Post Operative Orthognathic Care
Orthognathic surgery is typically performed in the hospital under general anesthesia. Once you have recovered sufficiently from the effects of the surgery and anesthesia, you’ll be discharged home. By this time you should be comfortable with oral pain medication, taking fluids by mouth without difficulty, and voiding without any problems. The doctor is available through the office number and anytime if you have any questions. Please do not hesitate to call should need arise.
SWELLING: During the first week after jaw surgery moderately severe swelling is normal. Medication to control swelling is given while you are in the hospital. After this medication is discontinued, it is normal for there to be some increase in swelling, particularly during the third and fourth day after surgery. Swelling can be controlled to some degree with ice packs applied to both cheeks at 10-minute intervals. This is most effective when used during the first 24-48 hours after surgery. Ice packs may be continued after this time for comfort but will have little effect on swelling. I should not be applied directly to the skin. A wash cloth or gauze pad should be used to protect the skin from freezing.
PAIN: Pain can usually be adequately controlled with oral medication. Your doctor will write a prescription for you post operatively and instructions will be reviewed with you in detail. Liquid ibuprofen, 600 to 800 milligrams may be taken every six to eight hours unless you are allergic to aspirin or ibuprofen. If this does not provide adequate pain relief, liquid hydrocodeine 5 mg or liquid oxycodone may be taken every four to six hours if prescribed. If the pain medication is not adequate to keep you comfortable, please call our office to speak with your surgeon.
SENSATION: Altered sensation of the lower lip, chin, upper lip, and cheeks generally follows orthognathic surgery. Numbness of the lower lip and chin usually persists for several weeks, up to several months. Numbness of the upper lip and cheeks usually lasts for two to four weeks. If you have questions about this the doctor will explain this as it relates to your particular case.
WIRES: Your teeth are usually fixed together with rubber bands to help stabilize your jaws for healing. In some cases it is necessary to apply wire fixation for a brief time following surgery. Should wires be applied to your teeth, you will have been instructed to obtain wire cutters for use in emergencies such as severe nausea and vomiting. It is rarely necessary to cut the wires for simple nausea and vomiting as any liquids can usually be expelled between the teeth.
DIET: Because it is necessary to immobilize jaws for purposes of healing, your diet will be limited to liquids for a minimum of two weeks. You will have received dietary instructions and written form and also in some cases from the hospital dietitian. A high calorie/high protein liquid diet will aid with healing. It is important to feed more frequently, as often as six meals per day, because it is difficult to take enough nutrition at one setting. The blender diet allows normal food to be taken in liquid form, however it is usually necessary to strain the food through cheesecloth to remove particles that are difficult to get between teeth.
HYGIENE: Oral hygiene is extremely important to prevent infection following surgery. Liquid antibiotics are prescribed for one to two weeks following surgery. Chlorhexidine mouthwash should be used as a rinse two to three times daily. Gentle brushing of the teeth, orthodontic appliances, and fixation wires with a small soft bristle toothbrush is very helpful. A water pick should not be used for the first four days after surgery. If you wish to use a water pick please ask the doctor for instructions.
SINUS PRECAUTIONS: If you have had upper jaw surgery it is important that you do not blow your nose for two weeks after surgery. You may clear the nose by breathing in. It is normal for the nose to become blocked for a few days after upper jaw surgery. As the swelling subsides the nose will open after about four days. Decongestants and nasal sprays will be prescribed to help keep the nose open. Small amounts of bloody drainage and occasional clots may be expelled from the nose in the first week after surgery. Significant bleeding following upper jaw surgery is relatively rare. If you develop a nose bleed you should call the doctor immediately. If the bleeding is profuse you should go immediately to the emergency room at your nearest hospital and the doctor will meet you there.
WOUND CARE: Most orthognathic surgery is performed through incisions inside the mouth. Oral hygiene as described above is usually sufficient to keep the wounds clean. Small skin incisions are sometimes used, and you may have extraoral stitches following surgery. These areas should be kept dry. You may shower or bathe but keep these areas as dry as possible. Extraoral stitches are usually removed at your first post-operative visit. Stitches within the mouth usually dissolve without removal. They may be removed after one to two weeks if they are bothersome to you.
POST OP VISITS: The doctor will see you at least once per week following jaw surgery for approximately six weeks. You may be seen more frequently if needed. It is not uncommon for fixation wires and elastics to need adjustment periodically. In some cases fixation wires may need to be removed or adjusted under intravenous sedation.
It is our goal as an office team to make your recovery as comfortable as possible. We make every effort to keep you informed of your progress, and to help you towards normal activity as soon as possible. We go to great efforts to be available to answer questions so please do not hesitate to call us.
If you wish to reach us after office hour, please call the office number, 805-541-3220, and asked the operator to page the doctor.
We will make every effort to return your call promptly.