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.
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.
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.
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.
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 is discouraged the week before surgery and for 2-4 weeks after surgery as smoke irritates and can lead to infection and delayed healing.
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 Dr.Touchan or consider going to the emergency department ASAP.
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.
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.
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.
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. Dr Touchan 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 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.
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 the next day and make an arrangement to be seen.
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.
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 Dr. Touchan 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.
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.