Before Intravenous Anesthesia Sedation
- You may not have anything to eat or drink (including water) for eight (8) hours prior to the appointment.
- No smoking at least 12 hours before surgery. Ideally, cut down or stop smoking as soon as possible prior to the day of surgery.
- A responsible adult must accompany the patient to the office, remain in the office during the procedure, and drive the patient home.
- The patient should not drive a vehicle or operate any machinery for 24 hours following the anesthesia experience.
- Please wear loose fitting clothing with sleeves which can be rolled up past the elbow, and low-heeled shoes.
- Contact lenses, jewelry, and dentures must be removed at the time of surgery.
- Do not wear lipstick, excessive makeup, or nail polish on the day of surgery.
- If you have an illness such as a cold, sore throat, stomach or bowel upset, please notify the office.
- If you take routine oral medications, please check with Drs. Liston, Broadbent, Chandler and McCormick prior to your surgical date for instructions.
When you first wake up in the recovery room you will become aware of certain things. First, your jaw will be held together with elastics. Sometimes this can cause some anxiety for patients. You are in no danger. Try not to open your jaws against the elastics. Your head will often be wrapped in a cold ice pack. You will experience some nasal stiffness and feel like you have a sore throat for a few days. This is very common and will resolve in a few days.
In-Hospital Stay (If applicable)
During your stay in the hospital, you will be under the care of nurses who are very well trained and experienced in handling orthognathic surgery patients. At the hospital bedside, there will be a suction apparatus to suction out your mouth. Your head will be elevated with the ice pack in place. This will help decrease the swelling. You can begin to drink clear fluids after the nasal tube is removed. It may be challenging because in addition to the swelling, you lips will feel numb. The nursing staff will assist you in drinking. It is important to try and drink early. You should aim to have about 2-3 liters of fluid intake per day.
All patients feel discomfort or pain after an operation, although the level of pain varies from patient to patient. Take your pain medications as directed. When you go home, it is important that a friend or relative spends the first night with you. You will be able to shower on the second day after surgery. You must avoid hot, prolonged showers which may cause bleeding in the upper jaw if
surgery is performed there and can cause light headaches. Avoid exercises, lifting anything over 20 lbs or activity that raises your blood pressure or pulse for at least one month after the surgery. The blood vessels are still healing from the surgery and any increase in activity may cause bleeding. You may begin gentle exercise, such as walking on a treadmill, after 2 weeks, but do not do any cardio for 4-6 weeks after the surgery. Do not drive a vehicle or perform any task that requires coordination or judgment for at least 48 hours following your anesthetic and/or if you are still using pain medication.
It is not uncommon to have minor oozing from the surgical sites in the mouth. If you have had upper jaw surgery, you may also notice blood coming out from your nose when you lean your head forward or backward. You may continue to experience bleeding or oozing approximately 7-10 days after the surgery. However, please call your surgeon if there is excessive or active bleeding, or if you have any concerns.
The swelling is perhaps the greatest post-operative event of your jaw surgery, and will vary from patient to patient. You can anticipate a large degree of swelling over your cheek area as well as down into your neck. The swelling is maximal at day 4 and will slowly subside after 2 weeks. There is a possibility of some swelling that can last up to 2-3 months after surgery. You will be given medications during the surgery and immediately after to help settle down some of the swelling, on day 3, there is very little that can be done to eliminate it. You should place ice on your face while you are awake for the first 3 to 4 days. The ice will also have a numbing effect that will reduce any post-operative sensitivity. You must be careful not to apply ice directly on the skin, as it may cause burns. After day 4, a warm water bottle is then recommended to help reduce swelling.
Nausea and Vomiting
It is not uncommon to have some nausea and vomiting after surgery, especially in the first 24 hours. Importantly, this is not a life-threatening situation, even if your jaws are wired shut. Jaws are rarely wired shut. We will let you know if this pertains to you.
Remain calm, and turn your head to the side so that any fluids pass freely. Rinse your mouth afterwards. Most people will usually feel better after vomiting, and find that the nausea passes. If nausea and vomiting persist, please contact your surgeon.
You will typically be prescribed an antibiotic, pain medication, and mouth rinse after surgery. Use them as instructed on the bottle.
It is very important to follow a proper diet plan after surgery, as your body will be healing and will need nutrition and calories. Nevertheless, it is not unusual to lose 5-10 lbs after surgery.
