Question 1

Phase I - Immediately Before & After Surgery

Accepted Answer

Prior to your surgery

Prior to your orthognathic surgery, it is imperative that you have seen the orthodontist for placement of surgical hooks and your family dentist for a generalized cleaning, since oral hygiene will be a little difficult for the first two weeks.
Also, make sure to enjoy a normal routine and savor your favorite meals, since these will be curtailed for at least one month after surgery.

Day of your surgery

The morning before your surgery, it is important that you thoroughly brush all of your teeth and appliances.
You will be completely numb on the jaw that was operated on, so you will not feel a great amount of pain. However, the swelling will start immediately and you should anticipate some jaw stiffness. You will also likely be sore from the breathing tube placed by the anesthetist. However, this soreness will subside with time.
During your time in the hospital, it is important to stay hydrated — this is important for your recovery. We will also be coaching you to do some walking around. Keep in mind that too much activity may cause nausea, so limit your movement.

Immediately after surgery

While all patients feel pain or discomfort after an operation, the level of pain will vary from patient to patient. Take your pain medications as directed.
When you go home, have a friend or relative spend the first night with you. Continue to take any previous medications before following the instructions on the bottle.
You will be able to shower on the second day after surgery. You must avoid hot, prolonged showers which may cause bleeding in the upper jaw if surgery was performed there.
Avoid exercises, any heavy lifting or activity that raises your blood pressure or pulse for at least one month after the surgery. The blood vessels are still healing from the surgery and any increase in activity may cause bleeding. You may begin gentle exercise after 2 weeks, but do not do any cardio for 4 weeks after the surgery.
Do not drive a vehicle or perform any task that requires coordination or judgment for at least 48 hours following your anesthetic.

Prescriptions

You will be provided with the following prescriptions:

Amoxicillin 500mg Elixir which you will take 3 times a day for 7 days.
- This is an antibiotic that must be finished.
- If you are allergic to penicillin, you will be given another antibiotic.
Ativan 1mg tablet that you will place either in your cheek or underneath your tongue. You will be given 14 tablets. You are encouraged to use this for at least the first 7 days and then at your discretion after that period.
- This is to help you sleep at night without causing any undue clenching or grinding that may sometimes occur.
Analgesics to mange your pain
Antibiotics mouth wash to keep your wounds clean

Diet

Immediately after surgery, you will need to stay on a liquid diet in order to prevent the wounds from being infected. Here is our post-op suggested dietary plan:

For the first 5 days post-op, you will be on a full liquid diet, which includes any fluids, such as protein shakes.
Eventually, you can transition to a soft food diet. We recommend avoiding anything hard or crunchy. At this stage, most foods will be okay to eat, including pasta, rice, potatoes, etc.
Beyond this point, there are no restrictions on what you can eat, as long as you avoid excessive chewing.

Hygiene

The swelling of and around your cheeks will make it quite difficult to brush your teeth. In fact, you should not brush your teeth for 1 full week after surgery, otherwise the incisions can be damaged and you may cause bleeding.
You should use warm saline rinses (1/2 teaspoon salt in a glass of warm water). You can rinse your mouth with salt water as often as you’d like, even up to every 2 hours. Frequent saline rinses will keep your mouth nice and clean and will also shrink the incision lines inside the mouth.
Your hygiene will change when you enter into the second phase. You may also be given a prescription for Peridex, an antibacterial mouth rinse. If that is given to you, use it as prescribed.

Swelling

The swelling will reach its peak post-operation. It tends to vary by patient, however, you should anticipate a lot of swelling in your cheek area all the way down to your neck.
The swelling normally peaks on day 4 post-surgery and will slowly subside after 2 weeks. About 10 to 20% of swelling may be noticed up to 2 months after your surgery. You should only become wary of swelling about 3 months post-op.
You should place ice on your face while you’re awake for the first 3 to 4 days. The ice will have a numbing effect that will reduce any post-operative sensitivity. You must be careful not to apply too much ice directly on the skin, as it may cause burns. After day 4 post-op, a warm water bottle is then recommended to help reduce swelling.

Bruising

Bruising is also normal after jaw surgery. Depending on which jaw was operated on, you may have bruising in the area of your upper cheek and eyes as well as your lower cheeks and down your neck.

It is not unusual to have some bruising extend to your chest. The bruising is unsightly and disconcerting, but you must understand it is perfectly normal and should not be of any concern. It will go away after about 2 weeks.

Physical Activity

You should limit physical activity during the first week post-operation. You can walk and move about, but you should not do any exercises, jogging or weight lifting, regardless of how well you feel.

You will have lost some blood during the operation and you may be feeling weak or faint. This is not the time to try to get back into shape. It will take one month before you fully recover from the amount of blood loss and strength due to your surgery.

Other Findings

You may have some altered sensation to your hearing due to some of the swelling extending into the area surrounding the ear. This numbness or muffled sound is not unusual.

