Corrective Jaw Surgery Preparing for corrective jaw surgery
Undertaking corrective jaw surgery requires a major commitment
from the patient. Our team of expertly trained health professionals
which includes an oral surgeon, an anesthetist, nurses, residents
and hospital support staff will be there for you to help you deal
with any doubts or stresses about the procedure. They will do everything
possible to ensure that you have the best possible result from your
surgery.
The most frequently reported inconvenience associated with jaw
surgery is the inability to chew solid foods for a period of 4-6
weeks and often up to 8 weeks. This is necessary to allow the bone
cuts to heal completely before any undue pressure is applied to
the teeth and then transmitted to the jaws.
Your recovery period is an individual experience dependant on many
factors that vary from patient to patient. Patients are often concerned
about pain after surgery. You can be assured that during all steps
of your treatment, you will be carefully monitored and extra measures
will be taken to ensure that your pain is well-controlled at all
times. When you are at home you will be provided instructions on
when to take your pain medication to achieve optimal control. Patients
can experience minimal to moderate pain, but in most cases less
than they had expected. In fact, a significant number of patients
have reported report absolutely no pain after jaw surgery.
Patients often ask the question “When will I be back to normal?”
The answer depends on the type of surgery they have undergone. In
general, most patients will have recovered sufficiently to resume
their normal activities and obligations within about 3-4 weeks after
surgery. This is particularly true when the surgery involves the
upper and lower jaws. For single jaw surgery, the recovery period
can be significantly shorter (2 weeks). Patients may experience
some temporary side effects including limited mouth opening, reduced
strength in their “chewing” muscles and in some cases,
some numbness. It usually takes another 2-3 months for their facial
form to return to normal.
BEFORE YOUR SURGERY
Before you enter hospital for your surgery your oral surgeon will
have made molds and records at a prior visit which generally lasts
1-2 hours. During this planning stage, using a specialized computer
program your surgeon will likely provide you with some images that
will predict what your facial profile will look like after the surgery.
At this time you have the opportunity to share your concerns and
preference about your existing and future profiles and your facial
form. It is recommended that your family, siblings or life partner
be present to make them aware of these changes in appearance so
that there are no unpleasant surprises. We are pleased to report
that most patients are extremely satisfied both with their new facial
profile and appearance and with the improvement in the function
of their teeth and jaws.
Before your surgery, you must also visit your orthodontist for
placement of surgical hooks and your general dentist for a thorough
dental cleaning as hygiene will be somewhat challenging in the first
two weeks after jaw surgery.Your process of recovery after corrective
jaw surgery can best be described as a series of four distinct phases.
Phase
I – Your Hospital Stay
On the morning of your surgery it is essential that you brush all
your teeth and appliances.
You will meet the anesthetist on the day of surgery. He or she
will explain the steps you will go through during the surgery. The
length of the procedure varies but generally lasts about 2-4 hours,
depending on whether one or both jaws require surgery.
You may notice some swelling and feel groggy when you wake up from
the surgery. Your teeth may be held together by elastics which will
be changed during the first week. Your face may feel totally numb
so you will probably experience minimal pain. You will be provided
pain medication to ease any discomfort. Your bite and gums will
feel very different and you will have difficulty speaking. These
are all normal and temporary changes. You may experience a sore
throat from the breathing tube used during the anesthesia. This
will usually disappear within 2-3 days.
Generally you will stay in hospital for one night if the surgery
involved only one jaw and two nights if both jaws were involved.
It is critically important to drink fluids during this period to
keep yourself well hydrated. You are encouraged to get out of bed
and walk around as soon as possible but the first time you get out
of bed should be done with assistance. This will help reduce the
swelling and stimulate your circulation. However, too much activity
should be avoided because you need to conserve your energy for the
healing process.
Nutrition
After the surgery you will be given a liquid diet. For the first
two days this should be restricted to clear fluids such as water
and juices, but by the third day more substantial liquids that can
be prepared in a blender can be added. Try to vary your diet to
make it more interesting. Your choice of foods can include:
- Water, juices, soft drink, sport drinks
- Milkshakes, Carnation instant breakfast,
yogurt drinks, ice cream and milk
- Protein drinks and supplements (Ensure,
Boost or pre-mixed protein drinks)
- Soups, consommé, custard, pudding,
Jell-O.
Your Pain Control
During your hospital admission you will initially receive strong
pain medication by injection (morphine) to ensure that you do not
have any major discomfort. This medication is provided to you when
you need it, by the nurses in both the recovery room and the hospital
ward. After the first 24 hours this is usually changed to an oral
anti-inflammatory medication that is very effective in relieving
discomfort. Our goal is to provide you with the correct combination
of pain medication to keep you very comfortable.
