Corrective Jaw Surgery (Orthognathic Surgery)

Pre-Operative Instructions

This information is intended to provide an overview related to your surgical experience. No two surgeries or patients are the exact same, you may find you will be given additional instructions by your doctor and his staff at your consultation. We encourage any questions related to your procedure after you have read the following information.

Preparation For Surgery

Prior to scheduling your operation, your doctor will carefully review your medical history. At this time it is important to disclose any information related to past, and present medical problems, illnesses, operations, medications you are currently taking (prescribed or over the counter), allergies or any adverse reactions to medications or previous general anaesthesia.

You may be advised to stop taking certain medications (i.e. blood thinners) for a few days or weeks prior to your surgery. Your doctor will provide you with this information at you consult.

Mindset

Having a strong positive attitude towards the procedure and outcome will serve to make the whole experience a more positive one. If you are feeling negative and skeptical about the procedure take some time before booking the procedure to make sure this is something you are wanting and able to cope with. Having a support system such as family or friends to be with you for the first two to three days after surgery is important.

Physical Preparation

Prior to surgery we encourage you to get adequate sleep and physical exercise. Allow yourself time to rest as this allows your body to heal. Two weeks prior to surgery, be mindful of your diet. Reduce the sodium (salt) intake in your diet, as this will decrease facial swelling after surgery. A majority of sodium comes from processed and prepared (fast) food. Examples include: prepared (frozen) dinners, cold cuts, bacon, cheese, canned soups/ foods, dairy.
Fresh foods like fruits and vegetables, fresh meat, rice and oatmeal are just some examples of low sodium foods.
If you are a cigarette smoker, it is best to minimize if not eliminate the amount you smoke before and after surgery. Stopping cigarette smoking before surgery will help your body cope better with the anesthesia. Smoking after your procedure can increase your chances of post-operative complications including delayed healing, wound breakdown, and infection.

Admission To Hospital

This type of procedure will be performed at the hospital. Waiting lists are currently long due to reduced hospital availability. You will receive notification indicating your surgery date. Before your surgery date, you may also be seen at the hospitals pre-admission clinic. At this clinic any of the following may happen:

• A nursing assessment of your health will be done.
• You will be told about your operation or procedure and what will happen to you,
• You may have blood work and a heart tracing (ECG) done.
• You may see a medical specialist from anesthesia or Internal Medicine (sometimes both) and have a medical history and physical examination.
• You may meet with a physiotherapist, specialized nurse, social worker or other members of your healthcare team.
• You may be given instructions for fasting before surgery. You must follow these instructions carefully—it is very important that your stomach is empty before your operation.
• Stop smoking and do not drink alcohol at least 24 hours before surgery.
• Shower with an antibacterial soap and shampoo your hair the night before or the morning of your surgery.
• Shave any facial hair (beards and moustaches) if possible for the surgery.
• Remove all makeup and dark purple or black nail polish before coming to the hospital.

Day of Surgery And Anesthesia

You may receive medications in preparation for the general anesthesia and to reduce any pre- surgical anxiety. An intravenous (IV) will be placed in your arm; providing the means to deliver both fluids and medications, eliminating the need for repeated injections. It will be necessary for the anesthesiologist to pass a breathing tube (endotracheal tube) from the nose into the trachea (wind pipe). This will be done when you are asleep. When the surgery is complete this tube will be removed as soon as possible. Operations of this type are generally between 2-6hrs in length depending on the exact nature of the procedure.

Post-Operative Instructions

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

Following your surgery, you will be transferred to the recovery room where nurses will closely monitor you until you are sufficiently awake. An IV will be in place and you may have a bulky pressure dressing around your head and side of your face. These will be removed individually as your recovery progresses. From the recovery room you may be transferred to another unit to be monitored. You can anticipate staying for approximately one to four days.

Nasal Congestion And Throat Soreness

You may experience some nasal congestion or an irritated throat post-surgery for the first day or two. This is related to the endotracheal tube that was placed while undergoing surgery. This feeling should resolve in a few days.

Swelling

Significant facial swelling should be anticipated following your surgery. Generally it will decrease within two weeks. Following surgery, steps can be taken to minimize the swelling including:

• Keeping your head elevated when lying for at least 10 days post-surgery.
• Place ice packs on the sides of your face for the first 48hrs post-surgery. After the first 48hrs, the cold generally will not be of any value in controlling swelling, but some people like it for comfort.
• Moist heat to the face can be started on the fifth day post-surgery and will assist in resolving swelling and stiffness. Warm towels cam be used for 20-30minute intervals.

Pain

You will be prescribed a medication to help with any pain or discomfort post-surgery. Ibuprofen 600mg can be taken every 6hrs. If you are still in discomfort, you will use a stronger narcotic pain medication (Narcotic + Tylenol). Remember, most narcotic pain medications already have Tylenol in them, so do not take any extra Tylenol as it may cause a serious problem. Do not exceed over 4000mg of Tylenol a day. Avoid alcohol while taking any of these medications.

Numbness

Following surgery you will experience areas of altered sensation or partial numbness of the lip, chin, tongue, cheeks and teeth. During the first three to six months the small nerve fibers are regenerating and recovering. As healing takes place, you may encounter sensations of warmth and tingling over the affected areas. These may remain longer than six months and is some cases; altered sensation may persist for extended periods. Often patients are able to adjust to this altered sensation without great difficulty.

Bruising

Moderate to severe bruising can be expected for most patients. This bruising will normally appear shortly after surgery and may last for 2 weeks.

Smoking

Smoking is discouraged the week before surgery and for 2-4 weeks after surgery as smoke irritates and can lead to infection and delayed healing.