You may also experience some joint noises on both sides of your jaw. Your joints need to get accustomed to their new position.

Next Phase

Your surgeon will give you a handout regarding the second phase of healing once you are ready. Until then relax, take the medications, drink as best as you can and contact us if there are any problems.

Question 2

Phase II - 1 to 4 Weeks After Surgery

Accepted Answer

Changes from Phase I

In this phase, the majority of swelling and bruising will have peaked and should be starting to subside. This is the time to get your jaws actively working again so that you can resume normal activity. There are a few points to remember and a few changes to note:

Continuation of Phase I Diet;

Dairy products: continue with milkshakes, ice cream, soya milk drinks, yogurts, soft cheeses
Protein drinks and protein supplements as well as nutritional supplements (such as Ensure, Boost, Whey, protein powders, tofu)
Egg products (scrambled, boiled, omelets)
Pureed vegetables and meats of a similar consistency to baby food. (this would include potatoes, peas, carrots)
Starches such as mashed potatoes, rice and pasta
Other proteins such as minced meat and white fish
Again, there is no limit as to the amount you should eat and in fact you should try to now increase your nutritional intake, since there may have been some weight loss initially and now your body is demanding extra nutrition during this healing phase.
Once again, it is imperative that you do not actively chew and you should avoid anything at all that is hard, including tough meats, candies, popcorn, pretzels, peanuts and other nuts.

Hygiene

Now that the swelling is slowly starting to subside, you’ll be able to get into the mouth and cheek areas with more ease.

You should purchase a new toothbrush and, using a small amount of toothpaste, concentrate on brushing the metal braces. You should spend at least 15 to 20 minutes in the evening, prior to going to bed, doing a thorough cleaning of all your teeth and brackets.
Continue rinsing your mouth with salt water at least twice a day, but be careful not to injure the wounds with the head of the toothbrush. If you do hit the wounds, there may be a little bleeding, but this is normal and should not cause any worry.

Swelling

The swelling will now begin to subside and by the second and third week, the majority of it will be gone.

Remember, there’s still about 10 to 20% of swelling that can last up to 2 months post-op.
Ice will no longer help reduce the swelling; you may want to switch to using warm water bottles over the area. However, at this point, the swelling will go down on its own.

Bruising

Bruising may last into the second week, and spread down the neck and chest areas. Although this is unsightly, it is perfectly normal and will go away with time.

Physical Activity

You can resume a regular routine of physical exercise that you may have had prior to surgery. However, avoid engaging in any heavy running or activities that involve excessive head or neck motion. Instead, focus on simple walking, stair-climbing, and mild activities, as they are encouraged and can aid in reducing swelling.

New Findings

It is not unusual to hear some noises such as clicking or popping at the joint of your jaw near your ears,as you start to increase their function. These joint noises and discomforts will continue up until about 6 weeks post-surgery.
If you’ve had upper jaw surgery:
- The numbness tends to be reduced in the upper lip and jaw area. This is first felt as an itchy or pins and needles sensation. In the lower lip area, there will still be some numbness and pins and needles that can last until 6 months post-op.
- A nasal discharge of a red-brown fluid may occur. This is normal and is a product of the blood clots being dissolved just behind the upper jaw. If you should experience brisk bright red blood that is not controlled with pressure on the nose, please contact the office.

Physiotherapy

Facial Reanimation
- You should do lip and cheek exercises during the initial phases and up to a month post-surgery. This strengthens the muscles in and around the mouth and nose areas, reducing swelling and bringing life back to that area of your face.
- These exercises are quite simple and they consist of grimacing, pulling your lips apart, putting a pencil between your lips and trying to squeeze the pencil, smiling and all types of lip, cheeks and chin movements.
Joint Exercises
- These exercises consist in opening and closing your jaw. For the first 2 weeks, your goal should be to open your teeth approximately 2 finger widths apart.
- You can place some warm packs over both sides of your face and gently massage your jaw joints. Then, slowly and passively, try opening your jaw as much as you can.
- By 3 to 4 weeks post-operation, aim to open your mouth approximately 3 fingers wide.

Next Phase

Your appointments will now most likely continue at intervals of 2 weeks.
The antibiotics will have been terminated at this stage. If you need medications to help you sleep through the night, speak to your doctor.
You may find yourself clenching and grinding your teeth in the middle of the night; this is not unusual, but if it is disturbing your sleep, we can give you something to help.
Your final phase will be from approximately 4 to 6 weeks after the surgery until you have your braces removed. This phase will be further explained to you at the appropriate time.

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Prior to your surgery

Day of your surgery

Immediately after surgery

Prescriptions

Diet

Hygiene

Swelling

Bruising

Physical Activity

Other Findings

Next Phase

Changes from Phase I

Hygiene

Swelling

Bruising

Physical Activity

New Findings

Physiotherapy

Next Phase

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