After Facial Reconstructive Surgery
- Sleep with head elevated. No sleeping on sides of face until follow-up appointment.
- Ice for first 48 hrs. Start heat after 48 hrs.
- Facial support to be worn continuously for first 48 hrs, then in the evening and during the night until follow-up appointment.
- Keep oral incisions clean. Use mouth rinse as directed after first 24 hrs.
- Soft diet until follow-up appointment.
Please call office if you experience any of the following:
- Increased pain
It is normal to have considerable facial swelling following jaw surgery. This swelling will increase for 2 to 3 days following the surgery. The major portion of the swelling will be gone in about 2-4 weeks. A smaller amount of swelling over the surgical sites is to be expected for about 2 to 3 months. Some fullness in the cheeks (especially after upper jaw surgery) is normal for several months. This is due, in part, to the muscles and tissue adapting to the new jaw position.
First 2 days: Ice packs will be applied to the face for the first 24-48 hours following surgery.
Days 3-7: Use hot compresses. You should use hot compresses for 30 minutes 4 or 5 times a day for at least 1 week following discharge from the hospital.
Use 2-3 pillows to sleep at night. With your head elevated at night, this will minimize the swelling that occurs at night.
You will be given a steroid medication while in the hospital to reduce the swelling. This may not reduce the facial swelling to any great extent, but rather reduces the swelling of the membranes in the airway and nasal passages. Patients may experience a rebound swelling 4 or 5 days after the surgery (an increase in facial swelling). This is due to the decreasing level of steroid medication in the blood and usually resolves after about 2 to 3 days. Patients who have had upper jaw surgery may experience an increase in nasal stuffiness. An over-the-counter nasal decongestant can be used for this, taking care to follow the instructions on the bottle. If any problems arise with this, please contact the office.
A small amount of oozing is to be expected for several days following the surgery. Patients who have had upper jaw surgery may experience some bleeding or oozing from the nose for 4 or 5 days. Prolonged bleeding or sudden profuse bleeding following discharge from the hospital is not normal, and, should this occur, contact the office immediately.
This is normal following jaw surgery and will usually last 2-3 weeks. It can be localized or can be widespread towards the upper chest with lower jaw surgery, and towards the eyes with upper jaw surgery.
A special type of anesthesia is usually used to lower the blood pressure during surgery. This tends to reduce the amount of bleeding during surgery and thus decreases the likelihood of a blood transfusion. However, as the blood pressure increases immediately following the operation, some bleeding into the tissues occurs. This usually results in some bruising in the cheeks and around the base of the jaw. Gravity will cause this discoloration (usually a light yellow or green) to extend into the neck and occasionally the chest areas. This is normal and usually takes about 2 to 3 weeks to resolve.
Pain And Discomfort:
A moderate amount of pain and discomfort is to be expected following surgery. Severe pain is not common. There is usually less discomfort with upper jaw surgery. At the time of discharge from the hospital, a prescription for a pain-relieving medication will be provided.
Infections from jaw surgeries are rare. This is because of the excellent blood supply to the facial area. However, you will be given a prescription for an antibiotic on discharge from the hospital. Please take the medication as prescribed and until it is finished. Should you experience an increase in swelling and pain after the first week, this may indicate an infection and the office should be contacted.
Nausea is rare after the first 4 or 5 days. Should you experience problems with this, GRAVOL SUPPOSITORIES can be used (provided you have no previous allergies to GRAVOL). If nausea persists, contact the office. Your jaws are not wired together, but rather held together with elastics between the upper and lower braces. In some cases the elastics are quite loosely applied allowing a fair degree of mouth opening; in other cases firmer elastics are utilized and little or no movement of the jaw is possible for the first few weeks. In an emergency, these elastics can be cut and the surgical splint (if present) removed from between the teeth. You should always carry a small pair of scissors with you even, though it is extremely rare to have to remove the elastics. Alcohol or foods that you know may cause stomach upset should be avoided. If the elastics are removed, contact the office immediately.
You have had a major surgical procedure and your dietary intake has been altered by the jaw fixation. Physical activity should be kept to a minimum for at least 2 weeks following surgery. You will find that you will not have the same amount of energy that you had before the surgery, and you should pace yourself accordingly. Excessive activity (running, exercising, etc.) can cause bleeding. Excessive fatigue can slow the healing process and reduce your resistance, thus increasing the risk of infection.
The dietician will counsel you about your dietary intake while you are in the hospital. Patients will often lose their appetite for a few days following surgery, and you may find it necessary to force yourself to eat. Fluid intake is critically important following surgery. This is especially true during the first postoperative week. You should drink at least 2 liters of fluid a day. Excellent diet supplements are ENSURE, BOOST, or one of the numerous INSTANT BREAKFASTS that are available. You may have been given a syringe for feeding, but you can use a straw or drink from a glass as soon as you are able.
