Orthognathic (Corrective Jaw) Surgery:
Immediately post op: you will likely recover from the anesthesia in Post Anesthesia Care Unit from 14 hours. You should then be transferred to a room depending on hospital bed availability and should you elect to spend the night at the hospital.
During your care in the P A CU: a hospital nurse will monitor and assist you and provide you medications for pain/antibiotics/nausea, etc as instructed by your surgeon. A single jaw surgery procedure does not necessitate an overnight stay, unless directed by your surgeon. However, you may elect to spend 1-2 nights in the hospital depending on recovery, proximity to the hospital, and your comfort level. You may discuss this with your surgeon.
While in your hospital room: A hospital nurse will care for you as directed by your surgeon. Intravenous fluids and medications for pain, swelling, antibiotics, and nausea may be provided as ordered. You will be instructed on oral hygiene, oral and/or facial wound care, and breathing exercises in your recovery from general anesthesia. You may be instructed to walk around (ambulate) to assist your recovery.
First 24 hours:
Take your medications as instructed. To help reduce swelling: Keep with your head elevated. Ice to the face. Expect a good amount of swelling despite our best efforts. Keep any dressings around the face intact until your surgeon sees you the next morning.
Take in as much fluid as is tolerable while awake to prevent dehydration. A full glass of water (8 oz) every 3 hours (if an IV is not running) (= 64 oz/day = -1/2 gallon/day = 2 Liters/day) Avoid sugary liquids (sodas, juices, etc.) as they may make you dehydrated. You will be placed on a clear liquid diet (water, light juice, broth etc.) to start and advanced to full liquids (milk, etc). You should use the restroom as needed. The nurse may be available to assist you. Bleeding: Expect minor bleeding and oozing of blood from the surgery wounds for the first 24 hours. Expect: Numbness of your lower lip, chin, cheeks, tongue and teeth (for lower jaw surgery) and your upper lip, cheeks, nose, and teeth (for upper jaw surgery). Expect limited jaw mobility due to the surgery. You may be required to obtain an X ray at the hospital (or later at the office)
Use a baby tooth brush to keep your teeth clean. Be careful around the incision sites, which will be in the upper vestibule of the mouth (for upper jaw surgery) or near the molar teeth along the back-sides of the lower jaw (for lower jaw surgery).
Rinse with Peridex solution at least twice a day & brush your teeth at the same time. You may wish to brush your tongue during your hygiene periods.
Depending on the type of surgery, you may have a plastic splint wired to your upper teeth to help you guide your bite into the right location. Keep this area clean also. Depending on your specific surgery, you may be asked to use elastic (rubber bands) around your braces to help guide your teeth/jaw into the right bite.
For upper jaw surgery: do not blow your nose nor sneeze through your nose for the first 2-3 weeks. Take any additional antibiotics/medications (nasal decongestants, nasal sprays) as directed by your surgeon.
Upon discharge from the hospital:
You should have prescriptions and instructions for: Strong pain medicine (a narcotic analgesic) Antibiotics Anti-nausea medicine (if it was necessary) Peridex mouth rinse (an antibacterial mouth rinse) Instructions to follow up in the office the day of the discharge for X rays if not already done at the hospital. Instructions to call your surgeon in the event of any questions or problems. Instructions to return to the hospital (or ER) with the advice of your surgeon should there be any unexpected problems.
Expect swelling to be worst in the 1st week (it tends to peak in first 3’d through the 5th days) and will gradually lessen. At the end of the 1st week, the swelling will be much less noticeable, but still present. By the end of 2 weeks, the swelling will be significantly less. Ice is best for the first 24-48 hours to help reduce swelling, however, if it makes you/your face feel good to use it, then please do so. You may place crushed ice in a Zip-Lock ® bag and wrap the bag in a towel prior to placement on your face. You may use the ice pack for 15-20 minutes at a time, and remove to give the skin some rest /from the cold. Direct placement office to the skin for prolonged periods of time may produce a bum. Do NOT use heat to the area, as the swelling will worsen.
Expect bruising along with swelling. The bruising should begin to dissipate as the swelling subsides. The bruising may travel in the skin as it dissipates. It will likely change colors / black/blue/purple, to green, to yellow and may travel down the neck and chest. This is normal and will resolve in 1-2 weeks.
