Surgical Instructions

After Orthognathic Surgery

1. It is important that you go to each follow-up appointment Drs. Fraser and Michaels have scheduled for you. They need to evaluate the progress of your healing until it is complete. If you fail to follow your doctors' instructions or if you stop treatment before healing is complete, you are at high risk of developing complications such as infection, non-union of the surgical site, improper occlusion (bite), or nerve damage. These problems, if not diagnosed and treated early, can have serious effects on your overall health.

2. Swelling and bruising are normal reactions to surgery, and vary from patient to patient and from one surgery to another. Application of ice to the surgical sites during the first 24 hours helps reduce the amount of swelling. Use the ice packs 20 minutes "on" and  20 minutes "off" or alternate from side to side every 30 minutes. After the first 36 hours, the ice will not have much effect on swelling, but may make the surgical site feel better. Swelling usually reaches its maximum about 2 to 3 days after surgery.   A small amount of residual swelling may last as long as 6 months to 1 year.  Swelling can be reduced by sleeping in a semi-upright position in bed.  Using two pillows is usually adequate for this.  Bruising will resolve on its own after 2 weeks.

3. It is normal to have some difficulty opening your mouth due to post-operative swelling in the muscles. This should resolve on its own with time.

4. Application of moist heat 4 to 6 times per day to the surgical sites beginning 3 days after surgery increases the local blood circulation and helps to take away swelling. Do not apply heat until 3 days after surgery unless Drs. Fraser and Michaels tell you otherwise.

5. It is VERY IMPORTANT TO KEEP YOUR MOUTH CLEAN in the weeks following surgery. The splint, orthodontic bands and wires in your mouth are an irritation to your gums, but the cleaner you keep your mouth, the less of a problem this will be. You may begin cleaning your mouth as soon as you get home as instructed by Drs. Fraser and Michaels.  It will be uncomfortable at first, and your gums may bleed, but it will become easier as time goes on.  You do not need to use toothpaste each time - it is the brushing action that is important. Consider using a toothbrush for a child that has a smaller sized head.  Frequent gentle salt water rinses (8 times per day) will keep your mouth clean and promote healing.  Stir 1/2 tsp. of salt until dissolved into an 8-ounce glass of warm water. 

6. If you had any teeth extracted as part of your surgery, it is normal to have mild bleeding from the extraction socket. Do not spit the blood out, as this will remove the blood clot from the socket and bleeding will continue. It is recommended to use a damp washcloth to remove blood from your mouth.  If there appears to be excessive bleeding, call our office for advice.

7. No nose blowing or "sniffling" for 8 weeks following upper jaw surgery, cheekbone implants, paranasal augmentation or a septoplasty.  If you blow your nose you will get an infection.

8. No nose blowing or "sniffling" for 10 days following lower jaw surgery only. 

9. Hydration is very important following surgery.  After surgery, at least at least 8 glasses of water should be consumed per day.  Drinking plenty of fluids will help you heal faster and feel better.  If you don't drink enough fluids you will feel dizzy, weak and more congested. 

10. Do not use a straw for 8 weeks. 

11. Diet is another important consideration. Because of your inability to chew, it will be very difficult to take an adequate diet. It is not unusual to lose 10 to 15 pounds during the post-operative period. Therefore, several meals (6 to  8 per day) will be necessary. High calorie, high protein liquids will be your diet for the entire healing period. Anything (even pizza and meats) that can be mixed with whole milk and liquefied in a blender will help in the dietary intake. Additional dietary supplements may include Carnation Instant Breakfast and Ensure.  Do not chew even very soft foods until Drs. Fraser and Michaels have given you permission.  The slightest amount of chewing can cause mobility of the bones as they attempt to heal and can seriously compromise your surgical result.

12. Medications that have been prescribed for you are important. If an antibiotic has been prescribed, it is very important to continue taking it as directed by Drs. Fraser and Michaels until all has been taken. An antibiotic rinse may also be prescribed. Also, a liquid pain medication can be taken as directed only if needed for discomfort. Do not take any medications, other than those prescribed, without the knowledge of Drs. Fraser and Michaels. Aspirin and related drugs should be avoided, as they can prolong bleeding.  If you develop hives, a rash or any adverse reactions to a medication, discontinue all medication and contact our office immediately.

13. Blistex and Chap Stick may be used for chapped lips and moisturizer for dry skin.  Don't use Vaseline on your lips or face. 

14. There may be a slight elevation in temperature for 24 to 48 hours after surgery. This is a normal body response to the surgery. Infection is very rare following orthognathic surgery. If the temperature persists or is greatly elevated, please notify Drs. Fraser and Michaels.  A post-operative infection usually takes about three days to develop.

15. Post-operative nausea is usually due to swallowing a small amount of blood during and/or after surgery.  A small amount of carbonated drink, such as 7-Up or ginger ale every hour for 5 or 6 hours will usually relieve this feeling. Sometimes pain medications can cause nausea. If nausea continues, contact our office. If your jaws are wired, nausea is no cause for alarm. Remember that even if you should become nauseated and vomit, everything that is in your stomach has been strained through your teeth and can easily pass back through. However, at the first sign of nausea or vomiting, call Drs. Fraser and Michaels and they will prescribe anti-nausea medication for you in suppository form.

16. All patients with jaws wired should not drink alcohol for the period of fixation. No vigorous exercise, strenuous activity or swimming should be allowed because of the difficulty in breathing and the strain on your fixation wires. It may also cause increased swelling.  To facilitate breathing, a decongestant spray (e.g.: Afrin or Neo-Synephrine nasal spray) should be bought at a pharmacy and carried with you for cases of nasal congestion. This should be used very sparingly to prevent rebound nasal congestion.

17. Your period of fixation (having your jaws wired together) will range from 1 day up to 8 weeks depending on your individual type of corrective procedure performed and the method of stabilizing the bone segments. If your jaws are wired, you should carry your wire cutters with you at all times. They can be used to cut all vertical wires  and rubber bands between your upper and lower teeth in case of emergency.

18. If you had orthodontic treatment before surgery, further treatment will be required after surgery for a variable amount of time. The surgery aligned your jaws now the orthodontics will align your individual teeth.

19. It is expected that your gums and teeth in the area of surgery will be numb for a variable amount of time. If you had surgery on your upper jaw, it is expected that your upper lip, cheeks and side of nose will have altered or absent sensation. The same will be true for your lower lip, tongue and cheeks if you had lower jaw surgery. It sometimes takes many months for feeling to return to normal, and in very rare instances, altered sensation can be permanent.

20. Smoking after surgery reduces blood circulation to the tissues and will increase the risk of skin breakdown, scar formation and delayed or impaired healing. The smoke is also an irritant to the tissues and the incisions in your mouth and will increase discomfort and compromise tissue health.

21. If any incisions were made on your face, it is important to take good care of these sites to minimize scarring. Keep the wound covered for the first three days after surgery. Clean the wound twice daily and apply antibiotic ointment for the first 10 days. After this, when you go outside, cover the wound with sunscreen (SPF15 or greater) for the first six months.