Post-Operative Instructions: Orthognathic Surgery

After Your Surgery

Post-Operative Instructions

Instructions Following Orthognathic Surgery

The surgery which has been performed on your jaw(s) has placed your jaw(s) in a new position. The facial muscles and temporomandibular joints (jaw joints) must adapt both to the surgery and the new position. The time required for adjustment varies amongst individuals; however, a few general guidelines can assist your recovery.

LENGTH OF HOSPITAL STAY

You will remain in the hospital for a minimum of 1 to 2 days following surgery in order to maintain appropriate care and receive adequate rest. Your discharge will be dependent on your pain management level, level of swelling, and fluid intake. You will be required to follow up in the office in 2 weeks for a post-operative assessment.

DIET

The following information may not apply to you if your jaws have been wired closed after your surgery. In this case, a liquid diet is indicated for the next 6 weeks.

Maintain a high calorie, high protein diet for 1 to 2 months following surgery. This will support the body with increased nutritional requirements that facilitate healing. Five to six small meals per day are usually better tolerated than three meals per day for the first 1 to 2 weeks.

First week:

Blended or pureed consistency foods, protein supplements (such as Ensure^®), yogurt, scrambled eggs, and juices.

Weeks 2–4

Soft foods, such as pasta, fish, etc.

Weeks 4–6

Add to your diet as tolerated and as you feel comfortable doing so.

If the surgery involved the top jaw (maxilla) and the bottom jaw (mandible), dietary progress may be delayed approximately 1 week. However, the final determination of what to eat will be based on your comfort and ability to chew.

ORAL HYGIENE

• The mouth must be in an excellent state of oral hygiene to avoid a predisposition to infections.
• Rinse your mouth with warm saltwater 3 to 4 times a day, and after each meal (1 teaspoon of salt dissolved in a tall glass of warm water).
• Tooth brushing is permitted the first day post-surgery. The teeth near the incision areas will be tender but still must be brushed. Use a child’s toothbrush, if necessary, to access “hard to reach” areas.
• Water irrigating devices, such as a Waterpik^®, may be used, but the rinsing and brushing as described above must still be performed.
• If you have been advised to wear elastics after surgery, we recommend that they be changed twice daily.

DISCOMFORT FOLLOWING SURGERY

The method of surgery utilized involves internal fixation of the bone sites, which rigidly maintains the bone in position during the subsequent healing. Occasionally, the upper and lower jaws are wired together to maintain this level of rigidity. The fact that fixation is used often means that the level of pain experienced by the patient is best described as discomfort. This discomfort is usually controlled by the pain medicine prescribed. Ice applied to the area of the surgery can also assist in reducing achiness.

Maxillary Surgery (Upper Jaw Surgery)

The post-operative feeling is often described as pressure and is relieved by the prescription pain medication and the additional use of a decongestant to reduce sinus sensations. Ice applications are also helpful.

Mandible Surgery (Lower Jaw Surgery)

The mandible is the moving jaw and therefore discomfort is precipitated with increasing movement, such as chewing, yawning, and talking. Reduction and/or modification of these activities for the first few weeks following surgery alleviates the discomfort, as will the use of the pain medication and ice applications.

MEDICATIONS

Generally, antibiotic and pain medication will be prescribed to you. The antibiotic must be taken according to directions and until completed. If you do not require pain management, do not take the pain medication. A decongestant may be suggested or prescribed for those who have had maxillary surgeries.

Some people are sensitive to certain medications and may feel nauseous as a result of taking them. To prevent or minimize this, take all medications with a full glass of fluid or with a meal. If nausea persists, discontinue the medications and subsequently inform our office. The use of Gravol^™ suppositories to reduce nausea is acceptable.

IRRITATIONS

Following surgery, it is not unusual for you to experience feelings of “achiness,” fullness in the ears, or popping and clicking sounds. You may observe some movement or irregular alignment of certain teeth. Smiling may create a pulling or tight feeling. Water and liquids can pass into the nose for a few days following maxillary surgery. Bowel movements may be irregular and initially reduced in frequency following surgery. General fatigue or even post-op “blahs” with a mild depression can develop in some individuals (although this is unpredictable). Other situations can occur which relate to individual cases. Generally, these are quite expected; however, should you have specific concerns, please do not hesitate to contact us.

SWELLING

It is normal to want to view your facial appearance change immediately following surgery. Although Dr. Stefanuto and/or Dr. Fisher have used gentle tissue handling and medications which act to reduce swelling, tissues will swell as a response to the surgery. Occasionally, the swelling will increase from the first few days following your discharge from the hospital. The tissues will not achieve their final definition for several weeks or months as explained below.

Maxillary Surgery

• The swelling will centre around the nose and cheek areas initially and will reduce with time. At 2 weeks post-operatively, much of the obvious swelling is reduced. It may take 6 to 8 weeks before the tissues entirely lose their puffiness, although to achieve the final definition in the nose and cheekbone areas, 6 to 8 months may be required.

Mandible Surgery

• The swelling will occur mostly at the sides of the jaw in the area of surgery and will reduce significantly in 2 weeks. By 4 to 6 weeks postoperatively, the tissues will appear almost normal to you. The final definition is attained approximately 4 months following surgery.

Chin Surgery

• Swelling will result in the chin looking rounder and the lower lip puffier for approximately 2 weeks. After 2 months post-operatively, the tissue will appear much more normal to you. Final definition of the jaw line may require 4 months to attain.

