Information for Jaw Surgery Patients

This is a fundamental overview of what you might expect with jaw surgery. We hope this helps clarify what you can expect with your upcoming surgery and answers most of the questions you may have. Not everyone has the same type of surgery however, or the same recovery. The exact nature of your surgery will be explained to you by Dr. Reichman and our staff.

Our office will direct you in the paperwork that needs to be done prior to your surgery. There are forms and blood work that need to be completed one month before your surgery. This can be done by your family physician. X-rays and models will be obtained by your orthodontist 1-2 weeks prior to surgery.

The afternoon before surgery, our office will call you and let you know what time to arrive at the hospital. Please arrive on time with an empty stomach. Do not have anything to eat or drink the morning of your surgery, including water. Do not chew gum or suck on hard candy.

At the Hospital

You will see Dr. Reichman before you go into surgery. He will answer any questions and direct you to the nurses who will help you get changed into a hospital gown and direct you to the operating room.

The anesthetist will start an IV in the back of your hand and put medication into the tubing that will make you go off to sleep. While you are asleep, Dr. Reichman will perform the surgery on your jaw(s) under general anesthetic. He will make cuts in your jaw bone that will allow him to move your jaw into it’s new position. He then holds that position by securing it with very small titanium screws. These screws are considered permanent. All this work is done inside your mouth so you can expect dissolvable stitches at the incision lines. Patients that have surgery done on their lower jaw can also expect two small stitches just below their jaw line. These will be removed in our office on Day 6 or 7 after surgery.

After surgery, Dr. Reichman puts a small plastic ‘splint’ between your teeth and very small elastics from your upper to lower braces. This is to prevent you from inadvertently opening too widely. A final dressing is applied to the outside of your face, which helps minimize swelling. This dressing can be removed at home on the third day after surgery. It’s easiest to just get it wet in the shower and take it off that way. If you have any residual adhesive on your face from the tape, it will come off with mineral or baby oil.

Most of the surgeries performed by Dr. Reichman can last anywhere from one to four hours, depending on the amount and type of surgery being performed. Perhaps this sounds long to you, but the amount of time in surgery is no reason to become alarmed. You are carefully monitored at all times.

You will wake up in the recovery room with the IV still in place. The nurses can use that IV to give you medication to help with pain or nausea. Jaw surgery is not known as being an especially painful surgery, but if you are having pain, the nurses will give you medication to make you more comfortable. They can also give you extra fluids until you are drinking on your own.

Family members are not permitted in the recovery room (They are encouraged to come in the recovery room at BC Children’s Hospital however). When the nurses in the recover room see that you are awake and ready to move, they will take you upstairs to your hospital room. You will be able to see your family members then. Plan to stay in the hospital for one night.

After the surgery there is always temporary swelling and perhaps bruising. This is a normal healing response. It tends to reach its maximum around Day 3-4 following surgery and should resolve greatly within the first two-three weeks. Should you look in the mirror, remember this is only a stage of transition. You may feel more swollen than you actually are. This occurs as a result of the numbness (like going to the dentist and having a freezing for a filling). You will also notice with the swelling that follows these types of surgeries, it may be difficult to make facial expressions for the first few days or weeks. As the swelling and numbness subside, facial movements will quickly improve.

With upper (maxillary) and lower (mandibular) jaw surgery, it is not unusual to have bruising. Bruising with maxillary procedure can extend from the whites of the eyes into the cheek areas – ‘black eyes’. With lower jaw procedures it can extend fom the area of the jaw line down into the neck and chest. Do not worry. This gradually resolves but can take up to several weeks to completely go away. Remember, the bruising, if not present immediately, can become evident within three to four days after surgery.

Nasal Congestion – Throat Soreness

For several days following surgery, you might experience nasal congestion and a sore throat, not unlike having a cold. This should resolve within a few days.

Restrained Jaw

When you wake up following surgery, you will still find that you jaw may be restrained with orthodontic elastics. This is to prevent you from inadvertently opening too wide, which could cause loosening and failure of the fixation devices (screws and/or plates). These elastics will still allow you to move your jaw. Fixation devices are strong enough to hold bones into position without the need to wire the jaw together. The fixation devices are considered permanent but on occasion may have to be removed if they become loose or, when as sometimes occurs, they can be felt below the gum surface. In this latter circumstance, some individuals do not like their presence.

