Postoperative Instructions for Patients Undergoing Orthognathic (Jaw) Surgery

Orthognathic surgery is performed to realign the jaw bones so the teeth fit together properly when the jaws function. The surgery is most often performed in the hospital under general anesthesia. While some patients go home later the same day, others stay over night and are discharged the next morning depending on the length of the surgical procedure and the recovery from anesthesia. The nature of surgical procedures involving the mouth and jaws will produce some degree of swelling, discomfort and restriction of jaw movement. These findings are different for each patient and are usually not severe. These instructions are designed to provide the postoperative patient with information following orthognathic (jaw) surgery and also to address the most common problems that may arise during the postoperative period. Following these instructions should make your postoperative recovery as easy and as comfortable as possible.

Pain – Some degree of discomfort is to be expected following surgery on the jaws. However, the sensory nerves of the lips and cheeks may feel numb (like Novocain) as a consequence of swelling caused by the surgical procedure. This actually is to the patient’s benefit, because they rarely feel acute pain during the healing phase. This numb sensation (paresthesia) is usually transient and resolves slowly; normally lasting 8-10 weeks after surgery. Wearing rubber bands to limit the motion of the jaws will also help to decrease discomfort during the first few weeks. Of course, your doctor will prescribe pain medication in a liquid form, but in most instances patients will rely on it minimally. Other common complaints following surgery are minor earaches, muscle aches, and headaches that are all related to spasms and inflammation in the muscles attached to the jaws. Such complaints are certainly considered normal and will likely come and go over the first 4-6 weeks of the healing phase. These symptoms can also be controlled with the prescription pain medication if needed.

Swelling – You should expect swelling of the lips, cheeks, and areas around the jaw bones following surgery. This will reach its maximum point two to three days after surgery.This may be accompanied by some bruising, but usually only a faint yellow color will appear on the face and neck. The yellow color may settle down the neck and into the chest due to gravity and is not to be confused with an infection. Medications (Solumedrol or Decadron), and a pressure bandage are used over the first 24 hours to help minimize swelling and bruising. In any event, the swelling and bruising will usually resolve within 10-14 days. Ice packs applied to the face, especially for the first 6-10 hours after surgery will also help. A simple ice pack can be made at home by placing ice into a plastic bag and wrapping it in a wash cloth or hand towel. Place the ice pack on the side of the face for 20 minutes then take it off for 5-10 minutes. Repeat this cycle. After the first day, ice will do very little to reduce the swelling, however, if it makes the patient more comfortable it may be continued as it will certainly not cause any harm.

Swelling also occurs in the structures in and around the face such as the nasal and sinus membranes. Decongestants (Dimetapp elixir and Afrin nasal spray) are used to control this swelling and reduce the build up of mucous in the nasal passages. If a stuffy nose is a persistent problem, many patients find that standing in a hot shower will unclog their nasal passages and make breathing easier. Remember, you are not allowed to blow your nose for the first 2-3 weeks following surgery as air may be forced into the cheeks and result in an infection.

Bleeding – Rarely is postoperative bleeding a problem. However, a small amount of blood in the mouth is to be expected immediately following surgery. The pressure bandage and an ice pack after surgery help to minimize this problem. Some patients may also experience some minor bleeding (i.e. after sleeping) for the first 24 hours and occasionally after brushing your teeth. This is normal and you should not be alarmed. If this persists however, you should contact the office.

Oral Hygiene – Maintaining good oral hygiene is also very important during the initial healing phase to avoid infections. A clean mouth will also allow easier breathing, easier passage of liquid foods and your mouth will taste better! During the first few days with swelling at its peak, rinsing with salt water (1 teaspoon of salt in 8 oz of water) will assist in keeping the surgery sites clean. Once your doctor gives the okay (usually 24-48 hours after surgery), a child size toothbrush and toothpaste should be used to clean the teeth and braces.

Some patients will have a splint (a retainer like device) placed in the roof of the mouth at the time of surgery. Frequent vigorous rinsing with either the salt water or plain warm water, especially after meals, will keep this clean as long as it is in place (usually 4-5 weeks). You will receive a prescription for a medicated mouthwash (Peridex or the equivalent) which helps reduce the bacterial count in the mouth. It is to be used as prescribed for the whole time the jaws are healing and the splint is in place. It is not a substitute for brushing. In fact, if proper hygiene isn’t maintained, the food debris and plaque left on your teeth will stain dark brown. This is easily polished off your teeth by your hygienist after surgery, but can be prevented from occurring at all if you concentrate on good brushing. After the stitches dissolve (usually 2 weeks) a Water-Pic or similar irrigating device may be used, but please wait for your doctor’s okay before using such a device so as not to jeopardize the healing of the wounds.

Wound Care – Orthognathic surgery is performed primarily inside the mouth. However, to secure the jaws in place it may be necessary to make a small incision under the angle of the jaw in a cosmetic area. The sutures in the mouth dissolve over a two week period. Any sutures (stitches) in the skin will usually be removed 4-6 days following surgery. The stitches should be kept clean following surgery. This is most easily accomplished by gently cleaning with a Q-tip dipped in half strength peroxide (3% hydrogen peroxide, available from the pharmacy, diluted 50:50 with tap water). Remember, a clean wound heals faster with less discomfort and is less likely to become infected.

Diet – In the past, it was necessary to wire the jaws together following jaw surgery for up to 6-8 weeks. Now wiring the jaws together is seldom necessary, and it is considered routine to rigidly fix the jaws together such that only rubber bands are placed to limit the movement of the jaws while they heal. Approximately one week after surgery your doctor will instruct you, if it is appropriate, on how to remove and replace the rubber bands to facilitate nutrition and cleaning your teeth. Until that time, your diet will be primarily liquids such as fruit juices, milkshakes and clear soups. Please don’t drink through a straw as this may cause an infection. Drinking from a glass or cup is certainly acceptable for liquid foods. We ask that you try to avoid soda as it has relatively few calories and little, if any, overall nutritional value. After this initial period your diet can be advanced to soft non-chewing foods. Any food of the consistency of mashed potatoes, scrambled eggs, apple sauce, or ice cream is acceptable. You can alter the consistency of your favorite foods to be soft by simply passing them through the blender and perhaps adding some appropriate liquid. Your doctor will monitor your healing and let you know when you can begin to chew tougher foods (usually after six weeks). Nutritional supplements such as Carnation Instant Breakfast, Ensure, or Boost are certainly acceptable to augment your diet. For thicker blenderized foods using an infant spoon is helpful because it is small enough to fit in the mouth during healing.

If the above instructions are not clear or you have a persistent problem, please do not hesitate to contact the office for assistance.