• Melbourne Dental Surgeon

Orthognathic Surgery - Major Jaw Surgery Requiring Hospital Stay

ALL APPOINTMENTS & ENQUIRIES: 03 9820 5333

BEFORE YOUR SURGERY  
1. MOUTHWASH
Commence rinsing the day before surgery using chlorhexidine mouthwash (Savacol). Use this 4 times a day and hold the solution in your mouth for a full minute each time. You will continue to use this after surgery however do not use for more than one week as it may stain your teeth. This might require cleaning by your dentist.

2. FASTING
Make sure you fast for 6 hours prior to surgery. This means no food or drink including water. Please also do not chew gum prior to surgery.
      For morning surgery, fast from midnight the previous night.
      For afternoon surgery, fast after an early light breakfast before 7.00am.

3. ASPIRIN AND OTHER ANTICOAGULANTS
Anticoagulant medications and some vitamin/herbal drugs can cause increased bleeding during and after your operation. These should be avoided in the week prior to surgery. However in some cases your GP may have recommended that you remain on them.

4. SMOKING
Although it is best to permanently quit smoking well before surgery, in the very least you should not smoke for 24 hours prior to surgery to reduce respiratory problems from the anaesthetic, and for 72 hours after surgery to reduce the risk of delayed healing.

5. HOSPITAL ADMISSION
After admission to the hospital you will be seen by the hospital nursing staff and then assessed by your anaesthetist. Mention any medical problems or allergies to the anaesthetist at that time. There is usually a period of waiting before your operation actually starts, and this can vary depending on circumstances. Children and patients with certain medical problems are usually operated on first. While all efforts will be made to minimize the wait, some patients may have to wait for a couple of hours so it is recommended that you bring some reading material or other entertainment with you.

6. HOSPITAL DISCHARGE
Following surgery you will usually be in hospital for 2 nights. After discharge you will not be allowed to drive nor will you be permitted to go home alone in a taxi due to hospital policy. You will need to be accompanied home by another adult and have someone at home with you for the first night.
PLEASE FOLLOW THESE INSTRUCTIONS AFTER SURGERY  
  WHEN YOU FIRST WAKE UP (in recovery)
When you first wake up from the operation you will hear us talking to you. You may feel disorientated at first, but don’t worry – just lie still and breathe quietly, slowly and deeply. If you have elastic bands between your teeth you will still be able to open your mouth about half way. You will be able to breathe normally even when your teeth are together. Pain is usually moderate and can be controlled with medications. Usually you just feel numb due to local anaesthetic which has been placed during surgery, and this provides good pain relief for many hours after surgery. You will have a drip in your arm, ice packs held on your face with a bandage, and an oxygen mask. After you have spent enough time in the recovery room, you will be taken back to the hospital ward. The first night will be spent in the High Dependency Unit or a special single room so that you have the appropriate nursing care for this type of surgery.
  POST OPERATIVE (in the ward)
  • GENERAL – following major jaw surgery it is not uncommon to feel weak, tired, restless, uncomfortable, nauseous, or have interrupted sleep.

  • DRINKING FLUIDS – the most important thing after your operation is to drink plenty of fluids. You need to start this as soon as possible after the surgery. The earlier you begin drinking the quicker your recovery. Normally you drink 1.5 to 2 litres of fluid per day. Therefore it is important to drink as much as you can even if you do not feel thirsty. You might have to use a syringe, straw, or sipper mug, however drink normally out of a glass as soon as you can.

  • ORAL HYGIENE – you need to start cleaning your mouth soon after the surgery. Your oral hygiene will be managed with mouth washing, syringing, a small toothbrush, or an oral irrigating device if you have one. This will become easier as the swelling subsides.

  • FOOD – you should start to eat again whenever you feel hungry however it does not matter if you don’t feel like eating during the first day as long as you are drinking plenty of fluids. Your diet will commence with soup and mushy food then progress on from there. However your diet will remain very soft for the first two weeks.

