Following these instructions and the instructions the nurses have given to you will result in fewer complications and make your recovery period easier. Failure to follow these instructions could result in unnecessary pain, delay in healing, or complications, which could negatively affect the outcome of your treatment.
Following surgery, your jaws may be held together with elastics. A period of 2–6 weeks is usually required for initial bone healing.
What You Need For Home
- Saline (to make your own: dissolve 1 teaspoon of salt in an 8-ounce glass of warm water)
- Child sized toothbrush/Waterpik®
- Scissors/pocket knife (for cutting elastics if your jaws are held closed)
- Vaseline or lip balm
- Blender or food processor
If necessary, a prescription for medications will be provided at the time of your discharge. Please take the medication as prescribed until it is finished. You may be sent home with a prescription for a liquid pain reliever, which can be administered through a syringe as you have been shown, or sipped from a spoon. If your pain reliever is in pill form, you can crush it and mix it with 10–20 ml of water or juice to be supped or administered through a syringe.
You may also be given a prescription for a liquid antibiotic to prevent infection. It is important to take this medication as prescribed until it is finished. You may also be given a prescription for an antibiotic mouth rinse. It is very important to keep your mouth clean.
An increase in swelling and pain after the first week could indicate an infection, which may require treatment. Should this happen to you, contact your doctor.
Care of The Operative Area
For the first 48 hours after surgery, you will be given ice packs, which will help to minimize swelling. Following this period, you will need to use heat (hot, wet facecloth, hot water bottle, heating pad, or microwaveable pack) to help reduce the remaining bruising and swelling. As it takes about 2 weeks for the majority of the swelling to disappear, continue to use heat for 30–45 minutes, 4–5 times a day for at least 1–2 weeks after you are discharged from the hospital. A few minutes of gentle massage while using the heat also helps.
Prolonged bleeding, such as nosebleeds or bleeding from the incision sites following discharge from the hospital, is not normal, and you should contact your doctor if this occurs.
For the first couple of days following surgery, you may experience a sore throat and some nasal decongestion. This is normal after anesthesia and should go away within a couple of days. Drinking plenty of liquids usually helps with the throat tenderness.
You will be unable to keep your lips moist when your jaws are held together with elastics. In addition, cracking of the corners of the mouth does sometimes occur following surgery. Apply Vaseline or lip balm regularly to keep these areas from becoming too dry or chapped.
Oral Hygiene/Mouth Care
It is important to remember to clean your teeth and rinse your mouth routinely following surgery. Using a Waterpik® after the first week is an excellent aid. A mild salt solution or a commercial mouthwash (non-alcohol based) will assist you in keeping your mouth clean. It is important to rinse your mouth with 20–30 ml of saline frequently every 2 hours as well as after meals. You can make your own saline (see above). Use a child toothbrush to clean the outside of your teeth. You can start brushing the front of your teeth as soon as it is not too painful and progress to the back of your mouth when the swelling in your cheeks comes down. You must do this as thoroughly as possible. You will, of course, not be able to brush the tongue side of your teeth with a brush. The tongue side of the teeth can be brushed by moving your tongue across them while using a mouth rinse. You should avoid carbonated beverages, as they tend to decalcify your teeth.
Muscle Spasm and Mobilization
Occasionally, several elastics will break away during the fixation (teeth together) period. As long as you cannot open your mouth significantly, this is not a problem, and elastics will be replaced at one of your post-operative visits. If a large number of elastics are lost, and you can open your mouth, don’t be alarmed. You should, however, contact your doctor so that new elastics can be placed.
Since your jaws may be held together with elastics, you will require what is called a balanced fluid diet (blenderized). It is essential that your body receive adequate fluids and nourishment in order to maintain your nutritional status and promote healing.