Communication & Swallowing

For a few days following surgery, you may have some difficulty talking and swallowing. This is related to the swelling and a possible sore throat, or restraint by the orthodontic elastics. Most patients don’t experience this problem, however, trying to carry on lengthy conversations with relative or friends can be fatiguing and is best avoided for awhile. Difficulty swallowing can result in drooling. This can be embarrassing but will resolve usually within the first week. Practicing and forcing yourself to do these tasks will expedite their proper return to function.

Nausea & Vomiting

Patients are often concerned with being nauseated and/or vomiting after surgery. This does not happen very often or to everyone. The most important thing to remember is even when you jaw is hut, anything you ‘eat’ or take by mouth is already in liquid or pureed form. In the rare event that you are nauseated and have to vomit, these liquids can drain easily out of your mouth, if necessary. While throwing up is never pleasant, it is not a threat.

Don’t panic, just head for the toilet or get a bowl and let it come. If you feel it necessary to cut the elastics, you should contact us immediately. Should nausea persist, it can sometimes be due to the liquid medications you are prescribed. If in doubt, call our office. Anti-nausea medication such as Gravol are available in most pharmacies, without prescription, and can be obtained in liquid or suppository form if you feel you need them.

Bleeding

Bleeding associated with the surgery usually stops at the end of the procedure. It is not uncommon, however, to experience slight bleeding from the incision sites inside your mouth the following day of surgery. Subsequent to this, minor bleeding may occur from the incision sites as a result of mechanical trauma (such as associated with the brushing of teeth). When maxillary surgery is performed it is not unusual to experience minor normal-like nose bleeds. These occur as a result of small tears of the nasal mucosa often associated with nose blowing and or when the air humidity is dry.

Dietary Requirements

Following your surgery and throughout the post-operative recovery period, it is common to lose weight. Prior to your surgery it is OK to gain a few pounds in anticipation of this possible weight loss. Once the jaw is functioning more normally, patients quickly return to their normal weight. If excessive weight loss occurs, it may mean that you are not consuming an adequate volume or nutritionally proper forms of foods and liquids.

During the first week after your surgery, your dietary intake is very important. Your diet initially consists of liquids. Each day gets a little easier as you adjust to swallowing. Your tissue is in a state of healing and your nutritional requirements are faily high. This is not time to go on a diet – you will find you will lose weight regardless. We recommend you aim for 2 litres every 24 hours. In addition to any other liquid preferences during the first week, we recommend meal replacements and nutrient supplements such as ‘Ensure’, ‘Boost’ or ‘Carnation Instant Breakfast’. These are balanced in all appropriate fats, carbohydrates (sugars), proteins, minerals and vitamins.

You can use a syringe, child’s Sippy cup or soft sports bottle to aid in drinking. Patients seem to all agree that the sports bottle with the attached straws, work best initially.

Once the bone of the jaw has regained some of its strength, through the process of healing, you will gradually be guided back to a normal diet. Be aware, however, that this may take several weeks. Dr. Reichman does not want you to chew anything until he gives you the ok to do so. This is approximately 4 weeks after surgery. At your first visit in our office post surgery (Day 6 or 7), Dr. Reichman will replace the tight orthodontic elastics, with looser ones. This will allow you to get a spoon in your mouth, which will increase your dietary options. During Week 3 and Week 4, you options will increase, as you get used to swallowing. If you can swallow it without chewing, you can have it!

Oral Hygiene

Keeping your teeth clean is very important post-operatively. Your teeth should be kept as clean after surgery as you did before. Obviously, this will be more difficult initially as a result of the swelling, numbness, discomfort and the limited opening from the restraining elastics. Because of tight orthodontic elastics you wear the first week after surgery, you cannot brust the insides of the teeth during this time at all. Irrespective of this, the cheek side of the teeth can and should be kept clean. Use a small child’s toothbrush and brush your teeth at least 3-4 times a day with toothpaste. Do not use mouthwash for the next 4 weeks. It is important that you rinse your mouth with salt water immediately after eating or drinking though. Use a mix of 1/2 teaspoon salt dissolved in 8oz. Of water. You may find yourself rinsing your mouth 10-20 times/day.