A NUTRITIOUS DIETARY INTAKE IS IMPORTANT IN PROMOTING HEALING AND DECREASING THE CHANCE OF INFECTION.
You can expect to lose about 10 percent of your body weight if a prolonged fixation period is required (6 to 8 weeks). This, however, is less and less common. A rapid loss of weight during the first week is usually due to fluid loss and is quite common. With the shorter fixation periods utilized these days, total weight loss should not exceed 10 12 pounds and rarely continues past the first few weeks. Continued weight loss is a sign of inadequate nutrition.
Muscle Spasms And Pain:
While your jaws are immobilized, a certain amount of shifting or jerking of the jaw is normal. Some discomfort may also be experienced over the sides of the jaw or temple areas. This is due to the pull of the muscles and muscle spasm. This occurs as a result of the muscle adjusting to the new jaw position. Pain or tenderness of the jaw joints may also be experienced as a result of muscle pull. This is especially true if you had jaw joint problems prior to surgery. This usually resolves in a few weeks.
If longer-term fixation was utilized, on its removal you will probably be able to open only a few millimeters. This is partially due to stiffness of the muscles in the surgical sites and in part due to the length of the time the jaws are immobilized. Patients are given exercises and may be sent to a physiotherapist following removal of the fixation. The physiotherapy greatly assists improving jaw function and opening.
Occasionally several elastics will break during the fixation period. As long as you cannot open your mouth, this is not a problem and the elastics can be replaced at one of your postoperative visits. If a large number of elastics are lost and you can open your mouth, do not be alarmed. You should, however, contact the office so that new elastics can be placed.
First 2 weeks: No specific jaw exercises
Weeks 3-4: Stand in front of a mirror and attempt to open and close your mouth as much as possible. Do not use finger pressure to open your mouth.
Weeks 5-8: Start using gentle finger pressure between your front teeth on each side to help stretch your jaw muscles and increase your opening.
Numbness or altered sensation in the teeth, lips and face are not uncommon following surgery. Numbness in the tongue is less common. While this condition is usually not permanent, it may take several weeks or months to resolve. On rare occasions, some discomfort or burning sensations may be experienced.
Because the surgery is performed through the mouth, some bruising and, on occasion, lip abrasion is to be expected. This usually resolves in 7 to 10 days. Vaseline should be periodically applied to the lips to keep them from becoming too dry.
Blowing The Nose Sneezing And Coughing:
Blowing the nose should be done gently for 2 weeks following lower jaw surgery and avoided for at least 2 weeks following upper jaw surgery. The pressure caused by blowing the nose can force air through the surgical incisions and into the cheeks causing swelling and pain and increasing the chance of infection. Upper jaw surgery involves the nose and sinuses and is most prone to this problem. Sneezing and coughing are unavoidable and, while sometimes painful, will usually not cause any problems with the surgical sites.
It is important to start rinsing the mouth and cleaning your teeth as soon as possible following surgery. You should brush your teeth and rinse your mouth after each time you eat. Plan on using a child’s toothbrush with a small bristle head. For the first week, brush your teeth and braces and stay away from the incision sites. It is normal to have occasional bleeding from the incision sites when brushing for the first two weeks. This should stop within minutes. DO NOT use a WATER PIK or an irrigating device for at least 2 weeks after surgery because this can disturb the healing at the incision sites. You can start brushing the fronts of your teeth as soon as it is not too painful. You will, of course, not be able to brush the backs of the teeth with a brush. The backs of the teeth can be brushed by moving your tongue across them while using a mouth rinse.
Smokers should be careful. Smoking should be avoided for at least 2 weeks following surgery. Smoking increases the likelihood of infection and slows the healing process. Furthermore, it also stains the teeth while in fixation.
Post Surgical Depression:
The great emotional buildup prior to a surgical procedure can leave a patient feeling down or empty for a few days following surgery. Also, the steroid medications can, in some individuals, cause a mild euphoria or sense of well-being and a corresponding mild depression as the blood levels decrease. This usually occurs 2 days after surgery and passes in 1 or 2 days. You will receive an injection of a longer acting steroid prior to discharge from the hospital. This significantly reduces not only any depression, but also rebound swelling (see SWELLING).
If You Should Have Any Problems:
If you have any problems, do not hesitate to contact the office at Renew Oral & Facial Surgical Centre Phone Number 780-439-4399. After hours, the oral surgeon on call can be reached 24 hours a day, 365 days a year, by calling Renew Oral & Facial Surgical Centre Phone Number 780-439-4399.