Either on the day of admission or several days before admission, a physical examination will be performed to ensure that there are no medical contraindications to surgery or general anesthesia. You will be seen preoperatively by an anesthesiologist or nurse clinician who will discuss the anesthetic plan.
For young, healthy patients, a limited number of laboratory tests may be obtained before surgery. Women of childbearing age that have experienced any menstrual irregularity or missed periods must discuss this with the surgeon and/or anesthesiologist. If there is any possibility that you are pregnant you should not proceed with anesthesia and surgery. All women of childbearing age who have not undergone a tubal ligation will undergo at least a urine pregnancy test.
All adults over the age of forty will undergo an ECG (electrocardiogram) before surgery. It is extremely important that you reveal any medical problems and/or recent health status changes to both the surgeon and anesthesiologist before surgery. Not disclosing any and all health problems honestly may jeopardize your health and safety during and after surgery.
It is suggested that before surgery, patients acquire a blender. Commercial dietary supplements may also be of assistance during the period after surgery. These can be purchased in local pharmacies. Sustacal, Ensure, and Boost are examples of dietary supplements available. Most have a variety of flavors. Generic instant breakfast offered by most grocery stores is comparable to these supplements and is less expensive. It is recommended that the diet be kept simple for the first week after surgery. After the first week, you may explore many possibilities using a food processor/blender.
Eat a high-calorie, high-protein diet. Eating regularly and not missing a single meal will help you to feel better, have more strength, and heal faster. Drink plenty of fluids throughout the day to ensure you remain well-hydrated. Since your food intake will be limited for the first 1-2 days, you should compensate by drinking at least 1-2 liters of fluid per day.
Following surgery, you will be taking a narcotic (opioid) prescription pain medication. This will result in some mild to moderate constipation. It is recommended that you take an over-the-counter stool softener to help with this side effect. Begin taking this the day of surgery and continue taking this medication until you are no longer taking the prescription pain medication. In addition, it is recommended that you add powdered fiber to all of your liquid meals. There are many different brands available for purchase at the grocery store.
Caution: You may feel dizzy or faint when standing up from a lying or sitting position. If you are lying down after surgery, sit up slowly and place your feet on the ground. Stay seated with your head elevated for one minute before standing. On occasion, a patient may faint following sedation/anesthesia due to a lack of blood flow to the brain. If the escort witnesses the patient fainting, please elevate the patient’s legs above their head for 30 seconds. This will allow oxygenated blood to return to the patient’s brain and restore consciousness. Staying well-hydrated following surgery will help prevent fainting.
- The day before surgery, you should not eat any solid food after lunch the day before surgery. Additionally, you will be asked not to take anything by mouth after midnight the day before surgery. This will ensure an empty stomach at the time of surgery.
- You should brush and floss your teeth on the morning of surgery. If you have already picked up your chlorhexidine mouth rinse from the pharmacy, please rinse for 30 seconds after brushing and flossing. If it has been over three months since you had a professional dental cleaning, you should have them cleaned at least 1-2 weeks before surgery.
- If you are on any regular medications, you should discuss this with the surgeon and the anesthesia doctor before the morning of admission. High blood pressure medication, in particular, should be taken on schedule with a small sip of water.
- Do not take aspirin or aspirin-containing medications for two weeks before your surgery.
- Do not take anti-inflammatory medicines (Ibuprofen, Advil, Aleve, Bextra, Celebrex, etc.) for one week before surgery.
- Do not take any herbal preparations containing garlic, ginkgo, or ginseng for at least one week before surgery. These medications will promote bleeding at the time of surgery.
Time Away From Work Or School
Following surgery, you should expect to fatigue more easily but you will be asked to walk at least 200-400 meters per day to help prevent blood clots developing in your heart and lungs. Normal physical stamina usually returns in two to three weeks. Patients are encouraged to resume their normal activities as soon as possible, with the exception of patients who have had upper jaw surgery. If you had upper jaw surgery, avoid straining and lifting more than 20 lbs. for the first two weeks after surgery.
It is recommended that you notify your employer that you will require two weeks away from work to recover. Some individuals may return to their normal activities sooner than two weeks; healing times vary from person to person. Students may generally return to school one week after surgery, but they should be limited to non-strenuous physical activities
Care Instructions After Corrective Jaw Surgery
Day of Surgery
You are to arrive approximately 2 hours before your scheduled surgery. You will be seen by the anesthesiologist and certified nurse anesthetist who will administer your general anesthetic. You or your legal guardian will be asked to read and sign a consent form for your surgery.
A nurse will place an I.V. catheter and help you put on calf-length anti-embolic(compression) stockings. Women of childbearing age will be asked to provide a urine specimen for a urine pregnancy test. The anesthesia staff will spray your nose with a decongestant. Before being transported to the operating room, the anesthesia staff will administer a sedative in your I.V.
