Post-Operative Information For Jaw Surgery Patients
THE OPERATION – WHAT TO EXPECT
The operation takes approximately 2-3 hours for 1-jaw surgery and 4-5 hours for 2-jaw surgery, depending on the extent of surgery. Please refer to your jaw osteotomy information booklet (you should have received this at your initial consultation) for details of the operation.
Immediately after the operation, you will be quite drowsy and your jaw will feel numb, due to an injection of a long lasting local anaesthetic. You will have facial swelling and you will have ice packs around your face to reduce the swelling.
There will be a “drip” attached to your arm for fluids and medication. You will also be given a PCA (patient controlled analgesia), this is a morphine infusion that has a button which you can press whenever you feel pain or discomfort in order to self-administer pain relief instantly. It is programmed so you cannot overdose. Most patients find that this administers more pain relief than they require and usually stop using it after 48 hours. Panadine Forte tablets are usually adequate after 48 hours and you will be discharged home with these.
If you have had lower jaw or 2-jaw surgery, you will have two tiny drainage tubes (into small drainage bottles) from your lower jaw. These drain excess blood and helps reduce swelling. They will be removed painlessly 24 hours after surgery.
With upper jaw or 2-jaw surgery, you should expect some nasal oozing for the first 24 to 48 hours followed by nasal/sinus congestion, which can take 1 to 2 weeks to resolve. Nose drops (e.g.: Drixine) and decongestants (e.g.: Sudafed) may be helpful. With upper jaw surgery, in some cases (not all), you may also have a small stitch covered by a steri-strip on the bridge of your nose. This is due to placement of a small bone marker to measure and correctly reposition the vertical height of your upper jaw position during surgery. This stitch will be removed by Dr Lim at your review appointment a week after surgery.
All the stitches inside the mouth are resorbable and dissolve after 3 to 4 weeks.
You will have small titanium plates and screws (mini-plates) in your jaws. The titanium plates and screws in your upper and lower jaws will not be noticeable to you and will remain indefinitely.
You will also have some light elastic bands placed between your teeth to ensure the bite remains stable and heals in the right place. When you are comfortable (usually 1 week after surgery), you may remove the elastic bands during mealtime and to clean your teeth, and then you must replace them with new ones. The elastic bands are usually worn for up to 4 weeks after surgery to prevent relapse of the bite.
Dr Lim will review you while in hospital, and your progress monitored by the nursing staff, and you will be discharged home when you have adequately recovered.
You will be restricted to a soft diet for 6 weeks after the surgery to allow the jaw to heal properly. Below is a guide as to your progress with your diet:
- Day 1:Clear liquids only
- Day 2 to 3: Progress to full liquids (shakes, soups, yoghurt) and then progressing to a pureed diet as tolerated
- Days 4 to 7:A pureed diet (you will need a blender at home and you may wish to purchase dietary supplements to optimise nutrition)
- Week 2:Continue with the pureed diet and begin to introduce very soft, “mushy” foods (e.g.: mashed potato, scrambled eggs, very soft pasta)
- Weeks 3 to 6: Strictly a soft diet (see the “Soft Options” diet sheet attached for examples).
You will be issued antibiotics from the hospital. Complete the course of antibiotics as prescribed.
Oxycodone will be issued to you at the hospital for pain relief. This is a very strong medication and has side effects, such as drowsiness and nausea and/or vomiting. You should not take more than 8 tablets per day. You may wish to take 2 tablets of “Nurofen” or “Nurofen plus” alternating with Panadol during the day every 2 to 3 hours (maximum 8 panadols per day) and Oxycodone at night.
You should be rinsing your mouth four times a day (after every meal and before bed) with a mouth rinse (Savacol or Difflam-C is recommended) for at least 2 weeks after the surgery. Mouth rinsing should commence on the second or third day after surgery to prevent infection.
After one week, or when your mouth is more comfortable, you should start cleaning your teeth to remove all the food build-up from your braces with a small, soft, child-sized toothbrush regularly.
PAIN, SWELLING AND BRUISING:
You should expect to be taking pain medication for up to 1 week after discharge from hospital.
Most of the facial swelling should resolve after 2-3 weeks, with some residual puffiness present up to 4-6 weeks after surgery.
There may also be some facial bruising which may descend towards the neckline. This can vary depending on the individual patient, but it will slowly resolve after 1-2 weeks.
You will notice a residual numbness and/or tingling sensation from your upper and lower lip, front teeth, gums and chin region after surgery. As Dr Lim previously explained, this is due to the stretching of the related nerves involved in the surgery. The numbness may take at least 3-6 months (and possibly longer) to resolve and, as you know, there is a small risk that it may not resolve completely and occasionally, result in permanent numbness.
You will need to see Dr Lim for a review the week after the surgery and then weekly or fortnightly (depending on the position of your bite) for the next 4-6 weeks. Dr Lim will assess your healing, instruct you on the placement and removal of the elastic bands, remove the skin stitches if present, and send you for x-rays. A report will be sent to you orthodontist.
Your Orthodontist will also like to see you usually 2-3 weeks after the operation. The post-surgical orthodontics (adjustment of the braces and fine tuning of the bite) usually commences at 6 weeks after the surgery when the jaws have healed.
Dr Lim will see you again at 6 months after the surgery, and then finally one year after the surgery.