BLEEDING

It is common to have problems with bleeding following your discharge from the hospital. Patients who have had maxillary surgeries may have minor nose bleeds upon increased exertion or exercise for the first few days following surgery. This can be controlled by sitting down, placing an ice pack across the bridge of the nose, and squeezing the nostrils. It is advisable NOT to blow your nose for the first 2 weeks following surgery. It is common to notice blood-stained mucous subsequent to maxillary bone surgery for a period of up to 3 weeks. This represents a normal “cleansing” of the maxillary sinus region. The use of nasal decongestants is important in this process.

BRUISING

If bruising of the facial tissues is evident following surgery, resolution may require 10 to 21 days. Changes in color from purple to green to yellow will progress over that time. Bruising may drain toward the neck and chest due to the effects of gravity. This is normal.

SENSATION

Maxillary Surgery

• Initially, the roof of the mouth, teeth, and gums will feel numb. Sensation will usually return slowly over 6 to 9 months. The upper lip and sides of the nose may be numb or have an altered feeling following surgery, and improvement may require 4 to 6 months. It is also possible for the areas of numbness and tingling to persist indefinitely.

Mandible & Chin Surgery

• Any numbness or altered sensation of the lip, chin, teeth, and gums may require 4 to 6 months for improvement to be noted. It is common to experience changing sensation throughout the recovery course. It is also possible for the areas of tingling, altered sensation, or numbness to persist indefinitely.
• Areas of numbness should be protected. Use ointments to moisten lips and even the chin area. The lips often sense temperatures that you should be aware of, such as the temperature of any liquid or solid food before you put it into your mouth. Brushing your teeth and gums require special visual attention if they do not have normal sensation. Any orthodontic wires can loosen and abrade your lips and other intraoral tissues, so it would be prudent to periodically check that your wires are intact.

JAW MOVEMENT

Maxillary Surgery

• The lower jaw is the only moving jaw. If you had maxillary surgery only, lower jaw movement can begin immediately. Normal function will be regained in a short period of time as any facial swelling resolves. You may observe some minor movement of your top jaw. This is quite normal however, and stabilization of the upper jaw will progress over a period of a few weeks as healing occurs. Irregular alignment of the front teeth can result with certain surgeries and will be corrected.
• Mandible Surgery
• If your lower jaw has not been wired closed as part of your treatment, moving your lower jaw is encouraged and will become easier as your jaw muscles become more comfortable. Begin with attempts to wiggle the jaw from side to side and open as comfort permits. Forward movements are also good to practice as soon as you are able. Tease the jaw open further and further each week and measure your progress with your index and middle fingers. You should be able to open to two finger breadths by 1 month following surgery, and two and a half finger breadths by 2 to 3 months post-surgery. Sideways movements of the lower jaw should reach one full tooth width by 3 months post-surgery. Should you and or the surgeon feel that you are not progressing well, it is often recommended that you visit a physiotherapist for assistance.
• It is not unusual for you to experience aching and discomfort in the muscles and jaw joints for 4 to 6 weeks following surgery. Dr. Stefanuto or Dr. Fisher should be informed if the discomfort appears to increase, not decrease, over time.

SUTURES

• The stitches which may be in the mouth do not need to be removed but will loosen and come out over the next 2 to 3 weeks. Your surgeon will suggest if actual removal of the sutures is required at a later date.

ACTIVITIES

• Generally, surgery to the facial bones will require a 2-week recovery period, during which time you will experience less energy than normal. This recovery period will be longer if your jaw has been wired closed. It is important to rest and maintain a high calorie diet during this time in order to adequately recover. The bodily requirements for nutrition are significantly greater than normal due to the healing processes that are occurring. Light activity at home or work can begin as soon as you feel improved strength. This usually occurs approximately 4 to 7 days post-operatively. Students can often return to studies by the end of the first week, but still require home rest during the evenings. At 2 weeks post-operatively, significant recovery has taken place, often enabling a return to employment and regular activity. However, for physically demanding jobs or participation in sports, 8 weeks of recovery time may be required. Dr. Stefanuto or Dr. Fisher can assist you in determining your specific recovery time requirements.

ORTHODONTIC TREATMENT

• Your surgical treatment has been coordinated with your orthodontist in order to optimize your final result. Resumption of orthodontic treatment usually begins approximately 1 month after surgery but may begin sooner dependent upon the decision of the surgeon and your orthodontist. You should be scheduled with your orthodontist approximately 1 week following surgery. Specific X-rays are usually taken within the first 2 weeks following surgery and are necessary to evaluate the surgical areas. Elastics are often placed between the upper and lower jaws to assist in stabilizing the occlusion and coordinate the lower jaw movement. These should be changed daily or as instructed by your oral surgeon or your orthodontist.
• The surgery which has been performed for you is safe, accurate, and predictable in achieving excellent results. There are many factors associated with your surgery and recover which have been explained to you to assist your understanding and overall care. Should you have any questions or require additional information, we would be pleased to speak with you. Thank you for allowing us to participate in your care.

EMERGENCY CARE

• For non urgent issues, please call the office during regular business hours. (Elastics have come off, nausea, general questions.)
• For emergencies, please call the office and access the emergency after hours line. (nose bleeds that are persistent despite applying pressure.)
• Please call 911 or visit the local emergency room if it is a heightened emergency.
• If you have questions regarding your prescribed medications, please consult your pharmacy.