After Corrective Jaw Surgery

What Can You Expect After Corrective Jaw Surgery?

Post-surgical period: Following completion of your surgical procedure, you will be transferred to the recovery room. There, your progress will be monitored closely by the nurses on duty. You will remain in the recovery room for about one hour until you are sufficiently awake to be transferred to your room. Occasionally, it may be necessary to send you to the High Care Ward where you will receive more intensive nursing during the first few hours following your surgery.

Post-operative pain: In most cases the procedure is surprisingly less painful than expected however a certain amount of pain must be expected and the necessary painkillers will be provided. The discomfort is usually worse than the pain and may last for a few days to a fortnight.

Swelling: You can anticipate that swelling will occur and the degree of swelling is quite variable amongst individuals. More swelling usually occurs with lower jaw surgery than with upper jaw surgery. Swelling will increase for approximately 48-72 hours following surgery. At the completion of the surgery a soft pressure bandage will be placed over your jaw to assist in controlling the swelling. While your head will be slightly elevated during the period of hospitalization, ice packs will be placed on your jaws to further reduce the swelling.

Minor bleeding following surgery: It is common to experience some degree of bleeding following surgery, and minor nose bleeds may be expected for a period of 1-2 weeks following upper jaw surgery. This may be more pronounced when leaning forward. However, if bleeding continues for longer than 15-20 minutes contact your surgeon immediately.

Nausea and vomiting: You may experience some nausea and vomiting. This is sometimes the result of the anaesthetic or an irritation of old blood in your stomach. Therefore, if vomiting does occur, remain calm, and turn your head to the side so that any fluid produced clears your mouth freely. The nurses who care for you are used to dealing with patients who have had this type of operation and are properly trained to cope with this effect.

Numbness: A numbness of the lower lip and chin may be expected following lower jaw and chin surgery while the upper lip, cheeks, palate, and gums may feel numb following surgery to the upper jaw. This is due to interference with the nerves supplying sensation to these areas and is usually temporary. Feeling can be expected to return to these areas within a few weeks following surgery however may even take several months to return. Unfortunately, in a very small percentage of cases, this may be permanent.

Nasal stuffiness: The cause of nasal stuffiness may be either from the tubes placed during surgery or from the surgical procedure in the upper jaw surgery. When this occurs, it can be managed with a combination of nasal sprays and cleaning the nostrils.

Blowing of the nose: Do not blow your nose or sneeze with your mouth closed for at least 1 week following upper jaw surgery. This can cause air to be forced into your cheeks and lower eyelids with immediate severe swelling. A nasal spray will be provided to help decongest the nasal passages.

Medication: An intravenous infusion will be attached to your arm during surgery to provide required medication and nutrients until you are able to take sufficient liquids by mouth. During the period of hospitalization, you will usually be given antibiotics, pain medication, an anti-inflammatory, mouth wash, and medicated cream for your lips and for upper jaw surgery – a nasal spray. Most of the medication will be continued on discharge from hospital. It is important to utilize your medication as prescribed.

Elastics: Elastics are generally used to stabilize the jaws and to guide the teeth into the new bite. They are usually placed immediately after the operation, and should not be removed until the first post-operative appointment. At your first post-operative visit the surgeon will instruct you how to apply and use the elastics. The elastics should be used as directed until your next appointment with your orthodontist.

Cleaning your teeth: It may be difficult to clean your teeth during the first few days following surgery. It is however advantageous to clean your teeth after each meal and you fortunately, you will have sufficient time to do it! A small soft tooth brush can be utilized for this purpose and in addition a mouth rinse should be used. Soak the bristles in the mouth wash and brush slowly, in order to get maximum benefit from the antiseptic effect of the mouth wash.

Clear liquids: An adult requires approximately 2-3 liters of fluid every 24 hours as a normal fluid intake. Although this may seem like a large quantity, it can be achieved with constant sipping. It will be important that you drink a sufficient volume of fluid to allow the discontinuance of the drip on the following day. Once you have fully recovered from the after effects of the anaesthetic, you will be encouraged to drink clear liquids. This will often be easier directly from a cup or glass due to the loss of sensation in the lips. However a large catheter tipped syringe will be available to assist you if you find this method easier.

Splints: In selected cases, the use of a splint is necessary. This is a plastic template made after the dental casts have been positioned into the planned new bite. The splint is constructed of clear plastic (acrylic) and the teeth are wired into the splint to establish and maintain the correct jaw position. It is not visible to the casual observer and will remain in place until bone healing has been completed.

Wiring the teeth together: With the use of rigid fixation (small plates and screws) which will hold the jaw segments together, it is seldom necessary to wire the jaws together. However in some selected cases it may be advantageous depending on the technique used. The necessity for this will be discussed with you prior to the operation.

Day of discharge and healing phase: Most patients are ready for discharge within two days after surgery.

