Post-Operative Jaw Fracture Instructions

Proper care after surgery has an important effect on healing. Please read the following instructions carefully.

Mandible ( Lower Jaw) Fracture Surgery Post-Operative Instructions

• Avoid doing anything that requires heavy lifting, pushing or straining while your jaws are healing.
• Do not try to work you jaw back and forth against the wires. This will loosen the wires and teeth and prevent the bones from healing.
• Avoid water related activities such as swimming and water-skiing while your jaws are wired because it is hard to clear water out of your nose and airway.
• Do not drink alcoholic beverages while your jaws are wired.
• If you have elastics, they hold your jaw together. Over time elastics can loosen, fall off, or break. Losing a few elastics is not a problem as long as you cannot open the mouth. If you find that you are able to open your mouth due to loss of elastics, keep your teeth together and call the office (403) 235-0505.
• It is recommended that you sleep with your head slightly elevated (use 2 pillows). This helps to decrease the swelling in your face and it also makes it easier for you to breathe.

Care of Your Mouth and Teeth

Brush your teeth after every meal and at bedtime. Oral hygiene is extremely important to prevent tooth decay and gum inflammation caused by food build up between the wires and your teeth. Thorough tooth brushing is the single, most important part of good oral hygiene. It is best to use a child-sized, soft-bristled toothbrush with toothpaste. The head is smaller and will be more comfortable for you. Brush your teeth and wires by using rotating motions directly on the teeth and wires.

If prescribed to you, use the Peridex (Chlorohexidine 0.12%) mouth rinse three times a day after brushing. Swish it in your mouth for thirty seconds then spit it out. You may also rinse your mouth with a salt-water solution (1/2tsp salt in 1 cup of water) several times daily. In addition, run your tongue along the inside of your teeth several times a day to help clean them.

If the wires are rubbing against your lips or cheek and causing pain, irritation or burning, you may find dental wax helpful. Dental wax is available at most drug stores. Pinch off a small piece of wax and apply it directly over the wires that are irritating you. The wax will act as a cushion between the wires and your gum. You should remove the dental wax before brushing your teeth and then replace it as necessary.

Wired Jaws

If your jaws are wired shut after surgery, you will taught which wires need to be removed, and how to remove them in the case of an emergency.

During the course of healing, the wires around your teeth or jaws may loosen or break. This is not an emergency, but they should be tightened or replaced as soon as possible. Call the office the next day and make arrangements to be seen.

If You Have Trouble Breathing

If you have some minor difficulty breathing, follow these steps to open your airway as much as possible and call for assistance:

• Place a spoon inside your mouth between the teeth and your cheek and stretch the cheek outward to create breathing space.
• If you are not breathing well because of nasal stuffiness try an over the counter saline nasal spray. Saline nasal spray can be used as often as necessary with no adverse side effects.
• If this problem persists or in the case of an emergency situation, the wires or elastics on the jaw may be cut. Please call the emergency line if you have to cut the wires.

Diet

A blender or food processor will be helpful to prepare your meals. If you have enough spaces between your teeth, you may sip your liquefied food or use a straw. If you do not have adequate spaces, our office will provide you with a syringe that has a long tube attachment. This will allow you to draw up the liquids and inject them into the space at the very back of your mouth.

Most people prefer foods that are neither hot nor cold. Very hot liquids may injure tender or numb mouth tissues. Very cold liquid may be painful to sensitive, injured or fractured teeth. Basic good nutrition is essential to keep your health, speed up recovery and assist in healing. Even though you cannot chew, you still need to maintain a balanced diet. In addition to your blended meals, you may want to add a commercial nutritional supplement such as Ensure or Boost. These are convenient ways to increase calories and protein.

Nausea

If the nausea is mild, first try taking an over the counter nausea medication (Gravol) and lying on your side. You may take small sips of ginger ale. If the nausea is persisting and you feel you may vomit, follow these steps:

• Bend forward or roll onto your side.
• Put your finger inside your cheek and pull your cheek out.
• All the vomit will come out of your nose and mouth while you continue to lean forward.
• Stronger anti-nausea medicine can be prescribed if the nausea persists.

Pain management

Some amount of discomfort is to be expected following any surgery. If your doctor thinks that you will benefit from a prescription pain medication, you will receive a prescription following your surgery. Please follow the prescription instructions carefully.

