Corrective Jaw Surgery

This is intended to give you a greater degree of understanding concerning your jaw surgery and will describe the typical admission procedures, hospital course, and post-surgical period following discharge from the hospital. It is anticipated that you will have questions after reading this so you are encouraged to ask your doctor about any areas of concern.

day of admission (beginning of hospitalization)

You will receive a letter indicating the date, place and time of admission. You will also receive admission papers (or be scheduled for an appointment to obtain them) prior to your scheduled entrance into the hospital. These papers should be presented to the admission personnel at the hospital.

pre-operative evaluation

Either prior to or on the day of admission, a physical exam will be completed. The primary intent of this examination is to evaluate patients for any systemic diseases which may complicate treatment. Should questions arise as a result of this examination, appropriate consultations will be made. Laboratory examinations such as blood tests, urinalysis and chest x-rays will be obtained. A sample of blood is often taken for testing so that blood (autologous blood) may be obtained and stored up to thirty days for your exclusive use if a transfusion is required.

diet

Our office will provide you with dietary recommendations for your post-operative recovery. It is suggested that prior to admission to the hospital, you acquire a blender and a food strainer. Commercial dietary supplements may also be of assistance during the post-operative period. Sustacel and Ensure are some of the dietary supplements available. Instant breakfasts offered by most grocery stores are comparable to these supplements and are much less expensive.

An anesthesiologist, with whom we work very closely, will discuss the form of anesthesia as well as potential complications. You will be asked not to eat or drink anything after midnight of the evening before your surgery. This will ensure that your stomach will be empty at the time of your operation.

day of surgery

You will receive pre-operative medications. These medications, in addition to being an important preparation for the anesthesia, will reduce normal pre-surgical anxiety. After being transported to the operating area, you will be transferred to an operating table. There, an intravenous catheter (IV) will be placed in the back of your hand or arm. This is to provide a means of delivering both intravenous fluids and medications. Since general anesthesia is required and surgery will be performed in the mouth, it is usually necessary to pass a breathing tube (endotracheal tube) from the nose into the trachea. A second tube (nasogastric tube) may be passed from the nose into the stomach and will be used to keep your stomach empty. Both will be done while you are asleep. Sometimes a catheter (Foley catheter) will be inserted into the bladder to permit the monitoring of urinary output, both during the period of surgery and during the early post-operative period. After the completion of the surgical procedure, the endotracheal tube will be removed as soon as possible, but the IV, the nasogastric tube and the Foley catheter may remain in place, usually until the next morning.

post-surgicall period

Following completion of the surgical procedure, you will be transferred to the Recovery Room. While in the Recovery Room your progress will be monitored closely by nurses on duty. You will remain in the Recovery Room until you are sufficiently awake to be transferred to your room. This generally requires approximately two to three hours. Family members may see you after you are transferred to your room.

visitors

It is encouraged that visitation be limited to immediate members of the family. It has been our experience that while this is not a difficult time for patients, it may be for members of the family. It is advisable to limit the number of visitors during the post-operative period.

nausea

You may experience some nausea. It is important to realize that this is not a life-threatening situation since your stomach is empty. If vomiting does occur, remain calm and turn your head to the side so that any fluid clears your mouth freely. Although a wire cutter is attached to the head of the bed so that it is available in an emergency, it is very unusual to have to cut the wires which are securing your jaws in position. The nurses who care for you are familiar with patients who have their jaws wired together.

swelling

Swelling is a normal occurrence. The degree of swelling is quite variable and more swelling occurs with lower jaw surgery than upper jaw surgery. The swelling will continue to increase for approximately 24 to 48 hours following surgery. The swelling will remain unchanged until approximately one week following surgery; then, during the second and third weeks following surgery, the swelling begins to resolve dramatically. Every attempt will be made to minimize the swelling during the period of hospitalization. Ice packs will be used immediately following surgery. You will be given a special type of medication prior to surgery and in the post-operative period to prevent excessive swelling. The swelling of the lips can be minimized by utilizing the medicated cream which will be available at your bedside. You will be encouraged to keep your head elevated for the first week following surgery since an upright position and early ambulation minimize the swelling that may occur.

