Corrective Jaw Surgery
Please take a few minutes to review the below information which will help you better understand what to expect around the time of orthognathic surgery. It is important for your recovery that you better educate yourself and therefore, if you have any questions you should feel free to call us at any time.
Perhaps the most important factor to help in recovery is maintaining a positive outlook. It is normal for patients to experience ups and downs over the first few post-surgical weeks. In particular, the first week after surgery when everything is “new” can be the most challenging. You can expect to feel congested and swollen and even feel sad or flustered as a result of surgery or medications (steroids) and it is paramount to understand that these symptoms will soon pass and you will begin to feel more like yourself. You will be given several medications to help with these symptoms and their use will greatly help. You have been preparing for this surgery for a long time and maintaining an optimistic outlook will hasten your recovery and return to “YOU.”
Prior to having surgery, it is a good idea to review this information with both family and friends who will be involved in assisting you during your recovery period. It is also a good idea if you desire to review this with colleagues at work so they too can better understand what it is that you will be dealing with during recovery. The support of family, friends and work-mates is paramount to a smoother recovery and the better they are prepared, the easier it will be for them to help you with this process.
Prior to Surgery
You will be required to visit with your physician for pre-surgical clearance. Our office will provide you with the necessary paperwork. In addition to the physical examination, you will also be required to have routine lab work so that we can optimize your safety during surgery.
Day of Surgery
On the morning of surgery, you will be expected to arrive at the hospital several hours before your procedure start time. During this time, you will meet several nurses, the anesthesiology team and other surgeons who might be involved in your care while in the hospital. There will be several additional consent forms for you to review and sign which are all hospital protocol. Once completed, you will be transferred to the operating suite and your family will be escorted to the waiting area. Upon arrival in the operating room, several tasks will take place to optimize your comfort and safety prior to the onset of surgery which will take approximately an hour to complete. You will be comfortably asleep during this process however, after surgery when taken to the recovery room your family/support may see you and therefore it is important that they also understand what to expect. Multiple IV lines will be inserted along with a suction to help minimize nausea and a catheter to help measure your fluid balance during surgery. Lastly, a breathing tube will be inserted to protect you during the procedure. This is routinely removed prior to awakening in the operating room after your procedure.
Upon completion of your surgery, you will be transferred to the recovery room. The nurses there are well trained to optimally care for you. Once you have settled in, your family/support team will be brought in to see you. During your stay in recovery, it is typical for both the urinary catheter and nasal suction tube to be removed. This is not a painful process and they will be removed once you are more awake and able to better care for yourself.
Several hours after your surgery, you will be transferred from the recovery room to the hospital bed. Your family can accompany you there. You are encouraged to rest but as part of your recovery, it is important for you to begin to walk around, drink sips of liquids, void, begin routine oral hygiene and begin to resume a more normal daily lifestyle. Most patients will spend one night in the hospital. The next morning, you will be taken to the oral surgery clinic for radiographs. Once you have met discharge criteria (ambulating, pain well controlled, drinking ample fluids, voiding), your IV line will be removed and you can return home.
During the first 24 to 48 hours after surgery it is critical that you consume enough fluids to avoid dehydration. It is not critical what fluids you consume but that you are reminded to take small sips at regular frequency. During the first week after surgery, quality is less critical than quantity. One of the main issues that require re-admission to the hospital is fever related to dehydration. It is not sufficient for the liquids to be only water. Gatorade, Snapple, soup broth, Jell-O, etc. are more ideal as they not only contain water, but also some sugar and salt both of which are important during this early phase of healing. As you feel you can tolerate, milk shakes made with whole ice cream and watered down with whole milk or cream are a good choice. In addition, you should try store bought nutritional supplements like Ensure, Ensure Plus (extra protein), Carnation, etc. These will supply you with the necessary nutrition that you require during your recovery. This is not the time to use fat free, low calorie frozen yoghurt. Your body requires more calories than normal and supplying it with such will speed your recover, allow you to feel more energized, decrease your pain or discomfort and improve your overall well-being. You should plan on having five or six small meals throughout the day rather than the typical three meals. You can expect to have the feeling of a sore throat upon swallowing for the first few days after surgery because of the airway and suction tubes that were present. This feeling will pass. Once you are more comfortable, you can begin to advance your diet from full liquids to soft, non-chewing type foods. As you get further out from your surgery, quality increases in importance and therefore you will require protein and fat to help. Scrambled eggs, yogurt, pudding, tuna fish, egg salad, soft canned fruits and vegetables, ground beef/turkey/chicken, or Tofu are excellent choices. You will maintain this soft, non-chew diet for approximately 8 weeks at which time you may begin chewing. It is typical for patients to be able to fully resume a normal diet at approximately 12 weeks out from surgery. It is critical for you to understand that while during surgery, your jaws are fixated internally holding them and your bite in its new position, the force of chewing is far stronger than this fixation and you can easily bend the devices necessitating revision surgery for correction. In the office, you will be given a booklet which will have more helpful information and diet recommendations. Take the time to review these suggestions, as it will make the transition through recovery easier for you.