A suggested diet:
- The first 3 weeks should be liquids only. Taking adequate amounts of fluid after surgery is essential as it helps your body to heal. Suggestions include any clear fluids including water, soft drinks, Gatorade, and clear soups. Milk shakes, ice cream, Soya milk drinks, yogurts, protein drinks and protein supplements as well as nutritional supplements (such as Ensure, Boost, Whey, protein powders, tofu), or anything you can drink from a blender are good nutrition choices as well.
- After 3 weeks, you can commence a non-chew food diet. A recommendation is to eat food that you can easily squish between your fingers and anything that does not make any noise (e.g., hard or crunchy foods). Examples include mashed potatoes, scrambled eggs, fish, over-boiled/soft pastas cut into pieces etc.
- After 6 weeks, you can progress to a soft-chew diet. Portions should be small and cut into pieces to avoid placing too much pressure on the jaw. Soft fish dishes are excellent.
- After 6-8 weeks, you can progress to more normal chewing. However, continue to avoid overly hard foods or placing too much pressure on the jaw. Avoid pizza, apples, tough meats, candies, popcorn, pretzels, peanuts and other nuts etc, until at least 3 months after surgery.
It is important that you don’t chew too vigorously or with very much force, and you should avoid anything at all that is hard. Depending on the amount of mouth opening you have and also the amount of elastics that may be placed, your diet will continue to be restricted to your mouth opening. However, you can now start moving up to a more substantial diet.
The amount of swelling that will take place in your cheeks will make it very difficult to brush your teeth. Do not brush your teeth for one full week after surgery to avoid damage to the incisions and increased risk of bleeding. You should use warm saline rinses (1/2 teaspoon salt in a glass of warm water). You can rinse your mouth with salt water as often as you would like, even up to every two hours. This will keep your mouth nice and clean and will also tend to shrink the incision lines inside the mouth. You may also be given a prescription for Peridex, an anti-bacterial mouth rinse, which you should use as instructed on the bottle. Swelling begins to lessen after about one week, this will have allow you to have easier access inside your mouth. Purchase a baby toothbrush, using a small
amount of toothpaste, concentrate on brushing the metal braces. You should gently but thoroughly clean your braces, wires, teeth, and any plastic splint that is on your teeth. Be careful not to injure the wounds with the head of the toothbrush. If you do hit the wounds, there may be a little bleeding, but this is normal and should not cause any worry. Also continue to rinse your mouth with salt water regularly.
Avoid showering for the two days after surgery, although taking a bath is fine provided you do not get your facial incisions wet. After two days, feel free to shower, provided that the water is not too hot, as this may encourage bleeding following upper jaw surgery and may cause light headedness. Bruising Bruising is also quite normal after jaw surgery. Depending on which jaw was operated on, you may have bruising in the area of your upper cheek and eyes as well as your lower cheeks and down into your neck. It is not unusual to have some bruising extend all the way onto your chest. The bruising is unsightly, but it is perfectly normal and should not be of any concern. It will go away after about two weeks.
Nasal congestion is normal after surgery, especially if you have had upper jaw surgery. Do not blow your nose for at least two weeks after surgery. Use a saline nasal spray to loosen things up. Any nasal secretions that become crusty can be removed with a moist wipe, or with a Q-tip soaked in a one part hydrogen peroxide to one part water mix. Avoid placing anything into your nose to clean it, as damage can occur, especially following upper jaw surgery. Jaws that are Wired Shut If your jaws are wired shut after surgery, you will be provided with wire cutters to remove the wires in the case of an emergency (i.e. car accident). You will be taught which wires need to be removed, and how to remove them in the case of an emergency. During the course of healing, the wires around your teeth or jaws may loosen or break. This is not an emergency, but should be tightened or replaced as soon as possible. Call the office and make an arrangement to be seen.
It is normal to have decreased opening after jaw surgery. Do not attempt to force your jaws open with your fingers. After two weeks, you can begin to do simple jaw exercises: 3-4 times per day, simply try to open and close your jaw, move it side to side, and forward and back. This will be difficult at first, but will improve with time.
Most patients will have a numb sensation of the lips, cheeks, teeth, and jaws, depending on whether upper or lower (or both) jaw(s) surgery was performed. This is normal, and will usually resolve over the course of a few weeks to months with healing. The numbness does not affect the movement of your face. You may have some altered sensation to your hearing due to some of the swelling extending into the area of the ear. This numbness or muffled sound is not unusual and you should expect some of it. You may also experience some joint noises on the right and left side(s). Your joints need to get accustomed to their new position. It may be difficult to speak after the surgery, or to be clearly understood.