Orthognathic Surgery Post Operative Instructions

After you have undergone a surgical procedure to reposition your upper jaw, lower jaw, or both, attention must be directed to several aspects of post-operative care to help you 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 and other areas of the face, some difficulty is encountered in performing such tasks as eating, drinking, and cleaning your teeth. However, each of these things must be performed continuously and carefully to avoid post-operative problems. This is a list of instructions which should help you in your post-operative recovery.

Medications                                                     

You may be given several types of prescriptions following jaw surgery.

1. Pain Medication: should be taken only during the time that you feel significant discomfort. If the pain is severe, the prescription pain medication may be used. However, if pressure or mild discomfort is experienced, attempt using less potent over the counter medications such as Paracetemol, Nurofen, etc. Try and time your pain relief to be taken at night so that you get a good night sleep.
2. Antibiotics: You may be given a prescription for an antibiotic such as Augmentin, etc. These should be taken at the appropriate interval as described on discharge. Be sure not to miss any doses until the medication is gone. Note: Some types of antibiotics can reduce the effectiveness of birth control pills. Please contact your gynaecologist if you have any concerns.
3. Decongestants: Following orthognathic surgery, especially upper jaw surgery, there can be considerable stuffiness of the nose and sinuses. A decongestant such as Otrivine Nasal Drops, etc. can be indicated for 7-10 days following surgery if necessary.
4. Nasal Spray: can be used at 4-6 hour intervals to help improve breathing through your nose. In order to prevent overuse of nasal spray, this can be alternated with plain saline nasal spray or mist. These can be purchased from your pharmacy. If you have had upper jaw surgery, do not blow your nose for at least 14 days following surgery.
5. Lip Ointment: Use Vaseline for the first 10 days after surgery. Keep enough ointment on lips to keep them appearing moist.

Drinking

Following jaw surgery there is usually some numbness in the upper and or lower lips. When combined with facial swelling and soreness due to the incisions inside the mouth, a task as basic as drinking may seem somewhat difficult. Here are some basic tips which may assist you.

1. Attempt to drink from a cup if possible. While some fluid may spill while drinking in this manner, a cup is the most effective way for obtaining adequate intake. Drinking gets much easier after a little practice and healing.
2. Place a towel under your chin and pour a small amount of liquid into the cup. Tip your head back slightly and attempt to open your mouth a small amount while pouring in the fluid. Pour slowly taking in small amounts until it becomes easier.
3. If necessary, take the cup away from your mouth and use slight finger pressure to place your lips together and swallow. Again, this becomes much easier in a day or two.
4. If a cup is simply not working well, you may try a sports-type squeeze bottle to squirt fluid into your mouth. 

Remember:

• Taking in adequate amounts of fluid is essential following surgery. You will need about 1½ litres per day!
• Avoid fizzy drinks!

Eating (see smooth puree diet sheet for details):

Initially, it will be difficult to eat adequate amounts of food in 3 meals a day. Try to eat 5-6 times a day eating smaller portions each time. You will have the opportunity to meet with a dietician during your hospital stay. Use the following guidelines for progressing from a liquid or blenderized diet to firmer foods.

1. For the first 7 days after surgery: During this time the diet should be essentially a liquid diet. This can include soups, any food with baby food consistency, or blenderized foods. You can also eat such foods as mashed potatoes, porridge and rice pudding. Some sort of diet supplement such as Ensure or similar substitute may be used once or twice a day to increase calorie intake. Do not drink milk products for 2 days after surgery.
2. Day 7-14 after surgery: During this period your diet should include foods extremely soft in consistency and require minimal chewing such as pasta, and scrambled eggs.
3. 2 weeks to 5-6 weeks after surgery: At this point softer foods like ground beef crumbled in small pieces, flaky fish, and shredded chicken can be eaten. Remember, the important point is to avoid foods which require significant pressure between your teeth.
4. After 5-6 weeks: At this it will be much easier to eat. Remember that it will take a few more weeks for the jaw to completely healed and that it is still better to cut food into pieces during this time. Foods such as pizza, apples, tough meat etc. should be avoided until at least 10 weeks after surgery.

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 small lugs or hooks on the braces or arch wires. The purpose of these small elastics is to help train your bite into the new jaw position and limit jaw function. This splint has small indentations for each tooth to bite in to. With the elastics in place and your teeth together, your should see that the teeth fit into the grooves in the splint.

1. The elastics should be worn at all times except when eating and brushing unless instructed otherwise. They should be worn in the manner shown at your post-operative visits.
2. The elastics should be changed as directed by me or your orthodontist to new ones at to maintain their elasticity.

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. Since you will most likely be eating five to six times a day you will need to clean your teeth at each of these intervals.

During the first week be careful to keep the bristles of the brush on or very near the teeth. You may have some soreness and difficulty opening your mouth which will prevent you from cleaning the tongue side of your teeth. However, this will improve with time.

1. Each time you brush your teeth place a small amount of toothpaste on the brush and clean all areas of the braces and splint the best you can.
2. Rinse your mouth thoroughly with warm salt water or Corsodyl mouth wash.

The importance of cleaning your teeth cannot be overemphasized. This must be done thoroughly, several times each day.

You must not smoke or use other tobacco products for at least 8 weeks after surgery. Tobacco and smoking can cause severe healing problems.

Exercises

In the past, and occasionally at the present time, teeth must be kept together with wires or heavy elastics after surgery. This allows the jaw bones to be held still while healing. Most of the time, however, small bone screws and plates are used to hold the bones together during the healing period. With the use of these screws and plates the jaws can still move slightly during the post-operative period. It must be remembered that the bones are not healed and are simply held together by the screws and plates. Therefore, we encourage a gradual progression of movement and use of the jaws, keeping in mind that complete healing process does not take place for approximately two to three months after surgery.

1. Immediately following surgery: Since surgery causes soreness in the muscles and bones of your jaw, movement will be difficult initially. We do not recommend any specific exercises during the first week to ten day after surgery.
2. 10-14 days following surgery: Stand in front of a mirror and attempt to open and close your mouth. At ten days you should be able to get at least 1 finger between your teeth. This will increase gradually in the next several weeks. Simply move your jaw open and closed then side to side. Moist heat to the side of your face prior to these exercises can be beneficial. Do not use your fingers to force open your jaw.
3. 4-8 weeks after surgery: At this time you should be able to get 2 fingers between your teeth comfortably and can begin using gentle finger pressure to stretch your jaw muscles. By week 8 you should be able to get 3 fingers between your teeth. Again, stretch the muscles open and closed as well as side to side.

As you can see, recovery from surgery requires a lot of patience and effort on your part. We will be happy to answer any questions you may have regarding post-operative care. Remember, the post surgical process is sometimes uncomfortable and may seem to occur slowly. However, with some determination and attention to these instructions, you can maximize the healing process