TMJ Total Joint Replacement

TMJ Total Joint Reconstruction 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 14 days off normal activities.
  • If you had upper jaw surgery with your joint replacement, you will want to keep those incisions 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 while awake to assist in controlling swelling.
  • You will feel numb around your surgery sites. You may also have weakness to certain areas of your face. This is normal and most often lasts only a few days but can last longer.
  • It is normal to have slight bleeding in your surgical sites and nose for a few days. It is also normal to have a sore throat from your breathing tube.
  • You will 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.
  • WHEN YOU CAN CHEW AND START YOUR PHYSICAL THERAPY DEPENDS ON WHETHER OR NOT YOU ALSO HAD UPPER JAW SURGERY.
    • If you DID NOT have upper jaw surgery, you may start chewing and your physical therapy immediately after surgery (though you likely will not feel up to it for a few days).
    • If you had upper jaw surgery (Lefort I), you cannot chew or start Physical Therapy until instructed to (usually around 6 weeks).
    • Cold, soft foods (ice cream, pudding, Jell-O, yogurt, applesauce) 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 10 or more lbs 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 a multi-modal (multiple medication) approach on a designed schedule. The medications are discussed in more detail later, but the following medications are usually prescribed and are listed in order of importance.
      • 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 1 week and then 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 (or other opioid) every 4-6 hours only for extreme pain.
      • These medications can be combined. But ibuprofen is the most important and effective.

 

 Total Joint 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
  • □  FIBER SUPPLEMENT *Metamucil® (orange flavor is the best) or similar product
  • □  DINER STYLE KETCHUP BOTTLE, SIPPY CUP AND BABY SPOON to make eating easier.
  • □  BLENDER *ingredients for smoothies
  • □  DETERMINE A SPOT TO SLEEP **sleep elevated – at least a 30 degree angle for the first 1-2 weeks to help with swelling. We recommend in a recliner, on the couch propped up with pillows, or in bed with a wedge pillow.

 

  

TMJ Total Joint Replacement 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).

 

Home care 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 should help you in your recovery.

MEDICATIONS:

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 the first week. As needed thereafter.
  • Lyrica (Pregabalin) 80mg if liquid (75mg if pill form) every 8 hours for the first week. As needed thereafter. Your dose may be altered based on previous use or other factors.
  • Oxycodone 5mg every 4-6 hours. This is for extreme pain not managed by the other medications.  This is an Opioid pain medication.  Always take on an as-needed basis. If you find that every few hours you start to have pain then you can take this medication every 4-6 hours on a schedule for a short period of time.

All of the above medications can be combined.  But ibuprofen is the most important and effective as it treats both pain and swelling.

Antibiotic skin ointment: Neosporin or Bacitracin can be used for the first 4 days.  Apply 3-5 times a day with a goal of keeping the incisions clean and moist. Starting day 5, stop using the antibiotic ointment as it may cause irritation.  Start using Vitamin E based lotion (supplied) or Vaseline with the same goal of keeping the area clean and moist for 2 weeks.

Antibiotics: You will be given antibiotics usually for 7-10 days.  Take these as directed to avoid infection of your surgical sites and prostheses.

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 Petroleum Jelly (Vaseline) or other lip balms.

If you also had maxillary (upper jaw surgery) you may also have the following:

Chlorhexidine Mouth Rinse: You will be prescribed a prescription mouth rinse if you had upper jaw surgery and/or genioplasty along with your total joint replacement. 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.

If you had upper (maxillary) jaw surgery, do not blow your nose for 10 days and do not pour anything into your nose (Neti Pots, etc.)

 

RESTING

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 depending on your surgery and your specific recovery.

  • When awake, keep your head elevated. 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 you, sleep is more important than keeping your head elevated as not sleeping will only make your recovery more challenging.

DRINKING

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, rubber bands in place, and a sore throat from the anesthesia.  These factors will make drinking difficult, but the following may help:

  • If you did not have upper jaw surgery (Lefort I) or genioplasty, then you do not have any incisions in your mouth and can drink with a straw if you would like. If you did have these procedures, please avoid using a straw for 2 weeks as it will pull on your incisions.
  • 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. Make a concerted effort and have a plan to ensure you are getting adequate nutrition.

