Corrective Jaw Surgery (Orthognathic)
After the surgery, patients awake in the recovery room. There they will be monitored and observed until they are fit to return to their rooms.
Jaws may be held together with elastics and/or wires. There may also be plastic splints. In many cases, bones may be held internally with small pins, screws or plates. The period of jaw wiring may vary depending on your particular type of surgery. This again should be discussed with your doctor. In many instances, elastics will be used at the time of surgery and it will be necessary for the patients to learn how to apply and remove them. This should be reviewed with Dr Reynolds and with your orthodontist.
Virtually all patients will have some swelling after the soft tissue and bone incisions are made. A pressure dressing or ice pack may be used for a period of time to control this. They are generally removed before you are discharged from hospital.
Medications to control infection, nausea, and swelling are frequently used immediately after the surgery. Pain control medications will also be ordered as required.
Home care will also be discussed thoroughly. Appropriate instructions dealing with liquid and soft diets as well as oral hygiene will be provided. Depending on your age, health and type of surgery, extra help or home nursing may be recommended. Nausea or vomiting are rare but can be managed with the jaws together. It is rare to have to open the jaws urgently, but on discharge from hospital, you may be provided with instructions and/or cutters. Untoward occurrences such as bleeding when at home are rare but should be reported immediately. Contact numbers including Dr Reynolds and/or local health centers should be kept nearby.
Pre Operative Instructions for Jaw Surgery
1. Nothing to eat or drink after midnight on the night before surgery or for at least six hours before surgery.
2. Stop smoking 6 weeks prior to the procedure. (No smoking 6 months after the procedure.)
3. Stop use of aspirin and ibuprofen (Motrin, Advil) or ibuprofen-like (Aleve, Naproxen) drugs 7 days prior to the procedure. Do not take similar types of medicines called NSAIDS (Unless told to do otherwise by your other doctors and please inform us).
4. Discontinue all herbal medications, including vitamin E, fish oil, and vitamin supplements (except for a small daily multivitamin) 2 weeks prior to surgery. A daily multivitamin is advisable to optimize healing. But do not take it the morning of surgery.
a. Take preoperative medications if prescribed: (Take with a sip of water)
b. Antibiotic: Start first dose one day prior to surgery, if prescribed. But do not take any the morning of the surgery. This will be given through your IV during surgery. (ie; Penicillin, Amoxicillin, Cephalexin, Clindamycin).
c. Sedatives such as Valium may be prescribed to be taken the night prior to surgery.
d. Some medicines should not be stopped such as __________________________________ per Dr. Reynolds.
5. A responsible adult must accompany the patient. The person must be able to drive because the patient will not be allowed to drive for 24 hours. If the patient is discharged to home, someone must watch the patient for at least 8 hours after the surgery. They cannot be dropped off alone.
6. If you have a severe cold, sore throat or sinus infection with excessive drainage prior to surgery please call the office to inform Dr. Reynolds. He may want to see you in advance of the procedure or reschedule until after you have recovered.
7. No makeup or jewelry should be worn on the day of surgery. In particular at least one fingernail should be without nail polish to facilitate monitor placement. Do not wear contacts
8. Brush, Floss and Rinse before surgery.
Post operative Instructions for Jaw Surgery
1. SWELLING AND BRUISING:
Post-operative swelling and bruising should be expected for approximately two weeks. To reduce this condition, your head should be elevated and cold compresses should be applied around the jaws, nose and eyes. Residual bruising may be noticeable for several weeks. If you experience severe swelling or changes in vision call me immediately.
Sit up or semi-recline. Elevate the head of your bed 30 degrees. No strenuous activity, straining or bending over for 72 hours. Increase activity as tolerated with no heavy exercise for two weeks. Do not smoke or drink alcohol for 30 days following surgery. Avoid excessive physical activities that raise the blood pressure, such as jogging, swimming, weight lifting and bending for the first several weeks after surgery. No Nose Blowing. Avoid activities that cause pounding or jarring.
If a temperature above 100.5 occurs contact my office.
