Post-operative instructions for jaw fractures and jaw surgery (orthognathic surgery)
Strict adherence to the diet schedule below is crucial to allow your jaw to heal appropriately. Advancing too quickly to hard foods can cause the plates and screws to break or bend and the jaw to re-break, requiring further surgery. Occasionally, certain types of jaw fractures require a different protocol than the standard suggested below – you will be notified if this applies to you. Additionally, delayed healing or other problems may arise which could delay you from advancing as outlined below.
A suggested diet for standard cases is:
- Weeks 1-2: Liquid diet. For the first 2 weeks, your diet should be liquids or pureed foods only. Taking adequate amounts of fluid (no straws) after surgery is essential as it helps your body to heal. Suggestions include any clear fluids: water, soft drinks, Gatorade, clear soup and then progressing to milk shakes, smoothies, ice cream, Soya milk drinks, yogurts, protein drinks, protein supplements or nutritional supplements (such as Ensure, Boost, Whey, protein powders,) or anything you can puree in a blender to liquid form
- Weeks 3-4: Non-chew diet. After 2 weeks you can commence a non-chew food diet. The rule of thumb is to eat food that you can easily squish between your fingers and anything that does not make any noise(ie hard or crunchy foods). Examples include: mashed potatoes, scrambled eggs, fish and over-boiled/soft pastas cut into small pieces etc.
- Weeks 5-6: Soft diet. After 4 weeks, you can progress to a soft-chew At this point, just about any soft foods are okay as long as they are cut into small pieces and don’t require too much pressure on the jaw to chew. At this point Dr. Robertson may tell you that you can remove your elastics to eat and then replace them again afterwards.
- Weeks 6-8 and after: Slowly resume a normal diet. After 6-8 weeks, you can progress to more normal chewing, but advance slowly and cautiously (really hard foods should be avoided for another 1-2 months, including pizza, apples, raw carrots, nuts, etc.). At this point if it hurts to chew, it’s too hard.
Elastics: In most typical cases your teeth will not be tightly wired together, but you may have some elastics between your teeth to help support your jaw and guide your bite. If one or two elastics break, this is not usually an emergency and can wait until your next scheduled follow-up appointment to be fixed. If you were given extra elastics to take home, you can try to replace them if possible. However, if all of the elastics on either side have broken and you cannot replace them, make an appointment with your surgeon within a couple of days for them to be fixed. Until this occurs, try to avoid moving your jaw too much.
In the case of an emergency (such as vomiting/choking, excessive oral bleeding, or significant difficulty breathing), you may cut the elastics with any pair of scissors. If this occurs, call us right away at 403-263-5193 for further advice.
To reduce the risk of an emergency situation (as described above) and promote proper healing, you should not drink any alcohol or use any recreational drugs for the first 6 weeks after your surgery.
Oral Hygiene: Proper oral hygiene is extremely important for preventing infections of the surgical sites. The swelling in your cheeks may make it difficult to brush your teeth, but it is important to do so. You may brush the outside of all teeth starting the day after surgery with a soft toothbrush. Take care to brush the teeth only, avoid your gums where the incisions are. Keep braces and/or wires very clean. You may have elastics between your upper and lower jaws to support the lower jaw and to control the bite. If so, don’t worry about brushing the inside of your teeth.
In addition to brushing, you should use warm saline rinses (1/2 teaspoon salt in a glass of warm water) daily. You can rinse your mouth with salt water as often as you would like, even up to every 2 hours, but certainly after each meal and before bed. You cannot do enough rinses. This will keep your mouth clean and help shrink the incision lines. You may also be given a prescription for Chlorhexidine/Peridex, an anti-bacterial mouth rinse, which you should use as instructed on the bottle. Mouth rinses are very important for oral hygiene for as long as your sutures are present and/or you have elastics between your teeth.
Swelling: Significant swelling of the face, lips, and jaw areas is normal and expected following jaw surgery. Swelling typically peaks at 3-5 days after surgery, and then slowly goes away over the next several weeks. About 90% of the swelling should be gone by about 8 weeks, but the last 10% of the swelling takes 6-12 months to completely resolve.
