After Open TMJ Surgery
Please bring your splint if you have one to the hospital on the day of surgery.
Following TMJ replacement surgery, you can expect to spend one night in the hospital. The surgery will be performed with you fully asleep and will involve two skin incisions to allow the removal of the diseased joint and for the placement of the custom prosthetic joint. After surgery, these wounds will be covered with a dressing, which should stay in place for the first two to three days. After this time, you can remove these dressings and shower appropriately using gentle soap and water to keep the wounds clean. In addition, you may have an incision in the abdomen below the belly button and similar wound management should be used.
Please note, it is normal to experience some light bleeding and bruising from the incision sites however, heavy bleeding is abnormal and should be reported immediately. It is also not uncommon to have some dried blood in your ear, which can be managed with a rinse of half water and half vinegar put through a dropper three times per day if needed. Your doctor will discuss this with you.
You will have several medications to help reduce post-operative infection and for pain management. Your doctor will discuss this with you and should include:
- Antibiotics: Keflex 500mg: Take 1 pill 4 times per day for 7 days after surgery. If allergic, Clindamycin 300mg: Take 1 pill 3 times per day for 7 days after surgery.
- Analgesics: Prescriptions typically involve a narcotic analgesic (Percocet: Take ½-2 pills every 4-6 hours as needed for pain or Vicodin used in a similar dosage) and non-steroidal anti-inflammatory (Relafen 500mg: Take 1 pill 2 times per day until directed by your doctor).
- Muscle Relaxants: Patients who have had parafunctional muscle activity (clenching or grinding) may benefit from muscle relaxants (Zanaflex 4mg: Take ½-1 pill 30 minutes prior to bedtime) for several weeks after surgery.
- Anti-Nausea: Zofran Oral Dissolving Tablets: Dissolve 1 tablet under your tongue every 8 hours as needed for post-operative nausea and vomiting.
Your doctor will want to see you for several post-operative visits. Your long-term outcome can be dependent on your compliance with these visits. You will typically be seen one week after surgery, then the third and sixth weeks initially and visits will vary thereafter. You should report any issues immediately.
POST-OPERATIVE HOME JAW EXERCISES (PHYSICAL THERAPY)
Range-of-motion exercises are critical to your long-term recovery of function. During the first week or two, your opening may be limited because of elastics used inside your mouth. Once those elastics are removed, you will be instructed to begin mouth-opening exercises 5 times per day. These exercises include opening the jaw in as straight a direction as possible as well as moving the jaw to the left and the right as well as protruding the lower jaw. A typical cycle of therapy will include opening your jaw in a straight line looking in the mirror and holding for 5-10 seconds, then resting for 5-10 seconds. Next move your jaw to the left and hold again for 5-10 seconds followed by a rest of 5-10 seconds. Then move to the right and again hold for 5-10 seconds and follow with a rest. Lastly, you should protrude your lower jaw in as straight a line as possible and hold again for 5-10 seconds. You should rest again and then repeat the cycle. The cycle should be repeated 5 times per session and you should perform at least 5 sessions per day. Your jaw joint needs to move to help heal itself. Immobility greatly increases the chance of non-optimal surgical results. On occasion, your doctor may ask you to purchase a home motion device such as a TheraBite or EZ Flex II to help. Your doctor will review these range of motion exercises with you.
After surgery and during the time that guiding elastics are used, you will be on a liquid diet. Once those are removed, you will be on a soft, non-chew diet for approximately 6-8 weeks after which you can begin to advance your diet back to normal. Good foods to begin with are softer in consistency like tuna fish, ground beef or meats, yogurt, applesauce, canned fruits and vegetables, eggs, tofu, soft fish, soft bread without the crust, etc. It is critical that during the first several weeks after surgery you minimize the load on the jaw joints. Chewing hard foods (raw fruits and vegetables, tough meats, hard candies, chewing gum, pretzels or chips, etc.) will increase the load on the joint and greatly increase the chance of non-optimal surgical results. Again, the jaw needs to move to heal but it should not be loaded as this has the opposite effect of non-loaded movement.
FUTURE DENTAL APPOINTMENTS
Your doctor may have you pre-medicate with antibiotics prior to invasive dental visits for a period of time after your joint replacement surgery. It is critical that you discuss with your doctor whether this is advised prior to any invasive dental or medical procedures. On occasion, seeding of bacteria from a distant site can lead to infections around your prosthetic joint.