The numbness to the face will persist for many weeks, if not months. This is a normal outcome of this type of surgery. The numbness sensation should subside in the face as the nerves heal. Unfortunately, this may take weeks to months as nerves heal at a very slow rate. Please take the advice of your surgeon and discuss this outcome.
Do not over-exert yourself during the first week. You may return to light house-work or daily activities during this first week. Slowly resuming your activities will help speed your recovery. Avoid sun bathing or other activities in the sun.
A full liquid diet should be enforced during this first week. It is very important to remain hydrated (see above hospital course). Suggestions for a full liquid diet include: milk shakes, smoothies, juices (not very acidic types, as they may irritate the stomach), Jello, blenderized foods (use the liquefy setting on your blender). Avoid alcohol and carbonated drinks. Carbonated drinks may distend the stomach, leading to nausea, etc. Avoid very sugary fluids as they may promote dehydration. You may remove the elastics to eat, but replace them as instructed by your surgeon.
You may remove elastics for hygiene, but replace them as instructed by your surgeon. Use Peridex mouth rinse at least 2-3 times per day for the first week. Use a baby sized, soft bristled toothbrush to clean the teeth and adjacent gums (avoid the sutures and wounds) at least 2-3 times per day. Keep any associated ancillary “hardware” clean as well. Keeping the mouth clean will also help prevent a wound infection. The sutures should start to dissolve in the first week as the gum tissue starts to heal. Expect the tissues to go through their normal healing phases (redness, a grey-white film, normal pink). You may rinse with warm salty water to help sooth the wounds. Avoid mouth rinses with alcohol (a majority of commercial OTC mouth rinses) as they may bum and irritate the healing wounds. A void smoking as it may slow or prevent healing and may result in an infection. Avoid directing water picks to the incision wounds in the first week as fluid may become trapped in the wound.
Take ibuprofen (Advil or Motrin) 600 mg every 6-8 hours for the first week to help reduce pain and swelling. As you have more pain, than these medications can handle, then add the strong pain medication (narcotic + Tylenol) at least I hour after taking ibuprofen. Remember, the strong pain medication may already have Tylenol in it, so do not take any extra Tylenol as it may cause a problem. Avoid alcohol while taking any of these medications.
Take the Antibiotics as directed. If you also take birth control pills, antibiotics may alter the function of birth control pills and it would be strongly advised for you to take other necessary precautions to prevent pregnancy while on antibiotics simultaneously. Take any other prescribed medications as directed by your surgeon. Should you have any questions please contact our surgeon on call.
Be sure to return for a follow up post op visit with your surgeon I week after surgery to evaluate your healing progress. At this visit, you will have an opportunity to discuss any questions. We will review hygiene and medications. X rays may be taken if they were not taken the week prior. Second week: Swelling: should start to resolve and may lessen significantly by the end of the 2nd week. Swelling should get better and better from this point.
Should start to resolve as noted above. Numbness: as above Activity:
You may start to resume more of your regular activity as you see fit. Still do not over-exert yourself. Still avoid weightlifting for this 2nd week.
Continue full liquid diet and you may add or advance to a soft mechanical diet (scrambled eggs, flaky fish, well cooked (soft) pasta, grits, oatmeal … foods you can squash with your tongue and swallow without much chewing action).
Continue hygiene as above. Sutures may be dissolved away by the end of this week. You may stop Peridex at the end of the second week unless directed by your surgeon. Prolonged use of Peridex can stain your teeth brown. You may resume your pre-operative hygiene routine with tooth paste, etc.
Medications: You may take any of the pain medications as needed only now. The pain should be starting to get a lot better. Finish your course of antibiotics as directed. No more should be needed after the initial course. You should have less need for any other pain medications. Follow up: Continue follow up schedule as directed by your surgeon. After 2 wks of successive follow ups, you may be asked to return 2 weeks later.
Fourth weeks and beyond:
Diet: may start more of a soft mechanical diet. Hygiene: Continue as above and begin range of motion exercises to help relieve any muscle stiffness.
Six weeks and beyond:
You may return to orthodontist for dental adjustments. Resume a regular diet as instructed by your surgeon. Continue good oral hygiene routines. Post op x-rays and photos will be taken as needed to follow progress.