Hospital Stay
The hospital will contact you at least 48 hours prior to let you know exactly what time and where you should report. You will be asked to arrive a few hours prior to your scheduled surgery. The length of your actual surgery is approximately two to three hours per jaw.
Immediately post-op
You will likely recover from the anesthesia in the Post Anesthesia Care Unit (PACU) for an hour or so. You will then be transferred to a room for further recovery. Single jaw surgeries do not usually necessitate an overnight hospital stay and will be discharged when certain criteria are met. Double jaw surgeries will likely go directly to the Intensive Care Unit (ICU) for an overnight stay.
During your care in the PACU/ICU
A hospital nurse will monitor and assist you. You will be provided medications for pain, congestion and nausea as needed. You will receive antibiotics and steroids at scheduled intervals. You should be able to open your mouth, but you will have some light guiding rubber bands in place. You may have an acrylic bite splint wired to your upper teeth. You will have a light gauze dressing wrapped around your face. You will have an IV in your hand or arm providing you with fluids and medications. You may have a nasogastic tube (through your nose and into your stomach) to reduce the chances of nausea. You may also have a catheter in your bladder so that you will not have to get out of bed to urinate. These tubes are usually taken out early the next morning for overnight stays.
While in your hospital room
A hospital nurse will care for you as directed by your surgeon. Intravenous fluids and medications for pain, congestion, and nausea will be provided as needed. You will be encouraged to start drinking liquids. You will be instructed on oral hygiene, oral and/or facial wound care and breathing exercises to assist in your recovery from general anesthesia. You may be instructed to walk around (ambulate) to assist your recovery.
First 24 Hours
Medications
Take your medications as instructed. You will be receiving an antibiotic to reduce your chances of infection. A steroid will reduce inflammation and swelling. Ibuprofen or a similar NSAID will reduce discomfort and inflammation. Lortab (Hydrocodone with Tylenol) or a similar narcotic analgesic will reduce pain and discomfort. Sudafed or a similar decongestant will help you breathe through your nose easier. Saline nasal spray will keep your nasal passages moist. Robitusson or a similar expectorant will keep your secretions thin and help you to swallow easier. Chlorhexidine Gluconate or a similar disinfectant mouth rinse will help keep your mouth clean and reduce the chances of infection. Most patients prefer liquid medications. You may request pill form.
To help reduce swelling
Keep with your head elevated above the level of your heart. Apply ice to your face for at least 30 minutes out of the hour. Expect a good amount of swelling despite our best efforts.
Keep any dressings around the face intact until your surgeon sees you the next morning. Your steroid, NSAID and pain medication will all help to decrease swelling.
Diet
- Take in as much fluid as is tolerable while awake to prevent dehydration. A full glass of water (8 oz.) every 3 hours (if an IV is not running) (= 64 oz./day = -1/2 gallon/day = 2 liters/day)
- Avoid sugary liquids (sodas, juices, etc.) as they may make you dehydrated.
- You will be placed on a clear liquid diet (water, light juice, broth etc.) to start and advanced to full liquids (milk, etc.).
You should use the restroom as needed. The nurse may be available to assist you.
Expect:
- Minor bleeding and oozing from the surgery wounds and nostrils for the first 24-48 hours.
- A mild sore throat from the endotracheal tube.
- Numbness of your lower lip, chin, cheeks, tongue and teeth (for lower jaw surgery) and your upper lip, cheeks, nose, and teeth (for upper jaw surgery).
- Nasal congestion from upper jaw surgery and the endotracheal tube.
- Limited jaw mobility due to the surgery.
- You may be required to obtain an X ray or CT scan at the hospital (or later at the office)
Oral Hygiene
Use a baby tooth brush to keep your teeth clean. Be careful around the incision sites, which will be in the upper vestibule of the mouth (for upper jaw surgery) or in the cheeks near the molar teeth along the back-sides of the lower jaw (for lower jaw surgery).
Rinse with Chlorhexidine Gluconate solution twice a day and brush your teeth at the same time. You may wish to brush your tongue during your hygiene periods.
Rinse with warm salt water (one teaspoon per 6-8 ounces) every hour or so. Wounds heal faster when they are clean and moist.
Depending on the type of surgery, you may have a plastic splint wired to your upper teeth to help you guide your bite into the right location. Keep this area clean also.
