Following the completion of the surgical procedure, you will be transferred to the recovery room. There, progress will be monitored closely by nurses on duty. The breathing tube may remain in place for several hours after surgery to protect your airway. If you awaken during this period, you will not be able to speak. Although this may be uncomfortable, try to relax and the tube will likely be removed shortly. You will remain in the recovery room for two to three hours or until you are sufficiently awake to be transferred to the surgical intensive care unit (S.I.C.U.). During this period in the recovery room, it will not be possible for members of your family to see you. They will be free to see you after you are transferred to the S.I.C.U. Patients who have had extensive Orthognathic surgery are kept under close supervision for the first twenty-four hours. We feel that the S.I.C.U. provides the best environment for the close observation that is needed for patients who have undergone more extensive procedures. You will then be transferred to your room.
Patients who have had rigid internal fixation successfully applied and are not wired together, especially those who have had only lower jaw surgery, may be transferred directly from the recovery room back to their own room or to a stepdown unit.
We recommend that visitors be limited to the immediate members of your family. It has been our experience that too many visitors at one time create a circus atmosphere. It also may be emotionally unacceptable to you or for close family members. During these first 7-10 post-operative days, you need rest and quiet. Therefore, it is advisable to limit the number of visits during the immediate post-operative period.
Visitors should be prepared in advance for the significant facial swelling that commonly occurs with Orthognathic surgery.
There will be some swelling. However, the amount varies with each individual. Generally, more swelling occurs with lower jaw surgery than upper jaw surgery. Swelling will continue to increase for approximately forty-eight hours following surgery. Swollen lips can be made more comfortable by utilizing the lubricant available at your bedside. Swelling typically remains unchanged until approximately 4-7 days following surgery, while during the second and third post-operative weeks, it subsides dramatically. Every attempt will be made to minimize swelling. Ice packs and steroids (anti-inflammatory drug used to diminish swelling) will be used to minimize your swelling. You will be encouraged to keep your head elevated for the first week following surgery, since an upright posture and early ambulation minimizes the swelling that may occur.
Nausea and Vomiting
You may experience some nausea and vomiting. It is important to realize that this is not a life threatening situation. Therefore, if vomiting does occur, remain calm and turn your head to the side so that any fluid produced clears your mouth freely. Although wire cutters are readily available in an extreme emergency, it is very unusual to have to cut the wires that are holding your jaws in position. Most patients, however, no longer require jaw wiring due to the use of rigid fixation techniques.
Most patients will not have to have their jaws wired together after their surgery. This is due to the use of rigid internal fixation in most cases. When rigid fixation is utilized, patients awaken from their anaesthetic with light elastics between the dental arches. These are often worn for several months after the surgery to improve stability and patient comfort. Although your jaws may not be wired, you must adhere to the recommended dietary protocol to prevent loosening or separation of the screws in the early healing period.
Generally, the plates and screws do not have to be removed. Rarely the hardware may become infected or tender to touch which would necessitate their removal.
Clenching and Grinding Habits
Many people may clench or grind their teeth at night-time during sleep. Since this occurs during sleep, most are not aware of this habit. Your surgeon may identify the presence of this habit through a clinical examination process. Since clenching and grinding may lead to increased muscle and joint pain, limited jaw opening, as well as joint clicking or popping, your surgeon may recommend a nightguard (bite plate) for night-time use. This device, along with specific medications, may substantially decrease this habit and the symptoms described above. In addition, they may help protect your rigid fixation from loosening since clenching and grinding is similar to eating hard foods. It should be noted that the presence of Temporomandibular joint clicking, degeneration or dysfunction as well as jaw muscle pain and a grinding/clenching habit may predispose to increased risk of joint degeneration.
Relapse is the tendency of the jaws to return to their pre-operated position. Relapse is more likely to occur when pre-existing disease, such as joint degeneration, clicking, popping or muscle pain and a clenching or grinding habit are present. Your surgeon will discuss the implications of this condition and may make recommendations to help ensure a successful outcome. If you have any of these symptoms, make a point to discuss them with your surgeon.
