Orthognathic (Jaw) Surgery First Week

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After Your Surgery

Post-Operative Instructions

First Week

Swelling

Expect significant swelling. Double jaw surgeries will swell more. It will maximize during the first 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 3 pillows. Ice should be used for the first 48–72 hours. 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 washcloth 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. Nasal sprays and decongestants will help with this. Dr. Bryan or Dr. Goodson 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 of 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, so you should have normal face and lip movement. Ask your surgeon about this outcome if you have further questions.

Activity

Do not overexert 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. Suggestions for a full liquid diet include milkshakes, smoothies, juices (not very acidic types, as they may irritate the stomach), Jell-O®, and blended foods (use the liquefy setting on your blender). Ensure®, 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. 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 over-the-counter 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 Waterpiks® 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 plus 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 Dr. Bryan or Dr. Goodson after 1 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.

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