Speaking: Whether you have numbness or not, swelling of the lips and elastics between your teeth may make it challenging to speak at first. While it may be tempting to avoid trying to speak, this is not the right approach. Writing things down to communicate (rather than trying to speak) will only delay your return to normal oral function. The more you use your lips to speak and drink and eat (according to the diet instructions), the quicker you’ll return to normal function.
Bleeding control: A small amount of oral bleeding after jaw surgery is expected and will most often stop on its own with time. This is more common if teeth were removed in addition to the jaw surgery procedure. If bleeding persists, try to place some gauze over the area that is bleeding and apply pressure until it stops.
Sutures: All sutures used in the mouth dissolve on the inside and then fall out. Different types of sutures fall out at different times, but often after jaw surgery longer lasting sutures are placed which take 4-5 weeks to dissolve. If these sutures are particularly bothersome to you, Dr. Robertson may be able to remove them after 3-4 weeks.
Additionally if you have had surgery to widen the upper jaw, you may have a splint in place which is wired to your top teeth. This will remain in place for 6-8 weeks and will be removed in the office at one of your follow-up appointments. Use mouth rinses to keep this splint clean of food and debris.
Prescriptions: You will most likely have some prescriptions for pain medications, antibiotics, and/or mouth rinses. Take all of these medications as prescribed. Even with elastics between your teeth, you will usually be able to swallow pills, however if you think this will be challenging for you, you can ask your pharmacist to substitute the medications for liquid form.
If you’ve been given antibiotics, please take them until they are finished. The pain medications can be taken “as needed” (you don’t need to finish the bottle). If you have been prescribed pain medicine with a narcotic (Tylenol #3, codeine, Percocet, Tramadol/Tramacet etc.), do not drive after taking these medications, and discard the remainder of the pills once you no longer need them.
Recovery time: While it varies from person to person and depends on the exact surgery you’ve had, you should plan to be off work or school for at least 2 weeks following surgery. If your job requires a lot of talking or public speaking, you will likely need more than 2 weeks. Our office can give you a doctor’s note to this effect upon request.
You may begin gentle exercise (light jogging, swimming, light weight-lifting) after 2 weeks, but avoid strenuous exercises, such as heavy lifting or any activity that raises your blood pressure or pulse, for at least 4 weeks after the surgery. If you find that you have excessive throbbing or pain with physical activity, reduce the intensity. It is imperative that you do not play contact sports or do any activity where you could receive a blow to the jaw for at least 8 weeks.
Smokers: Smoking is one of the worst things for you for the proper healing following a major jaw surgery procedure. It is strongly advised to avoid smoking for at least 4-6 weeks after jaw surgery, and a nicotine patch can be used to assist with this if necessary.
Numbness: It is quite common to have numbness of the lower and upper lips following jaw surgery. Nerves take longer to heal than bones, so sometimes nerves will continue to recover for 6-12 months after surgery (well after the bones have healed). Patience is required during this time period while the sensation of the lips and teeth slowly returns. A feeling of “pins and needles” or “electric shocks” means that the nerves are recovering.
Usual medications: Unless specifically directed by Dr. Robertson, you may take all of your usual medications as normal.
Mouth opening exercises: It is typical to have reduced mouth opening for a period of time following jaw surgery. Dr. Robertson will tell you when it’s okay to begin “passive” and “active” mouth opening exercises. Passive mouth opening exercises can typically begin at 5-6 weeks after surgery and involves opening your mouth wide and shifting it from side to side, but without pushing on it. Active mouth opening exercises can typically begin at 8 weeks after surgery and involves using your fingers to stretch your mouth open (push and hold for 10 seconds at a time). Continue mouth opening exercises until your mouth opening is back to the levels it was prior to surgery. Failure to perform these exercises may result in permanent restriction in mouth opening.
If you have any questions at all, don’t hesitate to contact our office at 403-263-5193. During our regular business hours we’ll be happy to help you through any questions or problems you’re having, and outside of business hours you can call the same number and follow the prompts to be directed to the 24-hour on call surgeon.