Minor Bleeding Following Surgery
It is not uncommon to experience some degree of minor bleeding and increased salivation following surgery. A suction at your bedside may help to clear your mouth of these excess fluids. Swallowing the normal saliva that is produced in your mouth should be done. If you have had upper jaw surgery you may experience some oozing and weeping of blood and mucus from the nasal cavities for up to 10 days following surgery. Do not blow your nose for two weeks following surgery. Suctioning of the nose can be done by the doctor or nurse.
It will be important that you drink sufficient fluids as soon as you can so that the I.V. can be removed. Your fluid intake and output will be monitored during the early post-operative phase. An average adult requires approximately two to three litres of fluid every twenty-four hours. While this may seem like a large quantity, it can be achieved with constant sipping. As soon as possible, you will be encouraged to drink clear fluids and you will also be encouraged to drink directly from a glass or a cup. Do not use a straw for eating for the first seven days as this creates a negative pressure in your mouth and could cause bleeding or wound breakdown.
The ease with which you can communicate and be understood is not predictable. Speech will only improve, however, by repeated attempts on your part to talk and be understood. It is important that you slow your rate of speech, concentrate on each word, and be willing to try repeatedly. Most patients can be understood within twenty-four hours after surgery. It is interesting to note that people may speak to you more loudly, confusing your speaking difficulties with a hearing loss.
Discomfort may be anticipated. In most instances, it is mild and is treated easily with medications. When bone grafts are taken from the hip, more discomfort should be anticipated. Many patients have indicated that the removal of impacted wisdom teeth produces more discomfort than Orthognathic surgery. It is difficult to predict the amount of discomfort you will have. Most patients have very little, while a few have had more than usual. Every effort will be made to keep you as comfortable as possible.
For those patients who have had rigid internal fixation applied and their jaws are not wired together, it is our experience that there is a slight weakness of the muscles. It is, therefore, important that patients understand that even though the jaws are not wired, it is necessary for them to restrict their diet at least in the early stages to liquids and very soft foods. Often, elastics will be applied to the braces to help keep the jaws together loosely and stabilize the bite.
It is not unusual for patients to complain of earache or discomfort associated with the jaw joints. This may be partly due to muscle spasm or changes in the position of the joint that have occurred at the time of surgery. If you have trouble sleeping because of facial pain, headaches, earaches or difficulty equalizing pressure, a medication can be given to you but you may have to ask the nurse for a doctor’s order as it may not be routinely offered.
Nasal stuffiness occurs, both from the tubes placed during surgery and from surgical procedures in the upper jaw. When this occurs, it can be managed with a combination of nasal sprays and cleansing of the nostrils. It is suggested that you remove nasal secretions using a Q-tip soaked in a solution of Hydrogen Peroxide and water (1 to 3 parts). It is essential that you do not blow your nose for two weeks following upper jaw surgery. Cleanliness can be maintained with moistened Q-tips.
When it is necessary to use the nasal spray, it should be sprayed with sufficient force for you to taste the medication. A buildup of nasal crustaceous material will happen as drainage occurs from the nose. These may be removed by either the nurses or the doctor. An evaluation of your ability to breathe freely through your nose will be made daily. If you feel this buildup occurring, please draw it to the nurse’s attention at once. The breathing of humidified air or oxygen (as a moisturizer) will greatly reduce this buildup facilitating its removal by suctioning.
You are encouraged to walk as soon as possible, even if a bone has been taken from the hip for use during surgery. The movement of getting you back on your feet early in the post-operative period is healthy for all body systems and can help shorten your hospital stay. Remember, you are a well person who has undergone elective surgery. The better prepared you are physically and emotionally, the sooner you will return to normal activity.
Expect some post-operative depression. This usually occurs on the second or third post-operative day. Do not let it concern you as it is not uncommon among patients undergoing this type of surgery, and this feeling is short-lived.