minor bleeding following surgery

It is common to experience some degree of minor bleeding following surgery. Minor nose bleeds may be expected for a period of one to two weeks following upper jaw surgery.

clear liquids

It is important that you drink a sufficient volume of liquids to meet your basic needs. An average adult requires approximately 2 to 2 1/2 quarts of fluid every 24 hours. While this may seem like a large quantity, it can be achieved with constant sipping. Once your fluid intake is adequate, the administration of intravenous fluids (IV) will no longer be necessary. As soon as possible, you will be encouraged to drink clear liquids. A large catheter-tipped syringe will be available to assist you in taking fluids. You will also be encouraged to drink directly from a cup or glass.

speech

The ease with which you can communicate and be understood is not predictable. Speech will only improve by repeated attempts on your part to talk and be understood. It is important that you slow your rate of speech, concentrate on each word and be willing to try repeatedly. Most patients can be understood within 24 hours after surgery.

post-operative discomfort

Discomfort can be anticipated. In most instances, however, it is mild and treated easily with medications. When a bone graft is taken from the hip (or chest) more discomfort can be anticipated.

nasal stuffiness

Nasal stuffiness occurs, both from the tubes placed during surgery and from surgical procedures in the upper jaw. It is managed with a combination of nasal sprays and cleansing of the nostrils. It is suggested that you remove nasal secretions using Q-tips® soaked in a solution of hydrogen peroxide and water (one to three parts). When it is necessary to use the Afrin® nasal spray, it should be sprayed with sufficient force for you to taste the medication. When utilized correctly, this will provide relief in approximately three to five minutes. The nasal stuffiness will resolve within approximately one to two weeks following surgery.

medications

During the period of hospitalization, you will usually be given antibiotics, pain medications, decongestants, nasal spray and medicated cream for your lips. In most instances, these will be continued following discharge from the hospital.

walking

You are encouraged to walk as soon as possible even if bone was taken from the hip.

cleaning the teeth when the jaws are wired together

You will be encouraged to brush your teeth following each meal. A soft pediatric toothbrush can be utilized for this purpose. Pay particular attention to keeping the brush in direct contact with the teeth. In addition to brushing, a mouth rinse should be used. You are cautioned not to use a water-irrigating device, such as a WaterPik®, until at least two weeks following surgery. These irrigating devices have sufficient force to result in a breakdown of the wound. However, a WaterPik®, along with a toothbrush, will provide an excellent means of maintaining oral hygiene two weeks after surgery.

splints

After the jaws have been repositioned, the teeth are wired into a splint to establish and maintain the correct jaw position. The splint is made from your dental models that have been positioned into the new bite (occlusal relationship). It is made of acrylic (clear plastic) and is not visible to the casual observer. This will remain in place until the wires are removed and in most instances, will be used for a period of time following the release of fixation.

rigid fixation

In some instances special bone screws or bone plates will be used to stabilize the jaws in their new position. In these instances the jaws may be wired together for a short period of time or not at all. If wires are not used, small rubber bands will be used to guide the jaws into their proper biting position within the plastic template. Although the teeth are not wired together, a strict liquid diet is mandatory for four to six weeks. Your doctor will inform you when your diet can progress to more solid foods as healing occurs.

weight loss

A weight loss of five to ten pounds may be anticipated during the post-operative period. This is a reflection, in most instances, of a loss of appetite rather than the fact that the teeth are wired together. One week following surgery your appetite should improve sufficiently to maintain and possibly increase your weight.

day of discharge

Most patients are ready for discharge a day after surgery. Medications with instructions will be sent home with you. You are encouraged to resume normal activities as soon as possible.

follow-up

Your follow-up examination should be within one week of your discharge from the hospital. At this time, cephalometric and panoramic x-rays will be taken to evaluate the post-surgical positioning of your jaws. Adjustments may be necessary pending the results of these x-rays. You will be monitored closely for several weeks following surgery.

If at any time during your post-operative recovery you have questions or concerns, please contact your doctor immediately.