Depending on your specific surgery, you may be asked to use elastic (rubber bands) around your braces to help guide your teeth/jaw into the right bite.
For upper jaw surgery: do not blow your nose nor sneeze through your nose for the first 2-3 weeks. Take any additional antibiotics/medications (nasal decongestants, nasal sprays) as directed by your surgeon.
Upon Discharge From the Hospital
You should have prescriptions and instructions for:
- Strong pain medicine (a narcotic analgesic)
- Antibiotic
- Anti-nausea medicine (if it was necessary)
- Chlorhexidine Gluconate mouth rinse (an antibacterial mouth rinse)
Instructions to follow up in the office within 24 hours of discharge for I-CAT scans if not already done at the hospital.
You will have Dr. Vandervort’s cell phone number. He is available 24/7 if you have any concerns.
First Week
Swelling
Expect significant swelling. Double jaw surgeries will swell more. It will maximize during the 1st week and diminish thereafter. Keep your head elevated above the level of your heart at all times. Do not lay flat. Sleep in a recliner if possible or propped up with three pillows. Ice should be used for the first 48-72 hours. You may place crushed ice in a Zip-Lock ® bag or use a bag of frozen baby peas. Wrap the bag in a towel prior to placement on your face. You may use the ice pack for 20 minutes at a time, and then remove to give the skin some rest from the cold. Direct placement of ice to the skin for prolonged periods of time may produce a burn. Remember, your face will be numb. You will be given some form of steroid to reduce swelling, usually an injection prior to leaving the hospital. Your nasal passages will also be swollen resulting in congestion and difficulty breathing through your nose. Over the counter decongestants, expectorants and nasal sprays will help. A steam humidifier placed next to you at all times will also make you feel better. Similarly, some patients feel better sitting in a steamy shower. Heat in the form of a warm moist wash cloth may be used after 72 hours. You may experience “rebound swelling” near the end of the first week as the effects of the steroids wear off and you begin to use heat. This is a minor increase in swelling and should not be of concern.
Bleeding
Minor oozing from the incisions inside of the mouth should be expected in the first 72 hours. Upper jaw surgeries usually experience some minor trickling of blood through the nose. Although less common, lower jaw surgeries may experience this also due to the tubes used during surgery. This should not be concerning. You nasal sprays and decongestants will help with this. Your surgeon should be notified for a sudden or prolonged gush of bright red blood. Dark blood clots may be coughed up or expressed through the nose toward the end of the first week for upper jaw surgeries.
Bruising
Expect bruising along with swelling. The bruising should begin to dissipate as the swelling subsides. The bruising may travel in the skin as it dissipates. It will likely change colors from black/blue/purple, to green, to yellow and may travel down the neck to the upper chest. This is normal and will resolve in 1-2 weeks. Firm, swollen, painful bruising (hematoma) should be reported to your surgeon immediately.
Numbness
The numbness the face and lips may persist for weeks, sometimes months. This is a normal outcome of this type of surgery. Usually upper face and lip sensation resolves before the lower face and lips. Younger patients resolve faster. Motor nerves are usually NOT affected-you should have normal face and lip movement. Ask your surgeon about this outcome if you have further questions.
Activity
Do not over-exert yourself during the first week. You may return to light house-work or daily activities during this first week. Slowly resuming your activities will help speed your recovery and should make you feel better. Walking is highly encouraged. Avoid sun bathing or other activities in the sun so as not to become dehydrated.
Diet
A full liquid diet should be enforced during this first week. Although you are not allowed to chew, it is very important to remain hydrated (see above hospital course). Suggestions for a full liquid diet include: milk shakes, smoothies, juices (not very acidic types, as they may irritate the stomach), Jell-O, blended foods (use the liquefy setting on your blender). Ensure, Sustacal, Carnation Instant Breakfast and Protein Shakes are good sources of much needed calories. Avoid alcohol and carbonated drinks. Carbonated drinks may distend the stomach, leading to nausea, etc. Avoid very sugary fluids as they may promote dehydration. You may remove the elastics to eat, but replace them as instructed by your surgeon.