Oral Hygiene if the Jaws are Wired Together
You will be encouraged to brush your teeth following each meal. A soft toothbrush can be utilized for this purpose, paying particular attention to keeping the brush in direct contact with the teeth and not the gum tissue. In addition to brushing, a mouth rinse is recommended. A prescription antiseptic mouth rinse called Chlorhexidine will be used one or two times a day in the hospital and will be prescribed to you for home use. This antiseptic significantly lowers the bacteria count in your mouth. It may stain your teeth to some degree, but this is superficial and can easily be removed by our dentist. You are cautioned not to use a water irrigating device, such as a Water Pic until approximately two weeks following surgery. You will be told by the doctor when you can safely use this device. These irrigating devices have sufficient force that if used immediately following surgery, it can result in a breakdown of the wound. A Water Pic, along with a toothbrush, will, however, provide an excellent means of maintaining oral hygiene.
Weight loss of 5 to 10 pounds may be anticipated during the post-operative period. This is a reflection, in most incidences, of a loss of appetite. It may also reflect the character of your diet which has changed considerably from what you are used to. By one week following surgery, your appetite should be sufficiently improved to maintain and possibly increase your weight. Hunger is a common complaint by many patients, while others are delighted to shed an extra few pounds.
Day of Discharge
Most patients are ready for discharge two to three days after surgery. Medications with instructions will be sent home with you. A diet sheet will have been provided to you at a previous date for your use during your post-operative period. You will be given an appointment to be seen in the office usually within one week following your discharge from the hospital. If you have any questions or concerns, or if any complications should arise, please call us immediately. You are encouraged to resume your normal activities as soon as it is possible.
Jaws that are Wired Together
If your jaws are wired together following surgery, there will be a set of wire cutters and a special instrument for removing them at your bedside. As previously noted, jaw wiring is rare due to the use of rigid fixation. When surgery is on the lower jaw or both jaws, you may be wired together for four days to four weeks depending on the complexity of your surgery. We ask that you carry a set of large toe nail clippers or wire cutters, the type that fits onto a key chain, with you at all times. We will show you where these wires are located and how to remove them in the event of an emergency that would require their removal.
If you smoke, try not to during the post-operative period. Heavy staining will occur to the teeth, braces and splint, as well as retardation of wound healing. This may be a golden opportunity to quit smoking if you so desire.
Home Item Check List
- Water Pic (optional) – not to be used in the first two weeks after surgery.
- Blender (optional).
- Long Q-Tips (especially for upper jaw surgery).
- Instant Breakfast and Protein Supplement Meals.
- Multiple Vitamin tablets for daily consumption, and if necessary, a laxative.
- Chap-stick, cocoa-butter for lips.
- Mouth wash.
- Facial tissue.
- Pencil and paper or a magic slate.
- Regular room humidifier.
- Key chain type toe nail clippers to cut wires in extreme emergency if jaws are wired together.
Do’s and Don’ts
- Blowing your nose is a no-no following upper jaw surgery for the first 2 weeks.
- To sneeze, keep your mouth open so that no pressure is built up on your cheeks or in your nose region.
- Changes of pressure (as would be experienced in an airplane or on an upward travelling elevator) can be painful.
- Sleep with your head elevated.
- Use nasal sprays as required.
- Be prepared for nose bleeds or runny noses.
- When you are immediately unwired, it would be wise to stick to a liquid diet and gradually work into a soft and normal diet.
- If you suffer from nausea and if you have to vomit, it is important not to panic and simply turn your head to the side and let it drain out of your mouth.
- Avoid contact sports for at least eight weeks.
- Don’t exert yourself or do any exercises that may cause heavy breathing.
- If your jaws are wired, carry wire cutters with you at all times.
- Avoid any foods, liquids, or alcohol that may upset your stomach.
- Avoid the use of straws for the first week following surgery.