest. Bruising of this degree can take approximately two weeks to resolve.
Please take the antibiotics as directed. Make sure you take the antibiotics until they’re completely gone. Sometimes people will start to feel better and will stop the antibiotic because they do not think they need it anymore. This should not be done. Discontinue antibiotic use in the event of a rash or other unfavorable reaction, and notify the office of the reaction. Sometimes taking antibiotics with yogurt can help prevent diarrhea. If you take birth control pills, the birth control may become ineffective; use back up form of birth control.
Nausea and Vomiting
In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on flat coke, tea, or ginger ale. You can also purchase coke syrup over the counter which can have a soothing effect on the stomach. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. Please call if the nausea does not subside within 3 hours. There are medications we can call in to your pharmacy that work very well to control nausea and vomiting.
- If numbness of the lip, chin, or tongue occurs, there is no cause for alarm. As stated before surgery, this is usually temporary in nature although in some instances, it can be permanent. You should be aware that if your lip or tongue is numb, you could bite it causing injury, and not feel the sensation. Therefore, be careful. Call Dr. Hammond if you have any questions.
- Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
- Occasionally, patients may feel something sharp in the mouth with their tongue. These projections usually smooth out over time. If not, they can be smoothed or removed by Dr. Hammond.
- If the corners of your mouth are stretched, they may dry and crack. Your lips should be kept moist with an ointment such as Vaseline.
- Sore throats and pain when swallowing are not uncommon. The muscles get swollen, and the normal act of swallowing can then become painful. This will subside in 2-3 days.
- Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for a several days following surgery. In some patients, this is a normal post-operative event. Do not force your mouth open. Massage the muscles and apply heat, and usually this will resolve in time.
- If an upper jaw surgery is performed, you will need to be on sinus precautions. This entails not blowing your nose for 2 weeks. Try not to sneeze for 2 weeks. If you do sneeze, do it with your mouth open to equalize the pressure between your mouth and the sinus. Sinus congestion is very common following upper jaw surgery. Taking 30 mg of Sudafed on a daily basis over one week is indicated. Afrin nasal spray should also be used twice a day for the first 3 days. Afrin nasal spray should not be continued after 3 days. Oceans nasal spray, which is a saline spray, should be used 5 times a day over the next 2 weeks.
- Do not be alarmed if you have a nosebleed. This may or may not happen. If it does occur, stop your activity, sit in a chair with your head slightly reclined, and apply an ice pack and pressure to the nose. If it is uncontrolled or does not stop bleeding, call our office.
- Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it. The sutures will dissolve on their own approximately one or two weeks after surgery.
- The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call our office for instructions.
- Sometimes there will be an opening in the gum where the surgery was done. This opening will gradually fill in with new tissue over the next month. In the mean-time, the area should be kept clean especially after meals with salt water rinses or a toothbrush.
- Your case is individual as no two mouths are alike. Do not accept well intended advice from friends. Discuss your questions and concerns with either Dr. Hammond or a member of our staff.
- If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. Don’t participate in any contact sports for at least 6 weeks. We recommend that you take at least 4 weeks off from any vigorous physical activity or heavy lifting. When you do resume your exercise regimen, start with a light to moderate workout and gradually increase your regimen over several sessions. Stop exercising if you get light headed.
- An appointment will be made for 1 week to check the surgical sites. If you did not receive an appointment, please don’t hesitate to call our office and we will be happy to see you.
- If you have any questions regarding the condition, it is best to call the office during our regular office hours. A follow-up visit is provided as a courtesy at no charge. If you have a true emergency, Dr. Hammond or his assistant can be reached 24 hours a day 7 days a week. During the day call the office number. At night, call Dr. Hammond on his cell phone. If there is no answer, leave a message and Dr. Hammond will call you back as soon as possible.