Hygiene
You may remove elastics for hygiene, but replace them as instructed by your surgeon. Use Peridex mouth rinse 2-3 times per day for the first week. Use a baby sized, soft bristled toothbrush to clean the teeth, splint and adjacent gums (avoid the sutures and wounds) at least 2-3 times per day. Keep the splint as clean as possible, especially the area behind the upper teeth. Keeping the mouth clean will also help prevent a wound infection. The sutures should start to dissolve in the first week as the gum tissue starts to heal. You may rinse with warm salt water often to help soothe the wounds. Avoid mouth rinses with alcohol (a majority of commercial OTC mouth rinses) as they may burn and irritate the healing wounds. Avoid smoking as it will slow or prevent healing and may result in an infection. Avoid directing water picks to the incision wounds in the first week as fluid may become trapped in the wound.
Medications
Take ibuprofen (Advil or Motrin) 600 mg every 6 hours for the first week to help reduce pain and swelling. If you are still in discomfort, you will use a stronger narcotic pain medication (narcotic + Tylenol) at least one hour after taking ibuprofen. Remember, most narcotic pain medications already have Tylenol in it, so do not take any extra Tylenol as it may cause a serious problem. Avoid alcohol while taking any of these medications.
Take your Antibiotics as directed. If you also take birth control pills, antibiotics may alter the function of birth control pills and it would be strongly advised for you to take other necessary precautions to prevent pregnancy while on antibiotics simultaneously. Take any other prescribed medications as directed by your surgeon. Should you have any questions please contact our surgeon on call.
Follow-up
You will return for a post op visit with your surgeon within the first week to evaluate your healing progress. At this visit, you will have an opportunity to discuss any questions. We will review hygiene and medications. X-rays may be taken if they were not taken the week prior.
Second Week
Swelling
Swelling should start to resolve and will lessen significantly by the end of the 2nd week.
Bruising
Bruising should start to resolve and be gone by the end of the second week.
Numbness
Upper lip and face sensation should begin to return. Lower lip and chin may remain numb. You may experience tingling sensations in both upper and lower lips.
Mouth opening
You will begin “physical therapy” to re-establish your mouth opening and range of motion. This is important as scarring can in rare instances lead to permanent restriction of opening. You will be instructed to remove rubber bands at least 4 times daily and stretch your mouth open. This can be coordinated with your dosing of ibuprofen. Waiting 30 minutes after ibuprofen while applying heat to the jaw joints can allow for increased comfort. Applying ice to the same area for 20 minutes immediately following will reduce inflammation and decrease discomfort. The goal should be to open greater than 30mm or two fingers by the end of the week.
Activity
You may start to resume more of your regular activity as you see fit. Longer walks are encouraged. Still do not over-exert yourself. Exercise is not recommended at this time.
Diet
Continue full liquid diet and you may add or advance to a soft mechanical diet (scrambled eggs, flaky fish, well cooked (soft) pasta, grits, and oatmeal … foods you can squash with your tongue and swallow without much chewing action). You must maintain a good protein intake along with plenty of hydration.
Hygiene
Continue hygiene as above. Frequent (every hour if possible) warm water or saline mouth rinses are encouraged. Continue to use Peridex twice daily. Sutures may begin to dissolve and loosen toward the end of this week. They may trap food. If they are bothersome, your surgeon may remove them. You may resume your pre-operative hygiene routine with tooth paste, etc. A Waterpik can be safely used at this time.
Medications
You will probably continue to use ibuprofen every 6 hours. The discomfort should be greatly reduced. Narcotics will probably not be needed – remember they can be habit forming, cause sleep problems, nausea and constipation. Consider using Tylenol if the ibuprofen is not quite enough. You antibiotics should be finished and no more should be needed after the initial course.
Follow-up
You will be seen at the end of the second post-operative week. You may request bothersome sutures be removed. If everything appears to be normal, you may be scheduled to return two weeks later.
Third and Fourth Weeks
Diet
Continue soft mechanical/non-chewing diet.
Activity
You may begin to resume light, non-impact aerobics such as walking then biking or running on the treadmill. Start slow.
Mouth opening
Increase range of motion exercises as needed to increase your opening. By the end of the fourth week you should be able to open your mouth as wide as before your surgery. If there is still significant restriction, you may be referred for physical therapy.
Six Weeks and Beyond
At your six-week follow up, your splint will be removed if you still have one (Multi-piece upper jaw surgeries). You will return to your orthodontist for final adjustments (fine tuning). Resume your regular diet. Take it slow; your muscles will be weak at first. You will be followed at 3, 6, and 12 months, then yearly. Post-op I-CAT scans and photos will be taken as needed to follow progress.
