SEATTLE JAW SURGERY

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Postoperative

Postoperative Instructions for Orthognathic (Jaw) Surgery

After you have undergone a surgical procedure to correct the position of the upper jaw, lower jaw, or both, attention must be given to several aspects of postoperative care. This will help make the recovery as quick and easy as possible. Since surgery produces soreness in the muscles and bones of the jaw (as well as the lips & nose) some difficulty is encountered in performing tasks such as eating, drinking, and cleaning your teeth. However, each of these things must be done continuously and carefully to avoid postoperative problems. The following are instructions which should help you in your recovery.

Medication:

(You may be given several different prescriptions)

PAIN MEDICATION: Should be taken only during the time that you feel significant discomfort. However, if only mild discomfort is experienced, try to use a less potent, over the counter medication such as Ibuprofen to reduce inflammation. A does of 600 mg (3 tablets of Motrin® or Advil®) can be taken every 6 hours as needed. Ibuprofen can also be used to supplement the prescription pain medication, especially on the third day after surgery when the discomfort is worst. The prescription pain medication and the Ibuprofen can be alternated every 3 hours, so that each medication is spaced out 6 hours. This will keep you comfortable longer on the third day. Patients are typically prescribed Ibuprofen and then some form of a narcotic pain medicine.

ANTIBIOTICS: You will be given an antibiotic to take after surgery as a prophylactic antibiotic. This will be discussed with you to confirm any history of allergies or reactions with you before it is prescribed. Typically, this antibiotic is taken for 5 days after surgery. Pay attention to the bottle and instructions as some of the liquid antibiotics need to be refrigerated.


DECONGESTANTS: Following orthognathic surgery, especially upper jaw surgery, there is considerable stuffiness and congestion of the nose and sinuses. If decongestant such as Sudafed® is recommended, take the medicine as indicated on the bottle for seven to ten days or as needed for congestion. You can also try taking Mucinex over the counter that can help to thin out the mucous in your nose and sinuses.


NASAL SPRAY: (Afrin®, Neosynephrine® or equivalent) can be used at six-to-eight-hour intervals to help improve breathing through your nose. You can use the Ocean (saline nasal spray) as much as you wish during the first two weeks. We recommend using the saline spray especially in the shower. The humidity from the shower can help loosen up the dried blood in your nose and then using the spray can open up the nasal passages, this can be messy which is why we recommend doing this in the shower. Do not use Afrin® longer than 3 days. These medications can be purchased from your pharmacy. IF YOU HAVE HAD UPPER JAW SURGERY, DO NOT BLOW YOUR NOSE FOR 10 DAYS!

LIP OINTMENT: After jaw surgery lips can be swollen and dry. With numbness it can be difficult to perceive that your lips are try. Try to keep your lips moisturized that first week after surgery using something like Vaseline® or Aquaphor. This can help decrease the amount of swelling in the lips.
Nausea Medication: Nausea can occur after surgery. If you are feeling nauseous, please use the Zofran (ondansetron) prescription given to you during the preop visit. This tablet dissolves in your cheek or under your tongue. You likely were given a scopolamine patch in the preop area before surgery. This is a small patch for nausea that goes behind the ear. This can stay on for up to 72 hours. When you remove the patch please wash your hands. If you touch the patch and then accidentally touch your eyes it can cause blurred vision. Do not leave the patch on for longer than 72 hours as this can cause the opposite effect and cause you to feel nauseous.

Drinking

Following surgery, it is common to have some numbness in the upper lip, lower lip, and chin. When combined with facial swelling, a sore throat from anesthesia, a task as basic as drinking may be difficult.

Here are several suggestions which may help you:

  1. You will be given a syringe and small tube to help you begin drinking liquid by mouth. Do not use a straw for the first week after surgery as it can create more bleeding and cause the incisions to stay open longer.
  2. Even though some fluids may spill, you can try to drink from a cup. The use of a “sippy cup”, like those used by toddlers, may be helpful for the first few days. You can also try a coffee to go cup as this has a smaller opening so that you are not spilling as much on yourself.
  3. Place a towel under your chin and put a small amount of liquid into the cup. Tip your head back slightly and attempt to open your mouth a tiny bit while pouring the fluid into your mouth. If necessary, use slight finger pressure to place your lips together and attempt to swallow. This will be difficult at first, but you will find that it will become much easier in a day or two.
  4. If drinking from a cup seems to be impossible, continue using the syringe with the tubing attached. Another alternative is a squeeze bottle to squirt fluid in your mouth, these are like the “diner style” squeeze bottle. You can search online and they tend to be fairly inexpensive.
  5. All patients are different in what strategy they find most helpful for drinking, try out a few different ways and see what works best for you. It is very important to stay hydrated the first week after surgery. TAKING IN ADEQUATE AMOUNTS OF FLUID IS ESSENTIAL FOLLOWING SURGERY. YOU NEED ABOUT 2 TO 2 ½ QUARTS (8-10 CUPS OR ROUGHLY 2 LITERS) PER DAY

