Orthognathic Surgery Post-Operative Instructions-Overview
- You have had a major operation on your face and jaws. This requires recovery time so please make sure you arrange at least 10 days off normal activities.
- All of your incisions are inside your mouth, so it is helpful to keep your mouth clean with the prescribed mouth rinse. You may gently brush the outside of your teeth once you feel comfortable doing so, typically 2-7 days after surgery.
- You will have significant swelling. Do not be alarmed as this is normal.
- Take your prescribed Ibuprofen every 8 hours with food for the first week. This will help with pain and swelling.
- Ice packs can be worn 20 minutes on and 20 minutes off the first 3 days to assist with swelling.
- Sit and sleep with your head elevated as much as possible to assist in controlling swelling.
- You will feel numb around your surgery sites. This is normal and most often temporary. Numbness can last a few days to a few months.
- It is normal to have slight bleeding in your mouth and nose for a few days. It is also normal to have a sore throat from the breathing tube placed during your surgery.
- You may have rubber bands placed at the time of your surgery. Do NOT remove these until they are removed at your first follow up visit. If they happen to break, we will replace them at your next visit.
- You cannot chew until instructed to (usually around 6 weeks).
- Cold, soft foods and liquids (ice cream, pudding, Jell-O, yogurt, applesauce, cold soups/broths) will feel better initially.
- Progress to warmer foods (still soft) after the first week or as you feel comfortable.
- Stay hydrated. Drink more fluids than you think you should.
- Begin or continue taking a multivitamin. Liquids may be easier. Otherwise pills or crushing pills into your food will be necessary.
- Count your calories and track your weight to ensure adequate intake. Most patients lose 6-10lbs from this procedure and regain it once a normal diet resumes.
- Protein or nutrition shakes are very useful for maintaining calorie intake and weight.
- “Ensure” or other nutrition shakes are recommended.
- Pain control is often able to be obtained with ibuprofen alone if taken every 8 hours as instructed. Periodically you may require additional or stronger pain medication.
- Ibuprofen every 8 hours with food for 1 week unless G.I. symptoms arise. Alternatively, you may be prescribed Meloxicam.
- Acetaminophen (Tylenol) 1000mg every 8 hours for the first 5 days. Then as needed.
- Lyrica (Pregabalin) 80mg if liquid (75mg if pill form) every 8 hours for the first 5 days. As needed thereafter.
- Oxycodone 5mg (or other opioid) every 4-6 hours only for extreme pain.
- These medications can be combined. But ibuprofen is the most important and effective.
If there are any questions or concerns, please call us anytime during business hours at 480-896-0600 or for urgent matters, after hours at 602.492.3177.
Orthognathic Surgery Checklists:
Check list 4-7 days before surgery:
- □ Pick up prescriptions from pharmacy – (Ideally one week prior to surgery in case your pharmacy needs to order any medications or they have questions)
- □ Identify a family member or friend ready to help you after surgery for a few days
- □ Obtain blender, crushed ice, and humidifier (if desired/possible)
- □ Identify a location in your house to spend time after surgery such as a comfortable reclining chair or pillow arrangement in your bedroom
- □ Set up your supplies for oral care and eating nearby (some are given during your preoperative visit.)
Check list night before surgery:
□ NOTHING TO EAT OR DRINK AFTER MIDNIGHT (or 8 hours prior to arrival time whichever comes first)
□ Remove ALL fingernail polish and makeup including mascara
□ Brush your teeth before you come to the hospital. Do not swallow water or toothpaste.
□ Do not shave facial hair the morning of surgery (increases infection risk). Shave 2-3 days prior if desired.
□ Remove any facial piercings. This includes tongue, lip, nose, and ear piercings.
OTHER SUPPLIES THAT MAY BE HELPFUL
- □ LIP MOISTERIZER (Vaseline, chapstick, etc.)
- □ FIBER SUPPLEMENT *Metamucil® (orange flavor is the best) or similar product
- □ DINER STYLE KETCHUP BOTTLE, SIPPY CUP, AND BABY SPOON
- □ BLENDER and ingredients for smoothies
- □ DETERMINE A SPOT TO SLEEP **sleep elevated – at least a 45 degree angle for the first 1-2 week (if possible) to help with swelling. Options would include a recliner, on the couch propped up with pillows, or in bed with a wedge pillow.
Orthognathic Surgery Detailed Instructions:
We understand that following a surgery, patients and their families may be concerned and want to ensure their condition is “normal”. The following instructions are aimed with informing you and limiting this uncertainty. Please make sure to read these prior to surgery so that you are comfortable after surgery.
If something arises that can’t be addressed from these instructions, contact us at our office phone (480-896-0600). Please realize that the office phone is answered during business hours, but Dr. Wasson may be occupied in surgery or tending to other patients. If the office staff cannot answer your questions, he will return your call when available.
If you have an urgent matter after hours that cannot wait until normal business hours, please call the after-hours number (602-492-3177).
At Home Instructions:
With any surgery to the mouth and face, one challenge is that the activities that are most beneficial are often the most difficult to perform. The following are instructions which should help you in your recovery.