Bleeding

It is normal to bleed or ooze for some time after jaw surgery. Blood in the saliva or on your pillow is common for up to one week post-surgery. To control bleeding keep your head elevated and apply ice to the area. Use gauze or if not available a clean clothe or damp tea bag to apply gentle pressure. If you encounter a significant bleed from the surgical site or nose, please contact our office (403) 235-0505 or consider going to the emergency department ASAP.

Nausea

Nausea and vomiting can occur post-surgery, however it is not as common as many think. Measures are taken to try and prevent and control this issue. Medications are available and will be provided to you. If you are nauseated when you get home please follow these steps:

• Stay still as movement such as walking can increase your nausea.
• Drink clear fluids or carbonated beverages (ginger ale, 7 UP)
• You may have been prescribed an antiemetic by your surgeon that you can take or try taking an antiemetic like Gravol.
• Stop taking narcotic pain medication as these can frequently cause nausea. Instead try using plain Tylenol or Ibuprofen for pain management.
• If there is no relief, please call the office (403) 235-0505.

Communication

At first communicating may be difficult and you may want to have a small notebook and pen to write messages. Notify family and friends who plan to call or visit that you that you may not be able to answer the telephone. At first lengthy conversations can lead to fatigue. Most people are able to communicate relatively clearly.

Infection

If provided an antibiotic after surgery, make sure you take it as prescribed until finished. If you have had upper jaw surgery, please refrain from blowing your nose for two weeks since this may increase your chances of infection and could provoke a nose bleed.

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 the mouth
• Temperature above 38°C.

Diet

It is very important to follow a proper diet plan after surgery, as your body will be healing and will need nutrition and calories. Nevertheless, it is not unusual to lose 5-10 lbs after surgery. Your doctor will discuss with you when you are able to progress your diet at your follow up appointments.

A Suggested Diet Is:

• The first 3 weeks should be liquids only. Taking adequate amounts of fluid after surgery is essential as it helps your body to heal. Suggestions include any clear fluids (water, soft drinks, Gatorade, clear soups) and milk shakes, ice cream, Soya milk drinks, yogurts, protein drinks and protein supplements as well as nutritional supplements (such as Ensure, Boost, Whey, protein powders, tofu), or anything you can drink from a blender.
• After 3 weeks, you can commence a non-chew food diet. A recommendation 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, over-boiled/soft pastas cut into pieces etc.
• After 6 weeks, you can progress to a soft-chew diet. Portions should be small and cut into pieces to avoid placing too much pressure on the jaw. Soft fish dishes are excellent.
• After 6-8 weeks, you can progress to more normal chewing. However, continue to avoid overly hard foods or placing too much pressure on the jaw. Avoid pizza, apples, tough meats etc, until at least 3 months after surgery. It is important that you don’t chew too vigorously or with very much force, and you should avoid anything at all that is hard, including tough meats, candies, popcorn, pretzels, peanuts and other nuts. Depending on the amount of mouth opening you have and also the amount of elastics that may be placed, your diet will be still restricted to your mouth opening. However, you can now start moving up to a more substantial diet.

Oral Hygiene

Oral hygiene will be more difficult as swelling in your cheeks will make it difficult to brush. However, it is important for you to make an effort in applying the following recommendations:

• You must brush your teeth as thoroughly as possible
• A child size SOFT toothbrush is recommended.
• You should use warm saline rinses (1/2 teaspoon salt in a tumbler of warm water). You can rinse your mouth with salt water as often as you would like, even up to every 2 hours. You cannot do enough rinses. This will keep your mouth nice and clean and will also tend to shrink the incision lines inside the mouth. You may also be given a prescription for Peridex, an anti-bacterial mouth rinse, which you should use as instructed on the bottle.

DO NOT use a Water-PIK for the first two weeks after surgery. Food debris could be forced through the incision sites.

Wired Jaw

If your jaws are wired shut after surgery, you will be provided with wire cutters to remove the wires in the rare case of an emergency (eg. car accident). You will be 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 should be tightened or replaced as soon as possible. Call the office (403) 235-0505 the next day and make an arrangement to be seen.

Tooth Vitality

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

Change in Facial Appearance

It is important to realize that surgical repositioning of the jaw will be accompanied by some change in facial appearance. These changes are generally favorable and desirable. The nature of the changes will be explained to you in the initial consult.

Activities

The surgery along with the accompanying anesthesia can deplete your energy and increased bed rest may be needed. However, that does not mean you can stay in bed all day. In order to increase healing time it is important to do short walks or mild activity during the first few days postoperatively. You should not do any exercises, jogging or weight lifting, regardless of how well you feel for at least two weeks or as otherwise told by your surgeon. This type of activity can cause a rise in blood pressure. As your strength returns you may slowly begin increasing your activity level. Be prepared that you will need to avoid any contact sport, any sport with a ball, or any aggressive sports for an extended period of time after surgery. Your surgeon will discuss their recommendations with you.

Return to Work/ School

You are encouraged to return to school or work as soon as you are feeling well enough to do so. Each individual will differ in their speed of recovery. You can anticipate being absent for at least 2 weeks from work or school but allow some flexibility during this period as you may need more time.

Follow Up Appointments

You can anticipate that you will be having follow ups with your doctor for several weeks after your procedure. Your visits will become less frequent once he is satisfied with your surgical stability and outcomes. At this time he will provide you with further, detailed instructions regarding your post op care as it relates to your surgical progression.

Emergency

Remember if you have any problems or questions please call the office at (403) 235-0505. If you are hospitalized due to a complication from the surgery, please notify the office.