  • PAIN – pain following this surgery is generally moderate however you will be given appropriate pain relief to keep you comfortable. Strong analgesics are usually only required within the first 24 hours and after that oral analgesics are sufficient. These can be made soluble if you find it difficult to swallow tablets. Narcotic analgesics should be minimised if possible due to their side effects which include nausea, vomiting, respiratory depression, sedation and addiction.

  • SWELLING AND BRUISING – facial swelling is normal following jaw surgery, and is part of the healing process. This will continue to increase over the first 48 to 72 hours after surgery before gradually disappearing over two weeks. Ice packs will be used during the first 24 to 36 hours order to reduce swelling. Some bruising may also occur. Swelling and bruising may affect one side more than the other.

  • BLOOD LOSS – blood loss during the operation is usually moderate, and only in rare situations are transfusions required. A small amount of blood or oozing from your mouth or nose is not uncommon while in hospital during the first 24 hours.

  • MEDICATIONS – during your hospitalisation you may be analgesics for pain, antibiotics to prevent infection, dexamethasone to reduce swelling, and anti-emetics to prevent nausea.

  • DISCHARGE – you will be discharged once you are comfortable and able to drink, eat and clean your mouth adequately. When you go home you should make sure you have your chlorhexidine (Savacol) mouthwash and your discharge medications which usually include analgesics and antibiotics.
  AFTER DISCHARGE (at home)
There are two main things to consider when you go home:

  • SOFT DIET
    Initially your diet will be composed of soft foods only, for example soup, mash, pasta, eggs, and fish. It is more difficult and time consuming than normal to eat, so you need to have several small meals every day or lots of snacks, rather than just three meals per day. It may also be beneficial to use a nutrient supplement such as Sustagen. It is normal to lose weight following surgery. Make sure you are drinking plenty of fluids as you did while in hospital. After two weeks on soft food you should slowly start to get back to a normal diet, particularly after removal of your splint (see below). It may take a number of weeks before you have full chewing power as your jaw continues to heal and the muscles return to full function.

  • ORAL HYGIENE
    Oral hygiene is difficult but it is essential to do this meticulously. Use the chlorhexidine (Savacol) mouthwash 4 times a day for 7 days after surgery. This cuts down the plaque that builds up on the inside of your teeth where your toothbrush cannot reach. Also use warm salty rinses (glass of warm water with a teaspoon of salt) 4 times a day between the chlorhexidine rinsing, and continue to use for at least 2 weeks after surgery. You should also continue normal tooth brushing using a child’s size toothbrush or periodontal brush, after holding your cheek out of the way. Do not pull on the lower lip if you have had surgery on your chin. Brush your teeth, wires, elastics and orthodontic appliances as best you can. This will become easier as the swelling inside your mouth subsides. To start with, use only a small amount of toothpaste, or just dip the toothbrush in the mouthwash. You may also need to clean your nose if you have had surgery in the upper jaw. Use peroxide on cotton buds to remove any crusting from around the front of the nose. A short term nasal spray may be used as required to unblock the nasal passages for example Drixine or Otrivin.
  OTHER POINTS (A – Z)
  • ACTIVITY – when you first go home it is best to rest and not engage in much activity for the first week. After this, light activity or exercise is OK, but do not engage in any vigorous sporting activities or lifting of heavy objects for 2 weeks as this may put stress on the jaw. Contact sport should be avoided for 3 months.

  • BLEEDING – a little bit of oozing after this type of surgery is not uncommon particularly in the first 24 hours. If upper jaw surgery has been performed, sometimes there can be bleeding from the nose. If this occurs, squeeze the bridge of the nose and lie down with your head elevated on several pillows. If bleeding occurs from the mouth, place a rolled–up piece of gauze in the mouth over the bleeding area if you can locate it. Bite your teeth together to apply pressure against the gauze, or alternatively apply pressure over the side of the face and jaw using open hands. Place an ice pack on that side of the face. If these measures fail to stop the bleeding, contact Mr Allan or attend the Emergency Department of a hospital.

  • CHEWING –should remain on soft foods for the first 2 weeks. After this, you should slowly start back to a normal diet. There are no restrictions with your diet at this point although you should make your own judgment regarding what you can handle. It usually takes some weeks to be chewing completely normally again.