Your Dental Hygiene
You should not attempt to brush your teeth initially as it will
be very difficult due to the swelling after surgery. You should
refrain from doing so for the first week. As soon as you feel able
to you should:
- Rinse you mouth with warm salt water (1 teaspoon
in one glass of warm water) or the antibacterial mouth rinse that
will be provided to you.
- Loosen any food particles from your teeth, using a child-size
soft toothbrush.
- Two weeks after surgery patients often find
the use of a waterpik to be very beneficial.
It is very important to keep your mouth clean in this way. You
will receive new instructions for keeping your mouth clean when
you return home. If you are prescribed Peridex, an anti-bacterial
mouthwash, use it as recommended.
Your Appearance
The most apparent event immediately after surgery is facial swelling,
the extent of which can vary from patient to patient. You should
expect a significant amount of swelling over your cheek and down
your neck. This is maximal on the fourth day after surgery and then
slowly subsides. However, it is not unusual that 5 – 10% of
the swelling still remains two months-post surgery, so you should
only assess the final esthetic result after at least three months.
In the long-run, when your facial muscle tone and function return
completely, this small amount of residual swelling will disappear.
You should apply ice to your face during your waking hours for the
first 3-4 days to help numb the area. Do not apply the ice directly
to the skin as this may result in frostbite or burns.
Bruising is normal and expected after jaw surgery. This can extend
to your upper cheek and eyes and your lower cheek down to your neck,
depending on whether one or both jaws were involved in the surgery.
Be assured, that although it is unappealing, you should not be concerned
in any way as the bruising is temporary and should disappear within
two weeks.
Your Activity
You may walk around but should limit your activity and not attempt
to do any physical exercise for the first week regardless of how
you feel. This is not the time to get in shape. It will take at
least a month for you to recover the strength you have lost as a
result of the surgery, so be patient and give your body the necessary
healing time.
Other Sensations
Your sense of hearing may seem altered if the swelling extends
into the area of the ear. You can expect a sense of numbness or
muffled sound. You may also experience some clicking sound in the
jaw on both sides as your joints are getting adjusted to their new
position.
Should you have any problems or questions please contact our
office at (514) 931-7077.
Phase II – Your
First Few Days at Home
During this initial period at home your swelling and bruising will
generally peak on Day 4 after surgery and then will begin to diminish.
Follow-up
Dr. Chehade will continue to see you every two weeks during the
first two months after your surgery.
Nutrition
You should maintain the liquid diet you were given in the hospital
until the first few days after your surgery. By the third day, continue
all the liquids you consumed while in hospital and add some of the
following foods to make your diet more substantial:
- Egg products (scrambled, boiled, omelettes…)
- Pureed vegetables and meats with texture of baby food (e.g.
peas, carrot)
- Mashed potatoes, rice and pasta
- Other proteins such as minced meat and white
fish.
You should try to increase the amount of food you eat to compensate
for the weight loss you sustained after the surgery. You also have
greater nutritional needs at this time as your body is healing.
It is essential that you avoid any hard foods such as tough meats,
candies, nuts or popcorn.
Orthodontic Elastics
It is very common for your surgeon to apply elastics to the hooks
on your braces to control the way your teeth meet as well as the
movements of your jaw. Usually, patients are allowed to remove and
reapply these elastics in order to allow for drinking and cleaning
and flossing their teeth. Elastics are usually used during the first
month after surgery.
Your Pain Control
Your surgeon will prescribe anti-inflammatory medication such as
ibuprofen or other strong pain medication containing codeine. You
should take these as needed to control your pain. Your need for
pain medication will likely decline over time and by the end of
the first week after surgery, 90% of patients stop them completely.
In the event that you continue to experience severe pain, please
contact our office at (514) 931-7077. Do not be alarmed if you experience
headaches or muscle spasms. These are normal and temporary after
effects following your surgery.
Your Dental Hygiene
It is critically important to keep your mouth clean:
- Rinse your mouth with warm salt water (1
teaspoon in one glass of warm water.
- Loosen any food particles from your teeth, using a child-size
soft toothbrush.
- If you have a plastic splint attached to your upper teeth –
keep it clean by rinsing your mouth frequently with warm salt
water.
- You will receive a prescription for Peridex, an anti-bacterial
mouthwash. Please use it as recommended.
Your Appearance
During these first few days after surgery, your swelling will decrease
very quickly. The bruising will also disappear. You will begin to
notice changes in your facial appearance. Give yourself a chance
to get used to your new look. As your muscle tone and function improve
during the healing process, your face will begin to feel normal
again.
