Immediately following surgery:
o You will have the metal distractor device on your upper jaw inside your lips and cheeks. The device is kind of bulky so it pushes your soft tissue and upper lip out a little bit.
o You will have elastic bands that are helping to guide your bite into place. It is NOT an emergency if they break or pop off, so do not stress out about it. You can usually replace them yourself, but if you are having trouble you can come to our office during daytime hours and we will help replace them.
o You will have a numb upper lip with upper jaw surgery. It takes weeks to months for the nerves to recover from the stretch injury they undergo during jaw surgery.
o Most people stay in the hospital one night and go home the next day.
o It is very important to start drinking fluids soon after surgery to maintain good hydration. A sports water bottle with the top that you can pop on and off is great because you can aim it into your mouth and squeeze it. Some people do ok with an open rim cup, but it can be tricky with numb lips. A syringe with a soft tip is also an excellent option.
o Avoid vigorous activity for a full week. You should go on multiple walks every day. If you get dizzy when you stand up, you need to drink more fluids because this could be a sign of dehydration.
o Spend as much time as possible sitting upright and walking. If you lay flat during the first several days, the swelling will be worse. Prop your head up with a couple pillows for the first several nights or sleep in a recliner.
o Use ice packs or bags of frozen peas during the first 24-48 hours. 30 minutes on and 30 minutes off.
o No heavy lifting, vigorous running and no sports for 6 weeks.
o Your lips may get very swollen, so use Vaseline and lip balm to keep them from drying out and cracking.
Follow Up Appointments:
o We generally have an appoint 4-5 days after surgery. At that time we will start to activate the distractor. Please take some Tylenol or ibuprofen an hour before your appointment.
o The device is activated every day until the whole movement is complete. We move the upper jaw forward 1 mm per day. The device MUST be turned every day or the bone will heal quickly and it will get stuck.
o Most individuals are able to turn the device at home on their own or with help from their family members.
o If you are not comfortable turning the device at home, we will see you every day of the week (including weekends) until you are comfortable doing it on your own.
o We will also see you at 2 week, 4 week, and 6 week follow ups after surgery.
o After we are done with the movements, we have to let the bone heal for a couple months. During that time the distractor device remains in place.
o We will usually go back to the operative room for device removal around 3 months after surgery.
Diet:
o Pureed, non-chew diet for the whole time the jaw is being moved and for 4 weeks after we are done moving the jaw. At the 4-week mark, if you are healing normally, foods like scrambled egg consistency can be eaten.
o Things like Boost, Ensure, Carnation Instant Breakfast and other meal replacement drinks are an excellent source of the protein, fats, and carbohydrates that you need to heal well.
o DO NOT eat tough, chewy foods and foods like bread that require a lot of force to tear with your teeth. This could prevent normal healing or damage/loosen the metal plates and screws.
o Start with clear liquids (water, popsicles, apple juice, tea). It’s important to be well hydrated, so focus on drinking a lot of fluids. Avoid alcoholic drinks.
o Avoid sucking strongly on a straw (i.e. thick milkshake).
o If you have a lot of nausea and vomiting, then focus on clear liquids and maintaining hydration. If the nausea and upset stomach is persistent, please contact our office. We will prescribe an anti-nausea medication.
Bleeding:
o Some oozing of blood from the nose and inside the mouth is expected. A small amount makes a lot of saliva look pink/red. Avoid any strenuous activity as this may worsen bleeding.
o NO NOSE BLOWING. It is common to have blood clots in your nose. You should NOT blow your nose for 6 weeks after surgery.
o You can use Afrin twice a day for the first 3 days to help with congestion.
o Over the counter decongestants like Claritin and Sudafed can be used for 3-5 days if you are having a lot of congestion symptoms.
o Saline nose spray can be used throughout the day to help dissolve blood clots and keep the inside of the nose from drying out.
o If there is persistent bright red bleeding, then please contact our office.
Pain Management:
o Some discomfort is expected. The goal is to minimize the discomfort so that it is tolerable. It is unrealistic to expect zero pain after surgery, but we will work with you to minimize the discomfort as much as possible.
o Consistently taking ibuprofen and Tylenol has been shown to be very effective at controlling pain.
o You should take some Tylenol or ibuprofen about an hour before you turn the device.
o Very few people actually need to take a narcotic pain medicine. Narcotics have real risks and side effects such as nausea and vomiting, constipation, drowsiness and addiction. However, if there is severe pain that is not well controlled with ibuprofen and Tylenol, then we can prescribe a small amount of prescription pain medication. Take the narcotic pain medication exactly as prescribed to avoid a complication.
o Never exceed the maximum daily dose that is described in the over-the-counter instructions.
o Ice packs the first day can also help reduce the need for pain medication.
Swelling:
o Swelling is normal after surgery. It is normal for swelling to increase for the first 2-3 days after surgery and then reach its peak and start to lessen.
o Ice packs during the first 24-48 hours can help. You can also keep your head slightly elevated when you sleep. Spending more time sitting upright and on your feet, rather than lying flat will help reduce the swelling. If you sleep all night on one side of your face, it will be more swollen the following day, but should even out during the day when you are upright.
o Sometimes there is bruising that can take days to weeks to resolve.
o Some people get really, really swollen and sometimes the swelling can be around the eyes. Think of a volleyball.
Brushing/Rinsing:
o Use a small, soft toothbrush to brush the teeth twice a day. Be careful and be gentle in the areas of surgery.
o Use the Peridex mouth rinse twice a day for 3 weeks.
o No vigorous rinsing or spitting the day of surgery. Gentle rinses can begin the day after surgery.
o Gentle saltwater rinses can begin the day after surgery.
o Sometimes you have a plastic splint that is wired to your teeth. This collects a lot of food, plaque, and bacteria, so it is very important to keep it clean.
o If you were prescribed an antibiotic mouth rinse, use it twice daily for two weeks.
Activity:
o ABOSULTELY NO swimming in pools, lakes, hot tubs, rivers, or the ocean while the distractor devices are in place. It provides a direct pathway from your mouth to the bone and bad infections can result if dirty, untreated water gets in your mouth.
o I recommend you take 1-2 weeks off from school/work.
o You should not drive a car, operate machinery or sign legal documents if you are taking narcotic pain medication.
o You may want to place a towel over your pillow because if you drool at night it could stain your pillowcase/pillow.
Sutures:
o The sutures will dissolve/resorb on their own after about 7-14 days. It’s ok if you accidentally swallow them.
Antibiotics:
o Take the prescribed antibiotics as instructed. If you develop a rash or other side effect, stop the antibiotic and contact our office.
Medications:
o You should have the following medications:
o Pain Medications
o Antibiotic
o Peridex/Chlorhexidine Mouth rinse
o For upper jaw surgery:
§ Afrin
§ Nasal saline spray
o Anti-nausea medication