First Post-Surgical Week
In addition to the diet instructions above, there are several important things for you to understand. Recovery will be steady however, during the first week, while everything is new, you may experience ups and downs emotionally. Going hand-in-hand with mental attitude, your knowledge and understanding of what to expect will make this easier. This operation is not typically very painful. During the first several days, you may experience discomfort which is typically managed with a combination of over the counter medications and a slightly stronger pain medication. Your doctor will review with you all of the prescriptions and how to use them. After the first few days, most patients only require over the counter medications to manage any pain.& You will however, experience swelling, nasal congestion and throat soreness. You can expect this swelling to increase slowly over the first 2-4 post-surgical days. You will use ice packs during this time period which will help to minimize your swelling and nasal decongestants as prescribed by your doctor. Once the swelling reaches its peak, you can discontinue the ice unless it helps you feel better. You may also choose to begin to use a warm compress once the swelling peaks to help hasten its dissipation. It takes approximately a week to a week and a half for 50% of your swelling to resolve once it has peaked. It takes the next week to week and a half for 50% of what is left to dissipate. It is typical for patients to begin to feel much more like themselves as the swelling and congestion resolves. In addition, it is normal for patient to experience a numb sensation in the lips, mouth, tongue, teeth, nose and cheeks during recovery. The nerves that provide sensation to these areas are typically swollen during surgery and require time to recover. Sensation typically begins to return over the first few weeks and may take several months to fully return. There are some patient who experience this long term. You may have feelings of tingling, burning or stabbing that is short lived as the nerve fibers regenerate and sensation returns.
You should resume normal oral hygiene either on the evening of surgery or the next morning. Infection is another leading cause of re-admission to the hospital and maintenance of a clean oral cavity in addition to the prescribed antibiotics is the best way to avoid this problem. You should plan on brushing your teeth 5 times per day to keep your braces clean. We recommend using a soft tooth brush and you can expect that during your recovery you will go through a few tooth brushes. In addition, you will be prescribed an antibiotic mouth rinse that you will use twice per day. Your incisions are a good distance away from your teeth so you should not be afraid to brush. If you have a splint (your doctor will explain this) you will use the toothbrush and mouth rinse to keep the inside of the upper teeth clean. You may also use salt water to keep your mouth clean. It is a good idea to brush and rinse after each meal. You may find it helpful to use a Water Pik which you can purchase at the pharmacy to help in keeping your oral hygiene optimal. You should ask your doctor when you may begin to use this as it should not be used during the first week after surgery to avoid undue water pressure at the incision sights.
Follow-up Visits and Return to Work/School
You will routinely be seen between 5-7 days after surgery, then at two weeks, four weeks, six weeks and 8 weeks. You will then be sent back to your orthodontist to begin final tooth alignment. You are encouraged to return to work/school as soon as you feel ready. Patients who have both upper and lower jaw surgery typically require approximately 2 weeks off, while those having a single jaw typically require about one week. There is certainly variability from patient to patient but this acts as a good guide.
If you should have any further questions or if you desire further clarification on any of the above information, you should feel free to contact our office at any time. We hope this will help ease any anxiety you might have about orthognathic surgery and are here to help if you need.