• A period of rest for up to one week is recommended and after that you are encouraged to resume your normal activities as soon as possible. 
• Although you may resume with light physical exercises after 10 days, contact sport should be avoided for at least six weeks following surgery. 
• It is very important for the treatment team to be sure that all the oral and facial tissues adjust to their new relationship that bone healing is normal and that final soft tissue settling takes place. You would therefore see the surgeon or orthodontist for regular evaluation visits. 
• It is important to keep in mind that although 90% of the post-operative swelling disappears within the first 10-14 days, the initial healing phases will take approximately 6 weeks. 
• Completion of the healing and firming up of the muscles can only be expected after 6-10 months.

Diet:

• It is vitally important that chewing forces applied to the operated jaws are kept to a minimum during the first 3-4 weeks following surgery. 
• Under no circumstances are you to chew solid foods. It is suggested that prior to your jaw surgery you acquire a blender and a food strainer. 
• The usual post-operative program is: one or two days of liquids followed by a week of pureed foods and then three weeks of soft foods. Food and nutrition plays a vital role in our daily lives, especially where healing needs to take place. A soft diet can still be balanced providing all the necessary nutrients. It is important that all the components required for your rehabilitation should be available to your body. 
• You may select foods that you can manage. In order to ensure that you have a balanced diet, try and include something from each food group at each meal. 
• A weight loss of approximately 3Kg may be anticipated during the post operative period. This is a reflection in most cases of loss of appetite, rather than the soft diet. By one week following surgery, your appetite should be sufficiently improved to maintain and possibly increase your weight. 
• It is very important to realize that the bulk consumed with liquid diet is not sufficient to satisfy an appetite. Hunger or appetite is relieved by distention of the stomach, chewing, and the volume consumed, and a liquid or soft diet may not satisfy these demands. Thus more frequent intake is required and it is strongly recommended that your diet is taken as a breakfast, morning tea, lunch, afternoon tea, supper and before retire. This will keep the hunger pangs at bay! 

Known Risks and Complications

1. Loss or alteration of nerve sensation, resulting in numbness or a tingling sensation in the face, jaw, teeth or tongue may occur as nerve fibers are regenerating and mending. During the healing phase you may experience the sensation of itching, warmth and a tingling over the effected areas. The change of sensation seldom remains for longer than 6 months. In a small percentage of cases the altered sensation may be permanent, particularly in the lower jaw.
2. Infection is a potential risk following any surgical procedure, and if an infection does occur it is usually treated with antibiotics. If swelling reappears in the first 2-6 weeks following surgery, combined with fever and pain or pus develops, contact your surgeon immediately.
3. Sinus complications, such as pain and or a postnasal drainage may occur in some cases following upper jaw surgery. Sinusitis symptoms should be reported to your surgeon.
4. Injuries to adjacent teeth and roots, fillings or bridgework can occur during orthognathic surgery which may require appropriate dental treatment.
5. TMJ (the joint of the jaw) pain or limited range of movement may occur following orthognathic surgery. This can impair chewing or speech function and may need physical exercises to improve the condition.
6. Relapse of the jaw position or unexpected shifting of the jaw structure is uncommon but can occur. This complication may demand surgery for correction.
7. Excessive post-operative bleeding very seldom occurs however any post-operative bleeding, longer than 20 minutes, especially following upper jaw surgery, should immediately be reported to the surgeon.

Follow-Up Care

After the completion of your treatment, your orthodontist and surgeon will want to see you periodically to monitor you and to ensure that your teeth and jaws are staying properly aligned. You should maintain your oral health and visit your family dentist regularly.

Post-Operative Instructions After Corrective Jaw Surgery

Post-operative care after corrective jaw surgery is very important. If followed carefully, it may minimize side effects and prevent complications.

Immediately Following Surgery

• Avoid hot food and drinks as it may cause bleeding during the first 24 hours after surgery.
• Mouth rinsing during the first 24 hours after surgery should be avoided. This may dislodge the blood clots and initiate bleeding.
• The gauze pad placed over the surgical area should be left in place for half an hour. After this time, the gauze pad should be removed and discarded.
• Place ice packs to the sides of your face where surgery was performed. 
• Pain medication will be given to you intravenously during the first day after your surgery, but the next day you will be placed on oral painkillers. Take the prescribed pain medications as soon as you begin to feel discomfort. It is good practice to stay on top of pain by taking your painkillers regularly (i.e. 6-hourly) for the first 2-3 days. We prefer to prevent pain rather than treat pain
• Antibiotics will be given to you intravenously during the first day after your surgery, but the next day you will be placed on oral antibiotics. Do not take antibiotics on an empty tummy. 
• After arriving back in the ward, keep your head elevated for the first 6 hours after surgery. Avoid lying down flat as this may cause bleeding and an increase in swelling. 
• Do not BLOW YOUR NOSE or sneeze with your mouth closed for at least 1 week following upper jaw surgery.