Orthognathic Jaw Surgery
Osteotomies of the Jaw and Trauma Procedures
Your cooperation with the following instructions will go a long way toward helping you have a smooth and uneventful post-operative course.
After surgery to the mouth, face and jaws, healing usually occurs quickly and without complication. Due to the mouth and face needing to function immediately after surgery in order to eat, speak and breathe, the following concerns may arise in the healing phase.
Pain from your oral surgery may vary from slight discomfort to more severe pain. This is best controlled by the medications prescribed by Dr Webber. The pain relief medication is most effective when taken before the local anaesthesia diminishes (8-10 hours after your procedure) and normal sensation returns to the area. The hospital will control the initial phase of your pain relief. Please take care not to chew your numb lip or tongue as injury can result. Once home, when you start to feel a tingling sensation or some discomfort take your pain relief. We suggest that alternating your prescription medication (Panadeine Forte, or alternative non-codeine based medication) and Ibuprofen (Nurofen) third hourly. This will significantly reduce postoperative dental pain. Maximum dose of over a 24 hour period is 8 tablets of Panadeine Forte, and 12 tablets for Nurofen. Do not take prescription pain relief medication on an empty stomach. Narcotic pain medication such as codeine may cause nausea, vomiting, drowsiness, dizziness, itching or constipation. If these side effects occur, discontinue the medication. Alternatively you may take an alternative over the counter pain medication (Panadol) if necessary. If the pain worsens please contact Dr Webber.
Swelling may occur immediately and/or will increase gradually up to 72 hours after the procedure. It will hold for for 7-14 days before starting to subside. Ice packs applied externally to the area at 30 minutes intervals throughout the first 48 hours after surgery may help control swelling. Do not apply ice packs or ice directly to the skin, use a tea towel or washer as a buffer.
Continued pain, swelling or a raised temperature may indicate infection. If you are concerned about infection spreading or delaying healing, please contact Dr Webber. As the mouth cannot be sterilised, there is always a risk of infection in healing oral wounds. The risk of infection is increased with smoking and the placement of foreign objects into the mouth such as fingers or pencils. Strict oral hygiene can help avoid infection. The most important instruction starting the morning after the day of surgery is to rinse after every meal with a teaspoon of salt mixed into a glass (250ml) of warm water. Hold the solution in your mouth gently swishing to keep the surgical sites clean. Repeat step until glass is empty. Continue this for 1 week after surgery.
The wounds will be stitched closed with dissolvable stiches and usually soften and fall away. These can take anywhere from 7 to 21 days. Bleeding will be under control by the time you leave the hospital or Dr Webber’s rooms. Continued bleeding upon discharge is not normal, however, some oozing or blood-tinged saliva may persist for up to 24 hours. Should excessive bleeding occur, it may be controlled with pressure. Apply a folded gauze pad (from the chemist) or a small, cleaned, dampened handkerchief over the area and bite firmly for 30 minutes. This may be repeated if necessary. Sleeping with your head elevated above the level of the heart for the first two post-operative nights will minimize bleeding and swelling.
CARE OF WOUNDS & FOLLOW UP
Where an internal wound is involved, it is ESSENTIAL to maintain a very high standard of oral hygiene using a combination of warm salty rinses and regular tooth brushing. You should commence rinsing the day AFTER surgery. And should aim to use at least 3-5 mouthwashes per day. It may be necessary to immobilise your jaws with elastic bands or on occasion, wires to stabilise the end result of surgery. Most patients leave the Hospital with their mouths open but may be placed in to elastic fixation after discharge for approximately 6 weeks. You will require a follow up appointment with Dr Webber within the first week following your surgery. It is very important this appointment is scheduled, please call us on 07 5527 8858 if you do not already have an appointment time allocated.
NAUSEA & HEADACHES
Nausea may result from a general anaesthetic or the drugs prescribed for pain. Ceasing the prescribed pain medications (ie. codeine) and drinking a small glass of a carbonated beverage will generally control mild nausea. If you have had a general anaesthetic for the surgery, please make sure you drink plenty of water after the procedure as you will be dehydrated from fasting for the previous 6 hours which can result in headaches.
Soft foods and liquids will be required for the first week following surgery as this will apply pressure to any fixation screws, plates and possible grafts which may have been used, and will jeopardize your overall result. Avoid hot and spicy foods to avoid irritation.
ORAL HYGIENE & SMOKING
No smoking for at least 14 days following the procedure as this increases the risk of infection and delays healing. Hygiene should not be neglected. Brush your teeth as normal and follow with the mouth rinse instructions (noted in the “infection” paragraph) after each meal, beginning gently on the morning after the day of surgery. Avoid brushing over the extraction socket or oral wound to minimise trauma and bleeding.
After your operation it is important that you rest quietly at home. Avoid any activity for the first 3 days. Strenuous work or exercise may promote bleeding. Under no circumstances are you to drive a car or operate heavy machinery for at least 24 hours after a general anaesthetic.
Side effects such as an ear ache, hiccups, temporary ache of adjacent teeth, restricted mouth opening, stretching or cracking at the corners of the mouth or discoloration of the skin may occur postoperatively. These are temporary conditions which will improve as healing progresses.
NUMBNESS OF THE LIP AND TONGUE
It is quite common for patients to experience facial numbness following orthognathic and trauma surgery. For most other procedures this is usually uncommon, and if occurs is transient and no cause for alarm. Please avoid chewing a numb tongue or lip.
BONY AND SHARP EDGES
If you have had teeth extracted, you may feel hard projections in the area and think they are pieces of tooth. This is usually the hard, bony partition which surrounds the roots of the teeth. These generally work themselves out through the gum spontaneously. If not, please contact the surgery.
Please feel free to contact Dr Webber, regarding any unusual occurrences or if you have any questions. Dr Webber can be reached for emergencies (such as profuse bleeding, uncontrolled pain, persistent nausea and prolonged elevated temperature) and supply immediate advice during office hours on (07) 5527 8858.
After hours, please leave a message and we will return your phone call on the following business day; or, if necessary, present to your nearest public or private hospital.