Pre-Operative Information for Patients Undergoing Orthognathic Surgery

The following information represents a summary of the details your doctor discussed with you regarding your upcoming surgery. Please read it carefully and if you have any questions or concerns, please contact our office before surgery.

1.) Orthognathic surgery is performed to realign the jaw bones so the teeth fit together properly when the jaws function. It is normally performed in conjunction with orthodontics where braces are used to align the teeth within individual jaws before surgery and to precisely integrate them after surgery. In the past, it was necessary to wire the jaws together for the 6-8 week to allow the bones to healing properly. Now with the recent advances in surgical technique, wiring the jaws together is seldom necessary. It is now considered routine to rigidly fix the jaws together in a way that only rubber bands are placed to limit the movement of the jaws while they heal. In fact, 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.

2.) 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 result of such incisions, once healed, is a nearly invisible cosmetic scar which has not been a problem for any of our patients to date. The sutures in the mouth dissolve over a period of two weeks. Any sutures (stitches) in the skin will be removed 4-6 days following surgery. 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 will settle down the neck and into the chest due to gravity and is not to be confused with an infection. Medications (Solumedrol), and pressure bandages are used over the first 24 hours to help control swelling and bruising. In any event, eighty percent of the swelling and bruising will usually resolve within 10-14 days.

3.) Swelling also occurs in the structures inside the face. Nasal membranes, sinus membranes, and nerves may be affected. Over the counter decongestants (Dimetapp elixir, Afrin nasal spray, etc.) may be used to control swollen membranes and mucous in the nasal passages.The sensory nerves of the lips and cheeks are likely to feel numb (like Novocain) as a result of the swelling. While initially disconcerting, this is to the patient’s benefit, because they will not feel any acute pain during the healing phase. This numb sensation (paresthesia) is usually transient, normally lasting 8-10 weeks after surgery. Of course, prescription pain medication in a liquid form is available if needed, but in most instances patients will rely on it minimally.

4.) Nutrition is of utmost importance during the healing phase so the wounds and bones heal properly. A dietitian will advise you while in the hospital and your doctor will give you special dietary instructions following surgery. For the first week following surgery your diet will be primarily liquids such as fruit juices, milkshakes and clear soups. 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. You should expect a 7-10 pound weight loss over the first week and then about 1 pound per week for the remaining time your jaws are healing. Nutritional supplements such as “Carnation Instant Breakfast”,“Ensure”, or “Sustecal” are certainly acceptable to augment your blenderized diet. For thicker blenderized foods using an infant spoon is helpful because it is small enough to fit in the mouth during healing and when your lips are swollen. Drinking from a glass or cup is certainly acceptable for liquid foods but we ask that you refrain from using a straw.

5.) Oral hygiene is also very important during healing to avoid gum infections. A clean mouth will also allow easier breathing, easier passage of blenderized foods and make your mouth taste better. Your tongue will clean the inside of the teeth, but you must clean the outside surfaces. During the first few days when swelling is at its peak, rinsing with salt water (1 teaspoon of salt in 8 oz of water) is best. Once your doctor gives the okay (24-48 hours after surgery), a child size toothbrush and toothpaste should be used. After the stitches dissolve (usually 2 weeks) a Water-Pic irrigating device can 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.

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, however, 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.

6.) On the day your splint is removed, your jaw muscles will be stiff, causing some limited jaw mobility. You will certainly be able to open your jaws, but probably not wide enough to eat a “Big Mac” at first. You should expect some aches in the jaw muscles, earaches, or headaches as you stretch these muscles through normal chewing, talking, and swallowing.

7.) Many of our Orthognathic Surgery patients are under treatment for jaw joint (TMJ) problems.This is fairly common in patients with jawbone problems because the jaw joints, the jawbones, the teeth and the bite are
all interconnected. Some patients are scheduled for surgery on their jaw joints months prior to their jawbone surgery. On the other hand, some TMJ problems may not surface until orthodontic tooth movement starts or jawbone surgery is performed. Therefore, some patients may develop clicking, popping, locking, or pain in their jaw joint following orthognathic surgery. This is an important finding and should be discussed with your doctor as it may indicate the need for further treatment of the jaw joints to ensure a more stable overall result.

8.) Our “surgical coordinator”, will play an essential role in your surgical experience as she acts as a liaison between our office, you the patient, and the various institutions and health care professionals that we must interact with. If you have not done so already, you need to schedule a physical with your family physician 7-14 days prior to surgery. You will also need to contact the American Red Cross to donate one unit of Autologous Blood prior to surgery. Our office can assist you in scheduling any or all of these appointments. Lastly, you will need to contact our office to set up a series of pre-surgical appointments with the “surgical coordinator” in our Simsbury office.These appointments must follow the placement of surgical wires by your orthodontist. The “surgical coordinator” will then obtain the information that is needed to plan your upcoming surgery. This information includes: radiographs, photographs & slides, impressions, and facial measurements. The appointment immediately prior to surgery is reserved for the final case presentation, at which time family members are encouraged to attend.

Finally, you must have a signed medical insurance form on file with our office prior to surgery. You can bring it along on your pre-operative visit or simply mail it to the office before your surgery. If this is not on file at the office prior to surgery, your surgery may have to be canceled.
We hope that you have found this information helpful. Keep this letter and refer to it after your surgery as necessary. Again, if you have any questions, please write them down so you can ask your doctor at your final appointment before surgery.

Good luck with your upcoming surgery. If you have any questions, please do not hesitate to contact us.