  

EATING

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. 

  • IF YOU DID NOT HAVE MAXILLARY (LEFORT I) JAW SURGERY WITH YOUR TOTAL JOINT REPLACEMENT, YOU CAN MOBILIZE YOUR JAW AND START CHEWING IMMEDIATELY AFTER YOUR SURGERY ALTHOUGH YOU LIKELY WILL NOT FEEL UP TO IT INITIALLY.

 

  • THE SIMPLEST WAY TO EXPLAIN YOUR DIETARY RESTRICTIONS IF YOU HAD UPPER JAW SURGERY (LEFORT I) 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 are 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.  SEE OUR DIETARY RECOMMENDATIONS FORM FOR MORE IDEAS. 
  • 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. DO NOT CHEW!
  • Options could include scrambled eggs, pancakes, waffles, refried beans, mac and cheese, flaky soft fish. SEE OUR DIETARY RECOMMENDATIONS FORM FOR MORE IDEAS. 
  • 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.

Rubber Bands

You will have rubber bands on your braces or screws in your mouth. These are present to support your jaw 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 this will typically be removed at the 3-week post-operative visit.

HYGIENE

If you had upper jaw surgery or genioplasty, 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. 
  • If you had upper jaw surgery or genioplasty, the mouthwash should not be vigorously swished the first week after surgery as this may cause harm to your incisions. Simply swishing gently or placing in your mouth and rolling your head around for 30 seconds is sufficient. 
  • If you had upper jaw surgery or genioplasty 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.

DRESSINGS

  • 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 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: The sutures used on your facial incisions will dissolve on their own. For the first 4 days, use a small amount of antibiotic ointment (Neosporin/bacitracin) to keep the area moist (often required 4-5 times a day). After 4 days, stop using antibiotic ointment and transition to other moisturizing material (Vitamin E based lotion or Petroleum Jelly) until two weeks after your surgery. If you had upper jaw surgery and/or genioplasty the sutures used in your mouth will dissolve on their own.

PHYSICAL ACTIVITY

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!

  • It is crucial that you realize recovery is different for everyone and you should not be discouraged if you feel you are not ready for certain activities by certain times. The key is you getting better and not getting better on a schedule that may have applied to someone else.  
  • 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 by around week 4, light jogging can be started based on how you feel. Again, progress slowly and at YOUR own pace. 
  • 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 if you had upper jaw surgery (Lefort I) 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.

JAW EXERCISES & STRETCHES

Your jaw exercise program will depend on whether you also had maxillary (upper jaw) surgery.  Ideally, early and aggressive mobilization of your total joint prostheses are preferred to prevent scarring and limited mouth opening.  However, if you had upper jaw surgery, we often must delay or lessen this regimen to avoid causing movement of the upper jaw during healing.

If you had Total Joint Replacement surgery only:

For the first week after surgery, you will likely be in rubber bands. Do not perform any specific stretches or exercises.  However, moving your mouth to eat/drink/speak will help with mobility.  You will likely have rubber bands in place that prevent you doing much anyways.

Starting at week 2, You will typically start using your Therabyte or OraStretch Device. Your progress or recommendations may be different based on your 1 week post-surgery visit. Multiple times throughout the day, move your mouth open and closed to improve mouth movement. Use the provided device (Therabite or Orastretch) to help you start opening your mouth.  These devices have measurements to help you track your progress.

Starting at week 4 and beyond:  Continue the movements described above and being attempting to open your mouth as wide as possible without causing significant pain. This is the time to start being more aggressive to prevent scarring and ensure you have adequate mouth opening.

If you had upper jaw (maxillary) surgery with your total joint replacement:

Stick to the following above, except at week 2, do not start using your device. Delay this until week 5 or 6, depending on your specific instructions. Only open and move as much as you can on your own without placing anything on or between your teeth.