Operating Room/Recovery Room
You will receive a general anesthetic and be completely asleep during your operation. When you awaken, your operation will be completed, and you will be in the recovery room. Most patients will be in the recovery room approximately two hours before they are awake enough to be safely transported to a hospital room.
The recovery room is staffed by specialized nurses and anesthesiologists. This is a critical phase of your recovery, and family is generally not permitted in the recovery room. Your mouth may be wired shut when you awaken; however, most patients will only have orthodontic rubber bands holding their teeth together. You will have ice packs on your face, and you will receive I.V. pain medication as well as medication for nausea as needed. Many patients have very little recollection of the recovery room because of the lingering effects of the anesthetic.
When you are sufficiently awake and stable, you will be transported to a hospital room where you will spend the night of surgery. You will be permitted to sip clear liquids. Antibiotics and medications to control swelling and nausea will be administered through your I.V. Your pain will initially be managed with I.V. pain medication. Once you are able to take sips of liquid, your pain will be managed with liquid pain medication taken by mouth.
You will have compression stockinettes on your legs to prevent blood clot formation. These will be removed as soon as you are up and walking. You may get out of bed the night of surgery. It is very important that you do not attempt to get out of bed without assistance while in the hospital.
For the first night, your diet will be limited to clear liquids (iced tea, juice, broth, Jell-O, popsicles, etc.). You will also have a source of humidified air to keep your nasal passages moisturized. We ask that you have the humidified air hose close to your face. Your nurse will help you with nose sprays to keep your nasal passages open. Do not blow your nose if you had upper jaw surgery performed. Nose blowing will lead to air trapping/swelling in the soft tissue of your cheeks and around your eyes. This increases the likelihood of post-operative infection. You will have a suction catheter that you may use to suction your mouth as needed.
Most of your swelling the night of surgery is from fluids administered during surgery. Swelling will be controlled with head elevation, ice application, and I.V. medications you receive for the first 12-24 hours after surgery. Swelling inside your nasal passages will give you a stuffy nose. It is important to begin icing the first day of surgery and continue icing for the first 48 hours after surgery. You will be provided with a jaw braw to assist with icing. Applying ice with the jaw braw to the sides of the face and crushed ice in a bag over the cheeks and lips will limit how much swelling develops. Using a bag of frozen peas is a great way to ice under the eyes and around the lips. This will decrease your pain and discomfort. Ice should be applied at a 20 minutes on, 20 minutes off frequency.
Expect slight bloody oozing from your nose (upper jaw surgery) and the gum incisions during the first evening after surgery. Applying ice packs, keeping your head elevated, and avoiding blowing your nose will control the bleeding.
Patients and their families are understandably worried about nausea and vomiting after surgery when the jaws are wired closed. Usually the jaws are only held together with orthodontic rubber bands and this will alleviate many concerns. You will receive medication to control nausea before you awaken from the general anesthetic. Despite this, you may experience nausea and require additional doses of anti-nausea medication. It is not unusual for patients to swallow some blood in the recovery room. This will upset your stomach and produce some nausea and possibly vomiting.
Remember that if you must vomit, there is only a small amount of liquid in your stomach that will easily pass out your mouth and/or nose. If you feel like you are going to vomit, roll to one side and use your suction catheter. Your nurse will do everything possible to treat your nausea with potent medications. Despite this, vomiting is sometimes inevitable. If you wish, gently rinse and suction your mouth with saline on the evening of surgery.
You will notice an acrylic splint between your teeth. The splint is important to control your bite during and after surgery. The splint will make intelligible speech more difficult. With practice, you will speak quite well. Most patients resort to writing some communications during the first 24-48 hours after surgery. The splint may remain in place for six weeks following surgery.
Most patients do not sleep well in the hospital. You will be frequently disturbed for assessments by the nursing staff. These important assessments are for your safety and comfort. You will enjoy better sleep once discharged home, though it is not unusual to experience several restless nights after surgery. We suggest sleeping in a recliner for 2-3 nights to ensure your torso and head are elevated. This will allow you to breathe more comfortably and decrease facial swelling.
Visitors should be limited to immediate members of the family. It has been our experience that, while this may not be a difficult time for the patient, it can be for people who may not understand what is happening. Therefore, it is advisable to limit the number of visitors during the period immediately after surgery.
Day After Surgery
The first day after surgery is generally a good day from the standpoint of swelling. You will continue to apply ice packs and keep your head elevated. You will be encouraged to take clear and full liquids by mouth. You must demonstrate that you can take sufficient oral liquids to prevent dehydration before being discharged from the hospital. Your I.V. will be left in place until discharge, and you will be encouraged to transition from I.V medication to oral pain medication.