Eating

At least 1,500 calories daily

Initially, it will be difficult to eat adequate amounts of food. Try to eat five to six times a day, eating smaller portions each time. Use the following guidelines for progressing from a liquid/blended diet to firmer foods. You will also be given a “Jaw Surgery Cookbook” with some recipe suggestions.


WEEK 1: During this time the diet should be a pureed or blenderized diet. Think Smoothies, milkshakes, and pureed soups. (You can also eat foods such as applesauce, oatmeal, and pudding if able). It may be difficult to open your mouth wide enough to get a spoon inside. A baby-sized spoon may be helpful. A diet supplement such as Boost®, Ensure®, Sustacal®, or similar substitutes may be used to increase calorie intake.


WEEK 2-6: Your diet should include foods that are extremely soft in consistency that you do NOT CHEW. Think mushy food diet. NO CHEWING. Foods that you can smash with your tongue and roof of your mouth. For example: scrambled eggs, pancakes, waffles, refried beans, mac and cheese, flaky soft fish. Anything that you can cut up small enough that you do not need to chew. If you have a splint in place this will be removed in clinic sometime 3-6 weeks after surgery


Changes in your diet as well as the use of pain medicine may cause constipation. If you have not had a bowel movement by 2 or 3 days after surgery, you should begin to add fiber to your diet. Start taking Metamucil ® (1 teaspoon mixed with 8 ounces of water 3 times per day).

Elastics (Rubber Bands)

Usually some types of elastics (small rubber bands) are used during the time immediately after surgery. These rubber bands are placed around the small hooks on the braces or arch wires, or if you don’t have traditional braces on the “posts/tads” in your mouth. The purpose of these small elastics is to help train you to bite into the new jaw position and to limit jaw function. There may also be a plastic splint wired either to the upper or lower jaw. This splint is custom made to fit behind your teeth.

  1. The first week after surgery most patients just leave the elastics on as they were placed in the hospital. It is not an emergency if an elastic break. Just try to replace it as best you can, whatever hook you can get it on, just up and down on either side. If you cannot get it back on just leave off the rubber bands until you 1 week post op appointment.
  2. After the first week, you will be taking on and off rubber bands and will get more instructions regarding location and frequency of use at your post op appointments.
  3. In your pre-op bag, there are 100 Elastics which should be more than enough to get you through between your follow up appointments.

Hygiene

It is extremely important for you to keep all areas inside your mouth clean after surgery. You should brush your teeth and rinse your mouth after eating. Please use toothpaste when brushing your teeth.

  1. During the first week after surgery be careful while brushing your teeth to keep bristles of the brush on or very near the teeth and braces. Expect soreness and difficulty opening your mouth. This may limit your ability to clean the tongue side of your teeth, but at least brush the outsides as best you can. Brushing will get easier after you are seen for your post op appointment.
  2. Rinse your mouth thoroughly with warm salt water (8 ounces water with ¼ teaspoon salt stirred in) or Peridex® for the first week after surgery. Do not use a water pik or electric toothbrush inside your mouth for the first two weeks after surgery. Do not use an over-the-counter mouth wash like Listerine or ACT as this can hurt the incisions.

IT IS VERY IMPORTANT TO NOT SMOKE (CIGARETTES OR MARIJAUNA) FOR AT LEAST 4 WEEKS AFTER SURGERY AS THIS CAN CREATE PROBLEMS WITH HEALING AND MAY CAUSE INFECTION.