• Ibuprofen (such as Advil, Motrin) works very well for many patients and can significantly reduce the amount of narcotic pain medicine (Tylenol 3, Percocet) needed. You may find that taking 400-600mg of ibuprofen every 6 hours on a regular schedule for the first 2-3 days is all the pain medicine needed. If needed, you may take both the ibuprofen and the narcotic pain medication as prescribed for maximum pain management. Continue to take the pain medication as directed and as needed for pain relief. You can wean yourself off the pain medications if the pain is controlled. You may or may not need to take all the prescribed pain medications for this reason.
• Begin taking your pain medications as directed as soon as you get home and before the local anesthetic (freezing) wears off. Your pain medication can be taken with liquids but it is important to get some soft food in your stomach as soon as possible. Take all subsequent doses along with food to minimize nausea.

Infection

If your doctor thinks that you will benefit from antibiotics to prevent infection, you may receive a prescription for one. If prescribed, take as directed. It is important to ensure you finish the full course of the antibiotic.

• If you are experiencing nausea you may TEMPORARILY stop taking the antibiotic until the nausea subsides, however you must always restart and finish the antibiotics as directed.
• If any medications cause hives or itching, discontinue them immediately and call the office (403) 235-0505.

Call our office if you notice any signs of infection including:

• Increased swelling after 5 days
• Swelling that is painful, hard or hot
• A foul taste or odour in your mouth
• A temperature above 38°C

Swelling

Swelling around the mouth, eyes, and cheeks is a normal reaction to the surgery and usually takes 2-3 days to fully develop. To help prevent swelling:

• Apply ice packs to the cheeks for 20 minutes on and 20 minutes off. Keep your head elevated for first 48 hours after surgery. Ice serves no purpose after 48 hours and may contribute to jaw stiffness.
• Use crushed ice in a ziplock bag or a bag of frozen peas bag wrapped in a moist cloth to prevent frost bites.
• After the first 5 days, you can begin using a heating pad or moist heat for relief of swelling, bruising, and stiffness of the jaw.
• Apply heat 4 times/day for 30 minutes time intervals.
• If your doctor thinks that you will benefit from it, you may have receive a prescription for a medication (Dexamethasone) to help with swelling. Take the medication as directed. Occasionally, this medication will cause some people to experience tingling in their hands and feet. If this happens, stop the medication and contact the office (403) 235-0505.

Bleeding

As with any surgical procedure, there is always the risk of post-operative bleeding. If it becomes excessive, call the 24-hour emergency number. Do not blow through your nose or smoke cigarettes. You may experience some bleeding when you brush your teeth, but it should be minimal. Nosebleeds are quite common for those who have undergone upper jaw surgery. If you get one, pinch your nose until it stops.

Nasal Congestion

If you are having any upper jaw procedures your nose could be congested. For the first 3-4 days you can use a nasal decongestant as well as an oral decongestant. After a few days, discontinue the nasal decongestant and use saline irrigation. Bloody mucous discharge out of the nose is very common for the first 2 weeks.

Resuming Activities

If you have undergone a general anesthetic, you should go home and rest for the remainder of the day. Do not drive or engage in strenuous activities (sports) for at least 24hrs. On average people will take 3-7 days off from normal activity. You may return to work/school when you feel you have recovered.

Sutures (Stitches)

If you had plates inserted, you will have dissolvable stitches placed in your mouth. Ensure to keep them clean until they dissolve and the tissue is healed.

Notify our office, If You:

• Must cut your elastics or wires to open your mouth for some reason.
• Think the elastic or wires have shifted or have become loose enough to allow you to open your mouth.
• Have discovered an additional related injury to your face, jaw or body.
• Develop nausea that over the counter medications does not relieve.

Complications

Complications following repair of a mandibular fractures can occur. The most common complication is an infection or an osteomyelitis (bone infection). Malunion and nonunion of the mandible most often occurs because of failure to maintain the jaws wired together. Malunion (a delayed, incomplete, or faulty union of the bones) following a fracture can also occurs if you cut the wires prematurely after your surgery. Other factors contributing to a malunion or a nonunion include:

• Infection
• Severity of the injury
• Lack of fracture stability (being able to move the lower jaw freely while wired together)
• Alcoholism
• Metabolic and nutritional deficiencies

Tooth Vitality

Although it is not common, there is a possibility that a tooth can become devitalized (dead) after jaw trauma. It does not mean that you will necessarily loose the tooth. It can most likely be resolved with endodontic (root canal) treatment.

Questions

Your well-being is our primary concern and it is our sincere desire that you experience the least possible amount of discomfort and anxiety. Should you have any questions regarding your recovery, please do not hesitate to contact our office at (403) 235-0505.

Emergencies

If any unusual symptoms should occur please call our office at (403) 235-0505. If you are calling after our office hours or on the weekend, the answering machine will direct you to the oral surgeon on-call. In the event of an unexpected admission to a hospital due to a treatment rendered at this facility, please notify us.