You will be encouraged to get out of bed and walk with assistance. You will be asked to moisturize your nasal passage every 2-3 hours with a saline nose spray. Your nurse will help you spray your nose with the medicated nose sprays (e.g. Afrin and steroid nasal spray) twice a day.
Discharge from Hospital
Most patients are ready for discharge by mid-day or early afternoon on the first postoperative day. The most important criterion for discharge is the demonstration that you can take an adequate volume of oral liquids. You will be expected to drink approximately one liter (approximately one qt.) of liquids before discharge. If you or any family members are not comfortable with the discharge planning and/or instructions you have received, please speak to Dr. Foley or Dr. Le before you leave the hospital. Please take the three nose sprays and a bottle of mouth rinse home. You will be asked to come to the Foley and Le Oral Surgery clinic after discharge for routine post-operative x-rays.
Any major surgery can challenge one’s emotional balance. It is not unusual to feel blue and even depressed after surgery. Patients who come into the operation with a positive attitude generally bounce back very quickly from the insult of surgery. You will turn the corner and feel both emotionally and physically better. It generally takes about five days to appreciate the temporary nature of the physical and emotional insult of surgery, at which time you will feel better in all respects.
The following information will assist you and your family in caring for you after you are discharged from the hospital.
Swelling is a natural consequence of surgery. Your swelling will increase after you leave the hospital and reach its maximum about the second or third day after surgery. You should apply ice for at least 2-3 days after surgery. Make sure your head is elevated on 2-3 pillows for 5-7 nights after surgery.
You will need to use the medicated nose spray (e.g., oxymetazoline) twice a day to decongest the lining of your nasal passage. This is especially important if you have had upper jaw surgery. To prevent drying of your nasal passage, rinse your nose with saline nose spray every 2-3 hours. Twenty minutes after using the decongestant spray, give each nostril one squirt of the nasal steroid (e.g., Flonase-fluticasone).
Sleep with a humidifier at the bedside to minimize nasal passage drying. If your nasal passage becomes completely blocked and will not respond to the sprays, please contact our office. This usually means the nasal passages have become dry and blocked with crusting. If you do not feel you are receiving enough air, you may temporarily use a moistened spoon handle to hold your cheek away from your teeth.
It is recommended that you buy an over-the-counter saline nasal spray (ocean nasal spray). Please use this spray every hour in both nostrils for the first two weeks following surgery. This will keep your nasal mucosa moist, prevent nasal crusting and allow you to breathe more easily.
Reminder: Do not blow your nose for two weeks following surgery.
A slight bloody ooze from the incisions and nose is expected for two days after surgery. If you experience persistent (more than 10 minutes) bright red nasal and/or mouth bleeding, please contact our office immediately. At some point in the first week following surgery it is normal to have a relatively large amount of dark clotted blood discharge from the nose. This frequently happens in the shower and is not a reason to be alarmed .
Bruising is variable and temporary but may produce “black eyes” and discoloration of the neck and chest.
DO NOT SMOKE for a minimum of 4 weeks following surgery. The toxic chemicals and heat in cigarette and marijuana smoke increases the likelihood of surgical site infection and are harmful to healing wounds. Smoking following jaw surgery can result in catastrophic complications, including the loss of teeth and large bone and soft tissue segments of the jaw. These complications are permanent and frequently irreparable.
Keeping your mouth clean following surgery is essential to good healing and is one of the best ways to avoid infection. You should brush your teeth after each meal. Use a child’s soft toothbrush, paying particular attention to keeping the brush in direct contact with the teeth. It is very important to keep your mouth clean as the wounds heal.
You can decrease the accumulation of debris on the inside surface of your teeth and tongue by rinsing with warm tap or salt water after each meal/snack. Rinse with warm salt water (1/2 teaspoon of salt in a cup of warm water) six times a day. Continue this procedure until healing is complete. You will be prescribed a bottle of Chlorohexidine mouth rinse, which you will use twice daily for the first 2-3 weeks following surgery. Gently swish for one minute after you brush and floss your teeth and then expectorate. Do not use a water-pik for two weeks after surgery.
Remember: Keeping the wound clean will ensure it heals better and faster.
Sutures will need to be removed following the procedure.
While Wired Shut
Most patients are not wired shut, following surgery. However, if jaw wiring is required in your surgery please read the following instructions: After you return home, you should advance your clear liquid diet to full liquids (dairy products, etc.) and blenderized (liquefied) foods. It is very important that you drink an adequate volume of liquid to prevent dehydration. You should drink at least 1-2 quarts of liquid each day. It is not unusual to lose 5-10 lbs during the first week after surgery. You will need to have 5-6 meals/snacks daily to maintain adequate hydration and caloric intake.