Your Activity
It is very important to get as much rest as possible in the initial
few days after your surgery. This will stimulate the healing process.
Spending time outdoors is recommended. However avoid any possibility
of contact accidents. You should refrain from sports such as cycling
for the first two weeks and basketball, hockey, skiing or
football for at least 4-6 weeks. Walking outdoors will provide
you with the gentle exercise you need at this time.
We suggest that you remain in town during the first two weeks.
You may consider taking a vacation during your recovery period by
the third or fourth week following your surgery, provided that
you are healing well. It is preferable to limit your travel
to one week at a time so that you don’t miss any of your scheduled
follow-up appointments with your surgeon. These are extremely important
for the monitoring of your progress.
Other Sensations
Your nerves may have been affected by stretching during the procedure
and as a result of swelling of the soft tissues in the vicinity
of the surgical site. As your nerve function returns to normal,
you can expect to experience some tingling sensation in the middle
area of your face area as well as the lower lip and chin.
You will likely not be able to open your jaw fully. This is normal,
so do not be concerned. You may also notice clicking and popping
sound from your jaw joint also known as the “temporomandibular
joint” (TMJ). This may subside with time.
Phase III – Up and
About – 2-4 Weeks After Your Surgery
In this phase you need to begin exercising your jaws to increase
the range of motion of your jaw so you can get back into normal
activity.
Nutrition
You should continue the diet of liquid and puréed foods
as described in Phase II. Be patient and do not get discouraged.
We understand that this is reported by patients as the hardest part
of their experience, but it is essential for proper healing.
Your Dental Hygiene
You can begin brushing the metal braces, using a new toothbrush
with a small amount of toothpaste, for a period of at least 15-20
minutes in the evening before bed time. You should take care
to clean all the teeth and brackets as thoroughly as possible, but
avoiding injuring your healing wounds with the head of the toothbrush.
However, do not be concerned if you do hit the wound and see a bit
of bleeding. The brushing will also help diminish the swelling around
your gums. Warm salt water rinses should be continued at least twice
daily.
Your Appearance
By the second or third week after surgery most of the swelling
will have disappeared. Still, as discussed previously, in some cases,
10% of the swelling is maintained for two months. Ice is no longer
effective at this stage but warm water bottles can be applied to
the area.
You will continue to notice small changes in your appearance during
the healing period and friends and family will likely recognize
the transition. You may want to talk to them about these expected
changes you are experiencing.
Your Activity
Students may resume going to classes if they feel ready. They should
not however, participate in any after school activities. In particular
all sports should be avoided.
It is important to maintain a regular sleep schedule and ensure
you are getting adequate rest to allow your body to heal.
You will still feel somewhat weak at this point. However you may
slowly resume your activities. These can include going to the movies
or shopping. Avoid any heavy impact activities or running that involves
motion of the head and neck.
Other Sensations
Patients who have had upper jaw surgery may experience a sense
of itchiness or pins and needles in the upper lip as the numbness
subsides. A similar sensation in the lower lip can last up to 6
months post-surgery. Upper-jaw surgery patients may also experience
a red-brown colored discharge from the nose. However, if you experience
uncontrolled bleeding and the blood is bright red, please contact
our office immediately at (514) 931-7077.
Phase IV – You Have
Recovered
Nutrition
After your splint has been removed between 4 to 6 weeks after your
surgery, you may start adding soft foods to your diet including,
soft fish, cooked vegetables, soft pasta and rice. Remember that
you are “relearning” to chew at this stage. You must
give your muscles the time to regain their strength, so be patient
with yourself.
You can expect to return to your normal diet, enjoying most of
the foods you are accustomed to within about two months after your
jaw surgery.
Weight loss
As a result of your limited food intake, it is normal to experience
weight loss of up to 10 % of your original body weight during the
first two to three weeks after jaw surgery. It is critically important
to maintain adequate nutrition, taking in sufficient calories from
protein as well as carbohydrate sources.
This is not a good time to diet. You will gain this weight back,
as everyone does. Your body needs the energy or “fuel”
derived from these food sources to allow your muscles and bones
to heal.
Physiotherapy
You will learn exercises to improve your jaw joint function, that
is, the opening and closing of your mouth. In the initial 2 weeks
you should aim to be able to open your mouth 2 finger breadths.
By 3-4 weeks you should be able to open your mouth 3 finger breaths.
This is accomplished by placing warm packs over the area of your
right and left jaw joints and gently massaging the joint, followed
by opening your jaw as wide as you can in a slow and passive manner.
You will also learn jaw opening exercises to improve range of motion.
These will be reviewed with you at the four week point in your recovery. |