  • ELASTICS – you will have elastics between your teeth when you wake up. Initially leave these on all the time. However when you are able, you can take them off for eating and cleaning. Replace them with fresh ones using your fingers or a pair of tweezers, placing them over the hooks in a square pattern. After the first 2 weeks the orthodontist determines how you wear your elastics and for how long, but typically they are required for several months. Make sure you limit your jaw movements in the first 2 weeks even if you feel comfortable.

  • FACIAL MUSCLE EXERCISES – these should be done particularly after upper jaw surgery in order to return your facial muscles to normal function as soon as possible. They also help to remove the last of the swelling in the area. They simply involve moving your lips as though you were smiling, kissing, or whistling, and normal speech is also helpful.

  • FOLLOW UP APPOINTMENTS – you will have regular appointments to check on the healing and it is important that you attend these. The first appointment will be two weeks after surgery. Following this initial healing period, you will be returned to the orthodontist for continuation of your orthodontic treatment, so make sure you have an appointment 2 – 3 weeks after surgery.

  • INFECTION – antibiotics will have been given to you in order to prevent infection. However an infection is still possible and usually presents as a recurrent swelling, pain, or a bad tasting discharge in your mouth. If these signs occur, contact Mr Allan. Most infections are easily treated with antibiotics.

  • JAW STIFFNESS – this means that your jaw may feel stiff or sore when you try to move it. This is called “trismus” and is Nature’s way of splinting and resting the area that needs to be healed. It may take several weeks to return to normal. Jaw exercises and physiotherapy may be required in some cases, and further instructions would be given to you if necessary.

  • NUMBNESS – numbness of the lips, chin, cheeks, gums, teeth, tongue, or palate usually follows major jaw surgery and this will have been explained to you already. It may take a long time for the sensation to return to normal particularly in your lips. This may make it more difficult to drink initially, however you will be surprised how quickly you learn to adapt to this. Be careful not to burn your mouth or lips with food that is too hot.

  • OTHER PROBLEMS – other possible problems that can follow this surgery include jaw joint pain, clicking or locking, and also sinusitis. Report any symptoms you feel may be important. Apply a lip balm to prevent your lips drying out. If you experience sleeping problems after surgery try not to be concerned as they are quite normal and will pass quickly. Sleeping tables should be avoided if possible after this type of surgery.

  • PAIN – use analgesics such as Panadol, Nurofen, Panadeine, Nurofen Plus, or Mersyndol if you have any pain. Stronger painkillers may have been prescribed for you. Only use these for as long as pain persists and follow the instructions closely. Ice chips may be sucked for comfort if desired. These will also help increase your fluid intake.

  • SPLINT – a dental plate (surgical splint) will be fixed to your upper teeth and will be left in after surgery for a period of 2 weeks. This will be removed at your first postoperative visit by cutting the wires that hold the splint to the upper arch wire. Make sure you keep the splint as clean as possible as described above.

  • STITCHES – the stitches inside your mouth will resorb approximately 2 weeks after surgery. If you had a small nick in the skin of your cheek for screw placement in the lower jaw, the suture will need to be removed at your postoperative appointment. This suture is covered by a steri-strip and when it starts to peel off you can remove it. For males, be careful not to shave off the suture.

  • SWELLING – by the time you leave hospital your swelling should have maximized. This will slowly disappear over the next 2 weeks. You can continue to use ice packs but after a few days it is often good to change to heat packs in order to relieve symptoms. Be careful not to freeze or burn your skin. Facial exercises may also help to reduce swelling. If swelling returns later this may indicate that you have an infection.

  • WIRES – you may have some wires in your mouth, for example those holding the splint, or orthodontic wires and hooks. Sometimes these will irritate your mouth. Place a small piece of orthodontic wax over the sharp wire, and replace this regularly with a fresh piece.

POST-OPERATIVE CONTACT DETAILS


Office hours
After hours
03 9820 5333
Call Mr Allan’s pager service on 03 9387 1000

It is essential to leave a detailed message regarding the problem as all calls are triaged with respect to the degree of urgency.