You will be limited to a strictly liquid diet until your jaw is no longer tightly held together. During this period, you will become creative with your menu choices. It is especially important to drink adequate amounts of fluids, 3–4 liters per day. You can purchase liquid nutritional supplements (such as Ensure or Boost) in a grocery store. You may continue to use the syringe for feeding, or when you are comfortable, use a straw or drink from a glass. A nutritious dietary intake is important to promote healing and decreasing the possibility of infection. You can expect to about 5–10% of your total body weight during the first 6 weeks following your surgery. A rapid loss of weight during the first week is usually due to fluid loss.
After the first 6 weeks, you can progress slowly to a normal diet. The first 4 weeks following the removal of the tight elastics, your diet should involve soft foods (eggs, potatoes, fish, pasta, etc.).
Here are some tips for creating a personal menu:
- You may eat anything that can be thinned into liquid form. Meals may be blenderized until smooth. If food is still lumpy, use a strainer.
- Cold whole milk can be used to thin puddings, yogurt, cereal, sandwiches, ice cream, and cakes.
- Warm whole milk can be used to thin cheese, eggs, toast, hot cereal, muffins, pasta, hot main dishes, and casseroles.
- Fruit juice can be used to thin fruit, yogurt, and ice cream.
Weight loss is a common result of a liquid diet. If you are experiencing weight loss, try snacking between meals and adding whole milk cheese or skim milk powder to meals to boost caloric intake. Constipation may result from the low fiber content in liquid diets or may be a side effect of some pain medications. To avoid this, try to include a lot of fruits and vegetables in your diet, and add prune juice to your daily menu.
Alcohol and smoking can delay wound healing and promote infection. Alcohol and smoking should be avoided until your surgical sites are completely healed.
In the unlikely possibility that choking or breathing difficulties may occur, we recommend that you have scissors or a pocket knife with you at all times while your teeth are wired together. In the rare event that you need to cut the elastics, proceed with cutting the elastics and then contact your doctor immediately. The nurses will instruction in the art of cutting the elastics in the event of an emergency.
Avoid alcohol or foods that may cause your stomach to become upset. Should you experience nausea, you can use over-the-counter anti-nausea medication as directed on the bottle. If the nausea persists, please contact your doctor.
In most cases of vomiting, the elastics do not require removal. It is extremely rare to have to remove the elastics as the stomach contents are of liquid nature and can escape through and around the teeth. If emergency elastic removal (for vomiting or breathing difficulties) is required, please contact your doctor immediately. Remember that during the tight fixation period (with elastics), you should carry scissors or a pocketknife with you wherever you go.
Warning Signs of Complications
The following symptoms may be a sign of infection or other complications; therefore, you should follow up immediately with your doctor if they occur.
- Increased swelling
- Increased or excessive pain
- Foul odor from the mouth
- Fever and/or chills
- Bleeding inside the mouth (wires may need to be adjusted)
Physical activity should be kept to a minimum for at least 6–8 weeks after surgery. It is very important that you realize that you just had a significant operation that requires a well-rested recovery period. Excessive activity (running, exercising, swimming, heavy lifting, house cleaning, contact sports, going up and down stairs quickly, etc.) can cause bleeding and/or dizziness. If you had upper jaw fracture, you should avoid bending over during this time period as it may cause dizziness.
Excessive fatigue can also slow the healing process as well as increase the chance of infection by reducing your resistance. A gradual increase back to normal activity is the most sensible approach. Contact or other sports in which direct physical contact or injury are possible should be avoided for 2–3 months to minimize the risk of another fracture. If you have any specific activities you wish to perform following your surgery, please discuss this with your doctor.
Follow-Up With Your Doctor
A follow-up appointment should be arranged with your doctor’s office prior to discharge. If an appointment has not been made, please call your doctor’s office during regular business hours to arrange a follow-up appointment.
Please follow any other instructions that have been explained to you by your doctor.
If you have any questions or problems, do not hesitate to call our office at (360) 293-2808 or our after-hours telephone number at (360) 647-4027. However, if you are experiencing severe bleeding or breathing problems requiring immediate attention, please proceed to the nearest Emergency Department or Dial 911.