After Mouth Unwired
After your mouth is unwired or if you only have orthodontic rubber bands holding your teeth together and you are able to open, you may advance your diet to soft, mushy foods (mashed potatoes, etc.). Your diet must be soft enough that chewing is not necessary. You will resume chewing six weeks after surgery when the bones have healed.
Three activities are not permitted after surgery:
- While wired shut, do not swim in water where you cannot touch the bottom.
- Do not blow your nose for at least two weeks if you had upper jaw surgery. If you forget and experience acute facial swelling, please contact our office.
- Protect your face from injury. Wear seatbelts while driving, and maintain a safe distance from airbags. Do not participate in contact sports for 12 weeks.
You will be given several prescriptions when you are discharged from the hospital. Please fill these prescriptions the day you are discharged. Follow the instructions given by the pharmacist and as outlined on the bottle.
One of the medications prescribed will be a liquid narcotic pain medication. Begin taking pain medication at the first sign of discomfort. For moderate pain, take a dose (400-600mg) of Ibuprofen (Advil or Motrin) every 4-6 hours as needed for pain. Do not exceed the maximum daily dosage suggested on the bottle.
Do not take Ibuprofen if you:
- Have an intolerance to it
- Take blood thinners
- Have a history of stomach ulcers
- Have a history of kidney disease
For severe pain, the prescribed medication should be taken as directed. To avoid stomach upset, take the pain medication after a meal or with a small snack. If you have allergies to any medications above, do not take them. If your doctor has advised you not to take any of the medications mentioned above, do not take them.
While taking pain medication, do not:
- Operate a motor vehicle
- Operate machinery (lawn mower, etc.)
- Drink alcohol
If you still experience significant pain that is not improving 3-5 days after surgery, notify the clinic. Prescription pain medication has the potential to be addictive, so it’s very important that you only take it if you are experiencing significant post-operative pain. If you do not finish all your prescription medication, take the unused medication to the police station or a pharmacy, and they will dispose of it responsibly. Never leave unused medication in your medicine cabinet at home.
We recommend the following protocol for optimum pain management:
Take each medication with a small snack and a full glass of liquid.
Immediately Following Surgery: 1 Prescription pain dosage
3 Hours Later: Ibuprofen dosage
3 Hours Later: 1 Prescription pain dosagel
3 Hours Later: Ibuprofen dosage
NOTE: The dosage of the prescription pain medication can be increased to 1 1/2 to 2 dosages if needed for pain management.
Take the prescribed antibiotics as directed to help prevent infection. If you experience a rash or an unfavorable reaction to the antibiotic, discontinue use and notify our office. Be sure to take the prescribed antibiotics as directed to help prevent infection. Complete the entire course of treatment. If you experience an upset stomach, we recommend taking acidophilus or a pro-biotic along with your antibiotic.
Antibiotics may make oral contraceptives less effective. You should use an alternate form of birth control while on a course of antibiotics.
You are not likely to experience nausea after returning home. Nausea can be caused by pain medication taken on an empty stomach. Drink plenty of liquids, and do not let yourself become dehydrated. If you do experience nausea, take the nausea medication every 6 hours as needed for nausea. If you vomit more than two times in six hours, please contact our office.
You will be prescribed a liquid decongestant/expectorant that contains guaifenesin. This will help to break up mucous and secretions so you can swallow and breathe more comfortably. Avoid decongestants with pseudoephedrine if you are having trouble resting/sleeping or if you have a history of high blood pressure.
You received three nasal sprays in the hospital: decongestant (oxymetazoline), nasal steroid (fluticasone), and saline nasal spray. Use the medicated nasal sprays every 12 hours. When you no longer experience nasal congestion, you may stop the oxymetazoline. If you use oxymetazoline (Afrin) longer than five days, you may begin to experience rebound congestion. You should use the nasal steroid spray until you have exhausted your supply. Use the saline spray every 2-3 hours to moisturize the nasal passage and prevent crusting.
Chlorhexidine Mouth Rinse
You received a bottle in the hospital. Swish and spit one teaspoon twice a day for one minute. Do not drink fluids for 30 minutes following the use of the chlorhexidine mouth rinse.
Keep your lips moisturized with a lip balm of your choosing. Avoid Vaseline or ointments containing petroleum products. ChapStick products provide several good options for lip care. Crusting of the corners of the mouth is common after corrective jaw surgery. This irritation will not lead to scarring.
We want you to have a smooth and pleasant recovery. Following these instructions will ensure the best possible outcome. Please call the office if you have any questions or concerns about your progress. We are available 24 hours a day.
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