Postoperative Instructions for Patients Undergoing Temporomandibular Joint Surgery

By nature 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 patient with information following TMJ 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 jaw joints. Your doctor will prescribe the appropriate pain medication for your individual needs. The prescription pain medication may be required for a day or two. However, many patients find that ibuprofen-like medications, such as Advil or Nuprin, are significantly more effective in relieving discomfort several days after surgery. This is because ibuprofen reduces the swelling that is responsible for much of the discomfort. Other common complaints following surgery are minor earaches, muscle aches, and headaches that are all related to spasms in the muscles attached to the jaw joint and inflammation in the healing wound. Such complaints are certainly considered normal events and will likely come and go over the first 6-8 weeks of the healing phase. These symptoms can also be controlled with ibuprofen medications.

Swelling – You should expect some swelling associated with TMJ surgery which will appear in front of the ear and on the side of the face where surgery is performed. This will reach its maximum two to three days following surgery and will gradually disappear over the next seven to ten days. This may be accompanied by some bruising, but usually only a faint yellow color will appear around your ear. Medications (Solumedrol or Decadron) and a pressure bandage may be used during the first 24 hours after surgery to help keep swelling and bruising to a minimum. An ice pack applied to the face, especially for the first 4-6 hours after surgery will also help. A simple ice pack can be made 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.

Bleeding – The surgery sites should remain covered for the first 24 hours after surgery. Rarely is postoperative bleeding a problem, however, a small amount of blood on the bandage is to be expected immediately following surgery. Using the ice pack as described above will minimize this problem. Some patients may also experience some minor bleeding (i.e. after sleeping) for the first 24 hours. This is normal and you should not be alarmed. If this persists, however, you should contact the office.

Wound Care – TMJ surgery is performed through incisions placed in front of the ears. Following surgery there will be a few stitches visible in this area. The sutures will need to be removed approximately 5-7 days after surgery. The stitches and surgery sites should be kept clean following surgery. This is most easily accomplished by showering and shampooing your hair daily. The surgery sites can then be patted dry with a clean towel.

If any crusting develops over the sutures, this can be cleaned 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. It also makes it easier to have the sutures removed!

Diet – You will be most comfortable with liquids for one or two days after surgery. Following this your diet should be a very soft (i.e., non-chewing diet) during the early healing phase (approximately 6 – 8 weeks following surgery). Food should be of the consistency of mashed potatoes, scrambled eggs, apple sauce, or
ice cream.Your doctor will monitor your healing and let you know when you can begin to chew tougher foods.

Bite Splints – Many patients, but not all, will have a bite splint to wear prior to surgery. It is most important that you follow your doctor’s instructions carefully with regards to the bite splint following surgery. The minor alterations in your bite due to the surgery must be protected, or you can damage the repair work which has been done during surgery. Usually, the patients are instructed to wear the splint 24 hours a day including eating and sleeping (when the jaws are often experiencing the greatest function). The splint is removed for oral hygiene purposes and replaced immediately.

Gradually, the splint therapy will be modified as healing progresses. Usually patients use the splints a minimum of 6-8 weeks following surgery, although some wear it longer depending on their individual situation. Remember, opening the mouth will not damage the joint. It is biting down on a newly operated joint that may damage the repair. Although the temptation is great, don’t try to chew food until your doctor gives you the okay and keep your splint in place at all times.

Physical Therapy – After the first 7-10 days, your doctor may ask you to see a physical therapist. The therapist will teach you exercises to begin to increase the mobility of your jaw joint. The eventual success of surgery is closely related to the rehabilitation of a stable bite and rehabilitation of joint function. These exercises should be performed 4-5 times per day for 10 minutes a session. You may need to perform these exercises over the next several months depending on your response to surgery and your willingness to work hard at these exercises. Your doctor will monitor your progress carefully and let you know when to start exercising and when you can stop exercising and wearing your splint.

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