Orthognathic Surgery
Definition:
Orthognathic surgery is a surgical correction of the skeletal anomalies or malformations involving the mandible (lower jaw) or the maxilla (upper jaw). These malformations may be present at birth or they become evident as the patient grows and develops.
Due to orthognathic surgery or a jaw fracture, your jaw may be immobilized to heal properly. In order to do this, your teeth may be wired or have elastic bands placed on them to hold your jaw/bite in place. Chewing foods will create mobility between the bones that will prevent them from healing leading to infections and other problems including additional surgery, so even if your jaws aren't wired together you will generally be on a liquid diet for 4-6 weeks.
Oral Care:
Oral hygiene is very important while your jaws are wired or banded. Keeping your mouth and teeth clean will help you heal better and reduce the chances of developing infections or cavities.
After each meal, snack at bedtime, brush your teeth with a soft bristled toothbrush (child size works well). Use a circular motion and angle the brush at 45 degrees toward the gum line.
Rinse your mouth with a solution of warm salt water (1 teaspoon salt in one 8 oz glass of warm water). Oral rinsing should be done after every meal.
A moistened Q-tip or cotton swab may be used to wipe over the gums and tooth surfaces when brushing is impossible. You may follow brushing with a mild fluoride mouthwash to leave your breath and tongue feeling refreshed. Avoid use of products such as lemon glycerin swabs and commercial mouthwashes containing alcohol (these products can have a drying or irritation effect on the mucous membranes in the mouth(.
Use an oral water pik ONLY if ordered by your surgeon.
Avoid dry cracked lips by using Aquaphor, Blistex, Carmex, Vitamin E or Vaseline.
For protruding wires that are irritating in the mouth, warmed bees wax or orthodontic wax may be applied to the end of the wires (wax should be removed before eating and brushing teeth).
Keep your skin clean and apply topical antibiotics to any wounds.
Use facial moisturizers to soothe skin.
Do not smoke (smoking also dries and irritates oral mucosa). Avoid alcohol which can cause nausea and dehydration.
Diet:
You can reduce the risk of dehydration and keep secretions thin by drinking at least ten 8 oz glasses of fluids a day. Humidifier may be used for inspired air if recommended.
Follow a high protein, high calorie blenderized liquid diet. Calorie and protein supplements can be used and are encouraged. Products such as Ensure, Carnation and Boost are recommended. Protein powders can also be used. Protein powders can be purchased at GNC and most supermarkets. Increased protein intake after surgery is vital for maintaining the body's protective systems and for building healthy new tissue. You may lose between five and ten pounds during the first couple of weeks as your body adjusts to the diet change. You may eat anything blenderized that has a pourable consistency. There is a great website for soft and liquid diets. Go to 8weekswired.com.
Remember snacks! Juices, smoothies, puddings, yogurt etc.
Activity:
Do not participate in sports or strenuous activities, or return to work until permitted by your surgeon. Driving any motorized machinery or vehicle or signing any legal documents while taking pain medications is not recommended. The pain medications may cause alterations of visual perception and impair judgement.
When to call the Oral Surgery Resident: If you experience a fever greater than 100.5 F, your pain is not relieved with the pain medication, or you experience persistent vomiting, persistent bleeding, increased redness, swelling, pain, or tenderness in your upper or lower jaw.
Other:
Numbness in the lower jaw and chin may occur after lower jaw fracture or surgery and in the upper jaw and along the nose and lip following an upper jaw fracture or surgery. Avoid excessive head, cold or sharp items to prevent injury to the area. You may have moderate swelling which will gradually subside. For comfort, and to reduce swelling, you may wish to sleep with your head elevated on two pillows. Ice packs immediately following surgery will help decrease the swelling. You may use a warm wet washcloth or heating pad on your face to help alleviate discomfort and swelling after the first day following surgery. A side effect of pain medication is constipation. This can be alleviated by getting out of bed, adequate fluid intake, moving around and taking the stool softeners as prescribed. If your jaws are wired together, have the wire cutters on your person at all times.
Return Appointments:
Your first return appointment will be one to two weeks after your surgery. This date and time will be given to you at the time of discharge from the hospital. Follow-up appointments will be determined by your surgeon.
Questions:
If you have any problems or questions, call us. The Oral and Maxillofacial Surgery Clinic is open from 8:00am to 5:00pm Monday through Friday at (734) 936-5950. After 5:00pm or on the weekends you will need to call Hospital Paging at (734) 936-6267 and ask the operator to page the Oral Surgery Resident "on call."