Dressings

ICE PACKS: Ice should be used for the first week after surgery to reduce swelling. Apply ice to upper jaw (across cheeks and bridge of nose). You can continue to use ice on an off for the first week to help with swelling and discomfort. For the lower jaw, ice packs can be applied to your cheeks. Use ice as much as you can especially for the first few days after
surgery. You might get an ice pack from the hospital that you can use with crushed ice, or from our clinic that allows gel ice packs to be used on either side. Some patients have found that it is nice to get a “Jaw Ice Pack” online this is a wrap that also allows cold gel packs to be held on either side of the face. Putting some ice on your midface can help as well, frozen bags of peas or corn work well as they are not as heavy as ice and form to the face.


ELASTIC FACIAL DRESSING (jaw bra): (You will leave the hospital or our clinic with this on) The jaw bra is an elastic bandage that secures with velcro on the top of your head. This should be kept in place as much as possible for the first 24-48 hours. This bandage will help reduce swelling. Wearing this dressing at night will also help reduce swelling that may occur when lying down. You can take breaks from this jaw bra, take it off when drinking or shower, or if you feel that you just need a break from it squeezing your face.

ON THE THIRD-FOURTH DAY AFTER SURGERY: These are often considered the worst days for discomfort. Warm moist heat and massage should be used as needed. Warm, moist compresses or towels can be used around the face with light, circular pressure, or massage. If you wish you can continue to ice.

SUTURES: If you had lower jaw surgery one suture may be placed on the outside of your face. These dissolve on their own. For the first week use a small amount of bacitracin twice a day over the incision. After the first week you can change to Aquaphor ointment (over the counter).

TAPE: If you had chin surgery you may have some tape on the chin area. This can be removed three to four days after surgery in the shower. If it is still in place at your one-week post op visit we remove it in clinic but please try to take it off before then as it can irritate the skin under the tape.

Other Instructions

SLEEP: Sleep with your head elevated to at least a 45-degree angle. This is for the first 1-2 weeks to help decrease the amount of swelling after surgery. We recommend sleeping in a recliner, on the couch propped up with a bunch of pillows, or in bed with a wedge pillow.

Physical Activity

Following surgery, you will find that your energy level will be lower and will take some time to return to normal. For the first week you can walk around the house but take it easy and do not get your blood pressure elevated. Start slowly and work back up to your normal level. Physical exercise such as brisk walking or running can begin 2 or 3 weeks after surgery. Begin by going shorter distances and at a slower pace than usual. As your endurance and confidence increase, gradually increase the level of exercise within your level of comfort. Avoid getting hit in the face.

Jaw Exercises

We encourage a gradual progression of movement and use of the jaw, keeping in mind that complete healing does not take place until approximately two to three months after surgery.


IMMEDIATELY FOLLOWING SURGERY: Since surgery causes soreness in the muscles and bones of your jaw, movement may be difficult initially. We do not recommend any specific exercises during the first week to 10 days after surgery. 10 DAYS TO FOUR WEEKS AFTER SURGERY: Do these jaw stretches without rubber bands in your mouth! Stand in front of a mirror and attempt to open and close your jaw as much as possible. Simply move your jaw forward and backward, side to side, and open and close, attempting to increase your mouth opening with your jaw muscles only. Moist heat placed on the side of your face before and during these exercises may make them more comfortable and more effective. Do not use finger pressure on your teeth to help stretch your jaw opening.


FOUR TO EIGHT WEEKS AFTER SURGERY: Continuing the stretching (outlined above). At your 6 week follow up appointment we will give you jaw stretching devices to help your mouth opening. Using the jaw stretchers and getting back into chewing a normal diet will help you get back to a normal mouth opening.

While the postsurgical period can be uncomfortable and progress may seem to occur slowly, adherence to these home care instructions will help you achieve an excellent outcome in the shortest time possible.

Check list of medicines and supplies that may be helpful after surgery

Prescriptions given by your doctor

  • Pain Medication
  • Ibuprofen
  • Nausea Medication
  • Antibiotics
  • Nasal Sprays

Other supplies that may be helpful

  • Lip Moisturizer – keep your lips moist to prevent cracking, with numbness it can be difficult to tell if your lips are dry.
  • Fiber Supplement *Metamucil (orange flavor is the best) or similar product
  • Elastic Bands *in your white pre-op bag
  • Diner Style Ketchup Bottle, Sippy Cup, and Baby Spoon
  • Blender *ingredients for smoothies
  • Determine a spot to sleep **sleep elevated – at least a 45-degree angle for the first 1-2 weeks to help with swelling. We recommend in a recliner, on the couch propped up with a bunch of pillows, or in bed with a wedge pillow.