The following medications are part of a regimen we recommend for most patients. However, due to specific health conditions, allergies, or other medications you take, this plan may be altered to fit your specific needs. If the plan discussed with you at your appointments differs from below, please stick to the plan discussed and use the following only as reference.
Pain Control: You will typically be prescribed multiple medications to assist in pain control while attempting to limit opioids or other medications that have addictive potential or undesirable side effects. Please take the medications listed below. THEY ARE LISTED IN ORDER OF IMPORTANCE/PRIORITY, HOWEVER, THE FIRST THREE SHOULD BE TAKEN ON THE DEFINED SCHEDULE LISTED AND THEN “AS NEEDED” THEREAFTER.
- Ibuprofen (600 or 800mg depending on what is prescribed for you) every 8 hours with food for 1 week unless G.I. symptoms arise. Alternatively, you may be prescribed Meloxicam or Naproxen. Take on an as needed basis after the 1st
- Acetaminophen (Tylenol) 1000mg every 8 hours for 5 days. As needed thereafter.
- Lyrica (Pregabalin) 80mg if liquid (75mg if pill form) every 8 hours for the first 5 days. As needed thereafter.
- Oxycodone 5mg (5ml) every 4-6 hours. This is ONLY FOR EXTREME PAIN NOT MANAGED BY THE OTHER MEDICATIONS. This is an Opioid Pain medication and an alternative opioid may be prescribed.
These medications can be combined. But ibuprofen is the most important and effective.
Chlorhexidine Mouth Rinse: You will be prescribed a prescription mouth rinse. Using this after you eat each time is preferred but use at least 3 times a day until you can comfortably brush all your teeth (usually weeks after surgery).
Decongestants: Following upper jaw surgery, there is congestion of the nose and sinuses. If decongestant such as Sudafed® is needed, take the medicine as indicated on the bottle for seven days as needed for congestion.
Nasal Sprays: (Afrin, Neosynephrine or equivalent) can be used every 6-8 hours to help improve breathing through your nose. DO NOT USE LONGER THAN 4 DAYS AS THIS CAUSES WORSENING OF THE CONGESTION.
You can use Saline Nasal Sprays (such as Ocean) as much as you wish during the first two weeks.
DO NOT USE A NETI POT OR POUR ANYTHING DIRECTLY INTO YOUR NOSE/SINUSES.
If you had upper (maxillary) jaw surgery, do not blow your nose for 10 days.
LIP OINTMENT: You may be given lip ointment at the hospital. Use this for the first two days. Keep enough ointment on the lips to keep them looking wet. After two days stop using the ointment and use plain Petroluem Jelly (Vaseline) or other lip balms.
As much as possible, take it easy. While you do not require in-home medical supervision, having support in the way of a family member or trusted friend will be beneficial the first 2-7 days.
- When awake, keep your head elevated. This should be possible while awake-sit instead of lying or use a recliner, multiple pillows, or a wedge pillow. This will help with swelling.
- If possible, keep your head elevated while sleeping the first 1-2 weeks. Again, use a recliner, multiple pillows, or a wedge pillow. Some people do not sleep well unless lying flat in a bed. If this is the case for your, sleep is more important than keeping your head elevated as not sleeping will only make you more miserable.
You will have numbness in the areas your surgery was performed which could include your upper lip, lower lip, or both. You will also have jaw soreness and limited mouth opening from the surgery and a sore throat from the anesthesia. These factors will make drinking difficult, but the following may help:
- Do not use a straw for 1 week as the negative pressure will pull on your incision sites which can cause them to open and bleed further.
- Use the provided squeeze bottles (or any of your own you find easier to use) as needed.
- Attempt to use a cup even though some fluids may spill as this is the most efficient way to take in larger amounts of liquids. Often a child’s sippy cup will ease this transition.
- Initially, colder foods may feel better than warmer foods. Progress to warmer after the first week based on your comfort.
DON’T ALLOW ONE PROBLEM BECOME TWO! Although difficult, taking in sufficient nutrition is key to your healing and feeling better.
Initially, it will be difficult to eat adequate amounts of food. Try to eat multiple times a day, or throughout the day as best you can.
THE SIMPLEST WAY TO EXPLAIN YOUR DIETARY RESTRICTIONS IS THAT YOU CANNOT CHEW! If you can swallow it without putting it between your teeth and biting, then you can eat it. You could (but don’t) eat rocks if you can swallow them whole or blend them small enough to drink them!
- THE FIRST WEEK AFTER SURGERY: You will likely only want liquid or pureed/blended foods. But every patient is different, and you not REQUIRED to only drink liquids. JUST DO NOT CHEW!
- Options for liquids/pureed/blended foods would be Smoothies, milkshakes, and pureed soups. More solid type foods would be applesauce, oatmeal, and pudding.
- FOR WEEKS 2- 6 UNTIL TOLD YOU CAN CHEW BY DR. WASSON: Your diet should include foods that are extremely soft in consistency that you do not need to chew. Foods that you can smash with your tongue and roof of your mouth or cut into small enough pieces to be swallowed whole.