Some discomfort is normal following surgery. If pain medication is prescribed, take only as directed. Do not drive while using narcotic pain medications. Often it is beneficial to take the medication after eating to help prevent nausea.
Eat something when you feel ready. Your diet is to be PUREED (Mashed potatoes consistency or softer). Start with cool liquids at first. Have some dietary supplements ready such as Carnation Instant Breakfast, Ensure, Sustical, Boost, etc.
If you have incisions on the skin then do not get surgical site wet for 24 hours after surgery. Later you may let water run over the area for brief periods. Do not soak. Do not let shower spray directly onto surgical site.
7. WOUND CARE:
Use saline nasal spray at least four times a day to keep the nostrils clear. Use rinse as directed. Rinse with Salt water rinse at least 3 times a day. Start rinsing gently then rinse more vigorously after 2 days. After 7 days you should rinse with full force. Brush teeth 3 times a day. Facial sutures (if any) should be left open to air after the first few days. Use a small amount (very thin coat) of Polysporin to the facial wounds twice a day. If there is an increasing area of redness and itching then call Dr. Reynolds, you may be developing an allergic reaction to the Polysporin. The sutures should be removed in 5-7 days.
8. CLEANLINESS AND HEALING:
The incision will heal better if it is carefully kept clean during the healing period. Oral sutures dissolve in two weeks. Brush the teeth and gently rinse starting the next day after surgery. In the beginning don’t swish the mouth rinse too hard. After one week start gently running your fingertip along the incisions to massage them.
9. INJECTION SITE:
After having intravenous anesthesia, the arm vein may become hardened and tender. Apply moist heat over the area for one hour three times a day for three days. Contact me if there is no improvement
Nausea is a normal side effect of narcotic pain medications. If you have nausea or vomiting you may need to stop the pain medications or to take an additional anti-nausea medication. It is better for you take the extra medication when you feel the first signs of nausea than to wait until you vomit.
Active bleeding can be controlled by some simple measures. Keep head elevated. Stay calm and relaxed. For nasal bleeding use Neo-Synephrine (phenylephrine) or Afrin (Oxymetazoline) nasal spray. Be patient.
12. NO NOSE BLOWING:
You may gently sniff in. Use the saline nasal spray often. Only use the Afrin for nose bleeds.
Cease all use of tobacco for 6 weeks prior to and 6 months after surgery. Failure to do so may have serious negative effects on the success of the surgery.
Be careful not to put pressure on the area during sleep the changes in position of the bones need time to heal before they will be stable.
15. ANTIBIOTICS AND CONTRACEPTION:
Contraceptives may be ineffective while taking an antibiotic. Use extra protection
Elastics (rubber bands) will be placed. An elastics pattern may be given to you to follow. Keep the elastics on 24 hours a day except for removal for meals cleaning the mouth and jaw exercises which should be done three times a day. Replace the same elastics in the prescribed manner. Elastics may be reused until they appear worn or stretched at which time they should be discarded and new ones used.
Do not chew. Your diet is puréed. When you take off the elastics that does not mean you can chew. Eat with a spoon a straw or simply drink.
18. TMJ Exercises:
Each time you take off the elastics you should do jaw opening exercises. Open your jaw straight open move the chin side to side. Move the jaw straight forward. Do these exercises three times a day. Eventually your goal will be to open enough to fit three of your fingers stacked between your incisor
19. FACIAL EXERCISES:
Especially when having upper jaw surgery the muscles of facial expression will not work well and a lot of swelling will accumulate in the upper lip. Do smiling exercises three times a day after the surgery.
Sutures inside your mouth will dissolve in approximately one and a half weeks. If they are falling loose they may be trimmed but do not try to remove them before one week has passed. If small incisions were made on the face those sutures should be removed between five and seven days after the surgery. A small amount of triple antibiotic ointment should be applied twice a day to those facial incisions.
Ibuprofen is the active ingredient in Motrin and Advil and is an anti-inflammatory drug. It would be beneficial to start taking some ibuprofen as necessary for pain. This will help with the TMJ joint inflammation and general pain control. Take 800mg (4) 200mg tablets every eight hours unless you have gastritis stomach ulcers or are on Coumadin/Warfarin.