Healing problems and postoperative infections can be significantly reduced by proper cleaning. Caution: Do not use a “Water Pick” in the first 5 days and do not set it at a high pressure for the first week following surgery, as food debris could be pushed through the incision sites. Simply set the pressure dial to a low number such as one or two, for this period. You will discover your ‘stitches’ during your mouth cleaning. These are dissolving stitches and will gradually disappear in 10-14 days.

Your Return To Work Or School

You are encouraged to return to work or school as soon as you feel up to it. Each individual will differ in his or her speed of recovery. This depends on your age, physical condition, and the nature of the operation itself. The usual recovery time for most procedures is two weeks, although some individuals may need an extra week or two. Our office can supply letters for school and help you with forms for work to explain your absence if you need them. Just remember the healing process goes faster if you are busy!

Participation In Sports

Your fixation may limit your participation in sports or in exerting yourself. Rely on your common sense. Any blow to the face or jaw that might occur with sporting accidents or activities could be very harmful to your recovery. We recommend you stop these activities for 6 months following surgery, until the strength in your jaw has returned to its preoperative strength.

Complications & Risks

In all surgical procedures there are complications that may occur even under the best of circumstances. Fortunately these are rare. We list four issues that rarely occur and one that always does. Dr. Reichman will discuss all these with you in greater depth.

Infections

Every attempt is made to prevent infection by performing the surgical procedure in a sterile operating room and by administrating antibiotics. Make sure you take the antibiotics until they are all gone and be diligent about rinsing your mouth with salt water following surgery. If swelling gets worst at any time following your first week, let our office know.

Jaw Discomfort & Limitations Of Opening

Within a reasonable period of time (four to six months) following surgery, your jaw should function reasonably normally without any significant discomfort. In rare instances, Orthognathic surgery patients can experience jaw joint discomfort and/or limited opening. This can usually be relieved with warm compresses and Ibuprofen or other pain medication. Massaging the area may help as well.

Facial Aesthetics

The orthodontic and surgical treatment, wich has been recommended to you, has been planned to have your teeth come together properly, so as to restore the normal relationships of your bite. When whole or part of a jaw is moved to do this, there will be changes in your appearance. We have tried to describe these changes as best we can, and we anticipate the changes will be pleasing ones to you. There is a psychological element to this surgery however, that you must be aware of.

Relapse

The stability of the new position of the jaw or facial bones after surgery is dependent on good surgical and orthodontic planning and techniques, as well as the stretch ability of the adjacent soft tissues and muscles. The latter tend to drag the jaw back to its original position and this is called ‘relapse’. A slight bit of relapse occurs with all jaw procedures. In most instances, however, this does not significantly affect how the upper and lower teeth come together, or the facial appearance. If it does, then further orthodontics may correct the problem. In rare cases, relapse can be excessive over time. The only way to correct this is to repeat the jaw surgery.

Numbness

Numbness occurs as a result of jaw surgery due to bruising or stretching of the nerves in the jaw. It shows itself as loss of feeling or reduced feeling in the lips, cheeks, roof of the mouth (palate), chin or tongue. Permanent numbness is very rare. A more common occurrence is temporary numbness or altered sensation which can last several months. It does not result in any functional loss (movement is not effected) and does not change appearance. As nerve function returns, it can feel strange- tingly or itchy. Patients describe the feeling in all sorts of ways.

In about 20% of patients, the feeling does not return completely. It can best be described as a reduced sensation in the affected area. Patients usually adjust to this very quickly so that it becomes unnoticeable to them over time.

Summary

We would like to stress, once again, that these complications are quite rare in our experience and that each operation and individual patient is different. Rare complications that can be associated with your particular operation will be discussed with you, during your consultations. If you are confused or in doubt about anything we have told you, please feel free to call our office. Our staff will do their best to answer your questions or you can discuss any concerns with Dr. Reichman directly.