- Options could include scrambled eggs, pancakes, waffles, refried beans, mac and cheese, flaky soft fish.
- FOR MORE RECOMMENDATIONS, READ OUR DIET RECOMMENDATIONS FORM.
- Changes in your diet as well as the use of pain medicine may cause constipation. If you have not had a bowel movement by 2 or 3 days after surgery, you should begin to add fiber to your diet. Start taking Metamucil ® (1 teaspoon mixed with 8 ounces of water 3 times per day). If this doesn’t help within a day or two, call our office and we can suggest other medications.
You may have rubber bands on your braces or screws in your mouth. These are present to support your jaw or jaws in the new position. The first week after surgery attempt to leave the elastics on as they were placed in the hospital. If a rubber band breaks, this is not a concern and will be replaced at your post-operative visit if needed.
- If you have a splint in place on your top teeth this will be removed at the 3-week post-operative visit.
It is extremely important for you to keep all areas inside your mouth clean after surgery.
- Until your swelling subsides, and your rubber bands are removed, it may be difficult to brush your teeth. Usually, using the prescribed mouth rinse or saltwater rinses will help during this first week will provide adequate hygiene. Ideally, use the mouth rinse or saltwater rinse each time after you eat if possible. If not, use at least 3 times a day.
- The mouthwash should not be vigorously swished the first week after surgery as this may cause harm to your incisions. Simply placing in your mouth and rolling your head around for 30 seconds is sufficient.
- Do not use a water pik or electric toothbrush inside your mouth for the first week after surgery.
- Avoid rubbing or contacting your incision sites with a toothbrush or other items.
- DO NOT SMOKE FOR AT LEAST 4 WEEKS AFTER SURGERY. THIS CAN LEAD TO INFECTION AND DELAY HEALING.
- ICE PACKS: Ice should be used for the first 24-72 hours after surgery to reduce swelling. You can continue to use ice on an off for the first week to help with swelling and discomfort. Use ice for 20 minutes on/ 20 minutes off as needed.
- ELASTIC DRESSING: You will leave the hospital with a compressive white dressing on your face. KEEP THIS IN PLACE UNTIL THE FOLLOWING MORNING. This will help with swelling and after removal the following morning can be washed or rinsed as needed. Then it can be to be used simultaneously or alternated with the ice packs. Wearing this dressing at night when ice packs would not be kept in place will also help reduce swelling that may occur when lying down.
- SUTURES: If you had lower jaw surgery one suture may be placed on the outside of your face (not everyone). These dissolve on their own. For the first 5 days, use a small amount of antibiotic ointment (Neosporin/bacitracin) to keep the area moist (often required 4-5 times a day). After 5 days, stop using antibiotic ointment and transition to other moisturizing material (Vitamin E based lotion or Petroleum Jelly) until two weeks after your surgery.
Following surgery, you will find that your energy level will be lower and will take some time to return to normal. It is crucial that you remember that you may be light-headed, dizzy, and prone to fainting early on as you will be taking several medications, have reduced calorie intake, and will have had blood loss during surgery. If you are unsure, do not do it. DOUBT MEANS DON’T!
- For the first week you can walk around the house or outside with someone with you. Do not elevate your heart rate or blood pressure significantly as this will worsen swelling and pain.
- Starting week two, feel free to walk more vigorously outside taking care to slowly progress over multiple days/weeks to more strenuous walking. Keep in mind, you may be on medications that alter your balance and reaction time. Usually after the second week, stationary biking or non-inverting yoga can be completed.
- Usually by around week 4, light jogging can be started based on how you feel. Again, progress slowly.
- Week 6 and Beyond: At some point, you must return to normal diet and activity. This usually starts around week 6 with another slow progression to more activity such as weightlifting, more vigorous jogging/running, outdoor cycling, etc. Keep in mind that any action that results in trauma to your face could result in re-fracturing your jaws for 3-4 months. In theory, you could proceed with any activity if you knew your face would not be hit/traumatized. Use your best judgement.
Keep in mind that healing from jaw surgery does not fully occur until 3-4 months after surgery. This means any progression of jaw exercise should start slowly and progress over time.
For the first two weeks following surgery, do not perform any specific stretches or exercises. However, moving your mouth to eat/drink/speak will help with mobility.
Starting at week 2, Multiple times throughout the day, move your mouth open and closed, side to side, and forward and back to improve mouth movement. DO NOT use any pressure on your teeth to help stretch your jaw opening.
Starting at week 4, continue the movements described above and being attempting to open your mouth as wide as possible without causing pain. Open as wide as you can and then use your fingers to HOLD THAT POSITION BUT DO NOT STRETCH IT FURTHER!
At week 6, you can do the same as above but use your fingers to stretch it slightly further to assist in improving your mouth opening more rapidly. Do this 5 times (5 repetitions), 5 times a day (25 times total per day) until your mouth opening is back to near normal. At this point, you can also start to bite and chew foods which will help with mouth opening, mobility, and function.