Orthognathic / Corrective Jaw Surgery

Recovery After Surgery

The extent of the surgery, age at time of surgery, and several other factors determine the speed of recovery.  The more complicated surgeries will result in longer recoveries.  Also as one would expect, younger patients will usually recover faster than older ones.

Swelling

Swelling is common after jaw surgery.  Expect most of the swelling to occur at three to four days after surgery.  It will then gradually improve and usually then resolve in one to two weeks. It can be minimized by using a cold pack, ice bag or a bag of frozen peas wrapped in a towel and applied firmly to the cheek adjacent to the surgical area.  This should be applied twenty minutes on and twenty minutes off during the first 24 hours after surgery.  After this period, warm compresses applied in the same fashion can be beneficial.  If you have been prescribed medicine for the control of swelling, be sure to take it as directed.

Bleeding

A certain amount of bleeding is to be expected following surgery for 24 to 48 hours. Slight bleeding, oozing, or redness in the saliva is common.  Bleeding should never be severe.  If it continues, place gauze packs over the bleeding surgical area, and place gentle but firm pressure.  Do not change them for the first hour unless the bleeding is not controlled.  The packs may be gently removed after one hour.  If active bleeding persists, place enough new gauze to obtain pressure over the surgical site for another 30 minutes.  The gauze may then be changed as necessary (typically every 30 to 45 minutes).  It is best to moisten the gauze with tap water and loosely fluff for more comfortable positioning.

Persistent bleeding may mean that the packs are being clenched between teeth only and are not exerting pressure on the surgical areas. Try repositioning the packs and bite or apply finger pressure for 30-45 minutes. Repeat if necessary.

To minimize further bleeding, do not become excited, sit upright, and avoid exercise.

If bleeding remains uncontrolled, please call our office.

Pain

Unfortunately corrective jaw surgery is accompanied by some degree of discomfort.  You will have a prescription for pain  medication, often times in liquid form.  If you take the pain medication before the anesthetic has worn off, you should be able to manage any discomfort better.

For moderate pain, two tablets of 200 mg ibuprofen (Advil or Motrin) may be taken every four hours. These may be crushed to allow them to be easily taken; or liquid form may be purchased from the pharmacy.

For severe pain, take the medications prescribed as directed.

The effects of pain medications vary widely among individuals.  If you do not achieve adequate relief at first, you may supplement each pain pill with an analgesic such as ibuprofen (Advil, Motrin) or naproxen (Aleve).  Some patients may even require two of the pain pills at one time.

Remember that the most severe pain is usually within three days after the surgery; after that your need for medicine should lessen.  If you find you are taking large amounts of pain medicine at frequent intervals, please call our office.  If you anticipate needing more prescription medication for the weekend, you must call for a refill during weekday business hours.

The 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. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.

Some patients find that stronger pain medicine causes nausea, but if you precede each pain pill with a full glass of water or a small amount of food, chances for nausea will be reduced.

When taking prescription or over the counter medications, always follow manufacturer’s recommended dose. Do not take any medication if you are allergic or have been instructed by your doctor not to take. If you are not sure or have any questions, please contact your doctor, the pharmacy, or our office.

Limited Jaw Movement

To help patients become familiar with their new bites, rubber bands or elastics will be used after the corrective jaw surgery.  This will allow patients to maintain limited jaw function such as drinking, speaking as well as performing proper oral hygiene.  In rare cases, patients may have their jaws wired shut to minimize jaw movement.

Once swelling subsides, patients will begin to see significant improvement in movement of their jaws, susally over the next two to three weeks after the surgery.

Diet

Immediately following surgery, all nutrition will be consumed in liquid form; a challenge given an adult patient’s daily nutrition needs.

Since fluids remain the most important nutrient, particular care should be directed towards ensuring that you get your 6 to 8 glasses of fluids per day.  Meeting the caloric needs may also be challenging during this phase. Many proprietary liquid nutritional supplements are available, which, because of their high caloric density and balance of protein, calories and vitamins, will help you meet your goals. Brands such as Ensure®, Sustacal® and Boost® are available at any pharmacy for over-the-counter purchase. They can be further augmented with shakes or smoothies containing fruit, protein powders or other additives. It may be helpful to keep a diet diary to record your fluid volumes and calories to ensure your nutrient goals are being met.

Do not use a straw for the first few days after surgery.  It is important not to skip meals.  If you take nourishment regularly you will feel better, gain strength, have less discomfort and heal faster.

Following this brief dependence on liquids, it is likely that a semi-solid, “non-chewing” diet will be recommended. This diet should be of a consistency that can be consumed without biting or chewing. Many of your regular dietary choices are likely available to you, such as soft scrambled eggs, soft pancakes, overcooked pasta, flaky fish, etc. Remember, it is most important to avoid stressing the surgery sites until healing has progressed. This non-chewing diet should be maintained until Dr. Vahadi specifically approves a move to a more solid diet. This may be 4 to 6 weeks following surgery, although it may be longer for some patients depending on the complexity of their surgical procedures.

Nutrition

Nutrition, in its basic sense, refers to the intake of nourishment; specifically the fluids and fuels we need to survive. Following illness or surgical procedures, our nutrient needs are increased in order to facilitate healing. For oral and maxillofacial surgery patients this need may be particularly challenging for several reasons. The presence of surgical incisions in or around the mouth and postoperative swelling may make it more difficult to chew and swallow normally. Additionally, the type of surgical procedure may further necessitate a diet limited in consistency. These factors, in combination with the increased nutrient needs following surgery, mean it may be difficult to ensure that you are well nourished following your surgery.

Surgical Nutrition

The single most important nutrient is water. In general, the average adult should drink six to eight glasses of fluids per day. While this amount may be increased following surgery or due to illness, fever, etc., it is a good rule of thumb. Our total calorie needs may be estimated as 15 calories per pound of body weight per day. Again, for the average adult, this translates into about 2,000 calories a day. Protein needs may further increase following surgery as well, to promote healing.

Physical Activity

• Keep physical activities to a minimum immediately following surgery for the first week.
• After one week, you may be able to have some limited activity.
• It may take some patients longer to have limited activity depending on the extent of the surgery and how quickly you recover from the surgery.
• If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising.
• Be aware that your normal nourishment intake is reduced.
• Exercise may weaken you.
• If you get light headed, stop exercising.

Oral Hygiene

Keeping your mouth clean after surgery is essential.  Use 1/4 teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful.  Repeat as often as you like, but at least two or three times daily.  Use the prescribed mouth rinse as directed.

Begin your normal oral hygiene routine as soon as possible after surgery.  Soreness and swelling may not permit vigorous brushing, but please make every effort to clean your teeth within the bounds of comfort.

Remember: A clean wound heals better and faster.

Nausea

Nausea is not uncommon after surgery.  Sometimes pain medications are the cause.  Nausea can be reduced by preceding each pain pill with a small amount of soft food, and taking the pill with a large volume of water.  Try to keep taking clear fluids and minimize dosing of pain medications, but call us if you do not feel better. Classic Coca Cola, ginger ale, or 7-Up may help with nausea.

Further Care

Do not disturb the surgical area today.  Do NOT rinse vigorously or probe the area with any objects.  You may brush your teeth gently.  PLEASE DO NOT SMOKE since this is very detrimental to healing and may cause complications.