Orthognathic Surgery: Post-Surgical Instructions

Modern orthognathic (jaw) surgeries offer many advantages not the least being decreased postoperative problems. However, surgery is never without some discomfort and preparation for the most common difficulties will ease your own experience. The following information has been prepared to help answer your questions regarding postoperative care as well as to offer suggestions that will assist you in making the whole experience easier. It needs to be emphasized, that if you have any problems postoperatively that you can not manage or don’t fully understand, you should contact your surgeon as soon as possible. Office telephone is Calgary Office Phone Number 403-271-1665.

Pain

You will be given a pain control medication upon discharge from the hospital and this should be used to manage any significant pain you might have. Often you will be able to control most discomfort by using “over the counter” pain medications such as acetaminophen (Tylenol), and ibuprofen (Advil, Nuprin, Motrin, etc.). Usually, O.T.C. ibuprofen 200mg is the best since it can be taken safely in prescription dosages (600-800mg.) and are small enough to swallow easily postoperatively.

Swelling

Significant facial swelling should be anticipated following your surgery. Generally, it will decrease within two weeks to the point where it will not be noticeable to anyone but yourself, family and possibly close acquaintances. During your surgery and hospital stay, steps are taken to minimize the swelling. The head of your bed will be kept elevated after surgery and this position should be maintained while you are lying down for about 10 days after you leave the hospital. It is generally easier for you to bend your mattress by placing something solid under the “head” of the mattress instead of trying to sleep upright with pillows.

Ice packs will be placed on each side of your face as you awake from the surgery. These are reusable and you will be sent home with them for use over the next two days. After the second day, they generally will not be of any value in controlling swelling but some people like them for comfort. Mild heat to your face can be started after the fifth day and this will assist in resolving the swelling and stiffness. A heating pad or warm towels can be used at 20-30 minute intervals for this purpose.

Nausea

Every attempt will be made to minimize the chance of nausea while you are in the hospital. However, it will sometimes become a problem when you are home. The two most common causes are either swallowing some blood after surgery or the use of a narcotic pain medication. If you start having any feeling of nausea, you can decrease the chances of problems if you follow some simple rules:

  1. Stay down – movement especially walking around will increase the likelihood of nausea
  2. Drink clear fluids or possibly lightly carbonated beverages such as: Seven-up
  3. Stop taking any narcotic pain medications and try using “over the counter” medications as suggested earlier.

If there is no relief, call your surgeon as soon as possible.

Mouthrinses

Do not use Listerine or Scope for 2 weeks, instead mix two parts water (or mouthwash) with one part hydrogen peroxide for this purpose.

Pressured oral rinsing systems such as “Water Pik” should not be used until at least one week after surgery. Even then, the pressure setting should be kept at the lowest possible and care be used to insure the water is directed only at the teeth. Do not use a straw for two (2) weeks. It is recommended that you start brushing your teeth as soon as possible, concentrating on the teeth only. The use of a small “baby” toothbrush may be helpful.

Activities

The sooner you return to normal activities the more rapid will be your recovery. The recovery from surgery and accompanying anesthesia can deplete your energy and increased bed rest may be necessary. However, staying in bed all day simply delays your recovery and many times results in an inability to sleep at night. Short walks or other mild activity during the first few days postoperatively, will commonly be of great benefit. As your strength returns, increase your activity toward your normal level, unless it is a contact sport where there is a risk of being hit in the face. These sports should not be attempted until 10 weeks after surgery.

Infection

If your have been given an antibiotic after the surgery, make sure you take it as prescribed until finished. If you had an upper jaw surgery, please avoid blowing your nose for two (2) weeks, since this would increase your chance of infection and could also provoke a nose bleed. Call our office if you notice any signs of infection, increased swelling after five (5) days, swelling that is painful/hard/hot, a foul taste or odour in your mouth or a temperature above 100F/38C.

Bleeding

It is normal to bleed or ooze for some time after jaw surgery. It is not unusual to have blood in the saliva or on your pillow for up to one (1) week after surgery. To control some of the bleeding, please keep your head elevated and apply ice packs over the area. Gauze packs will be provided after surgery.

If gauze packs are not available, then a clean cloth folded as a pack or a tea bag may be used as a substitute. If you encounter a significant bleed from the surgical site or your nose, please contact your surgeon ASAP, or you should consider going to the emergency department of your local hospital.

Diet and Nutrition

We suggest that you keep to a pure or “soft” diet for 4-6 weeks after surgery, making sure you do not bite into very hard foods (apples, carrots…). You may want to use a blender to help “soft” your menu.

Bruising

Moderate to severe bruising is to be expected for most patients. The bruising will normally appear shortly after surgery and may last for two (2) weeks.

Smoking

Smoking is discouraged during the healing period (2-4 weeks). Smoke irritates and can lead to infection and delayed healing.

Remember – If you have any concerns after your surgery, please call Calgary Office Phone Number 403-271-1665.