surgical instructions

After Corrective Jaw Surgery

Day of Surgery

You will be given preoperative medications in the Ambulatory Surgery Unit to help settle your stomach. When it is time, you will be brought back to the Operative Room by the nurse. Upon arriving in the Operating Room, an intravenous catheter (IV) will be started in the back of your hand or your arm. This is to provide a means of delivering both intravenous fluids and medications, thus eliminating the need for repeated injections.

Hospitalization

In most case, patients having lower jaw surgery will be discharged from the hospital the same day of the surgery. Patients having maxillary surgery (upper jaw) or maxillary and mandibular surgery will remain in the Short Stay Unit and be discharged the following morning by 8:00AM. Families should plan to pick patients up by 8:00AM.

Nausea and Vomiting

Not uncommonly, you may experience some nausea or vomiting during the postoperative period. Vomiting is to deal with when handled calmly. If vomiting occurs, it is important to remain calm and call the nurse so he/she can assist you and then lean you forward. The liquid from your stomach can be pushed through your teeth and suctioned.

Nausea and vomiting are commonly caused by inadequate intake of oral fluids and can be compounded by taking oral pain medications. We suggest sucking on popsicles (not juice bars), drinking Coca-Cola and/or 7-Up. If these measures fail, call the Advice Nurse at the Oakland Medical Center.

Although wire cutters are available to trained personnel on the floor, it is unusual to have to cut wires that are holding your jaws in position. The nurses who care for you are experienced in dealing with patients who have their jaws wired together. It is not necessary to send you home with wire cutters. Remember…vomiting is not a life-threatening experience: remember to lean forward and push the liquid out of your mouth with your tongue.

Suctioning

You are encouraged to suction your mouth with the rubber catheter at your bedside. This should begin when you are awake enough to do so in the Recovery Room. The suction catheter may be placed between your cheek and teeth to suction saliva and blood from the mouth. Any liquid in you mouth may be pushed forward between the teeth with the tongue and suctioned. At home you can swallow the saliva in your mouth without needing to use the suction machine. You will not be sent home with a suction machine.

Swelling

You can anticipate swelling will occur and the degree of swelling is quite variable in different individuals. More swelling usually occurs with the lower jaw surgery than with the upper jaw surgery. Swelling will continue to increase for approximately two to three days following surgery and will dramatically resolve within ten days to two weeks. Application of ice-packs to the jaws, for the first three days, will help minimize the swelling.

Minor Bleeding Following Surgery

It is common to experience some degree of minor bleeding following surgery. Minor bleeding may be expected for a period of one week following upper jaw surgery.

Nasal Stuffiness

Nasal stuffiness, following maxillary surgery (upper jaw), is common and is to be expected. When this occurs, it can be managed with a combination of nasal sprays and cleansing of the nostrils. It is suggested you remove nasal secretions and scabs using cotton swabs soaked in a solution of hydrogen peroxide and water (one to three parts).

When it is necessary to use Afrin nasal spray, it should be sprayed with sufficient force for you to taste the medication. When used correctly, this will provide relief in approximately three to five minutes. The nasal stuffiness will resolve within approximately one week following surgery. You are not to blow your nose for at least three weeks following upper jaw surgery.

If nasal stuffiness continues after you arrive home, a humidifier may be used in addition to the above procedures. This is usually not required, but may be helpful in special instances.

Splints

In many cases, a splint is used. A splint is a plastic template constructed from dental models placed into the new bite (occlusal relationship). After the jaws have been divided, the teeth are wired together into the splint to establish and maintain the correct jaw position. The splint is constructed out of clear plastic (acrylic) and is not visible to the casual observer. This will remain in place until the jaws are unwired.

Teeth Cleaning With Jaws Wired Together

In order for wound healing to occur, you must brush your teeth after each meal. A child’s toothbrush should be purchased at your local store before your hospital admission for this purpose. It is important that you brush all the way in the back since the incisions for the lower jaw surgery are in this area and must be kept free of food. You need not worry about damaging the incision with a toothbrush. It is easiest to brush with a dilute solution of gentle non-alcohol mouthwash such as Cepacol or Liquadent Toothwash.

You are cautioned not to use a water irrigating device such as a “water pic” until approximately two weeks following surgery. These irrigating devices have sufficient force that if used immediately following surgery, it could result in a breakdown of the incisions in your mouth.

Postoperative Pain
Because of the numbness from your surgery, postoperative pain is minimal. While in the hospital, you will receive injections for the pain and will be sent home with a liquid pain medication.

Activity at Home

You should expect to be fatigued the first week after your surgery. Do not over exert yourself, but it is important that you do light activity such as walking. You should strive to return to your normal routing of activity when possible. Lifting heavy objects (nothing more than 5 lbs.) is forbidden for four weeks. Lifting heavy objects will delay bone healing.

Handy Items to Have at Home

Patients have told us that several items have been helpful during their recovery period. We would like to share these with you:

  1. A child’s toothbrush, several may be necessary as they wear quickly
  2. The use of a sippy cup or commuter cup for drinking while your jaws are wired together.
  3. Alcohol free mouthwash such as Cepacol or Liquadent Toothwash. Mouthwashes containing alcohol can burn the tissues without you feeing it.
  4. Lip balm or Vaseline for your lips.
  5. A blender
  6. A strainer (wire mesh or coffee filter system).

After your Jaw has been Unwired

It is very important that you follow our instructions after your teeth have been unwired. At this time, the jaws are not completely healed and may require reoperating if these instructions are not carefully followed.

After the wires are removed, small rubber bands will be replaced on your teeth to hold the jaws in the proper position. You should wear the rubber bands all the time except when you eat and brush your teeth. The rubber bands should be changed daily so they maintain their stretch.

Your diet after unwiring is very important. Although you can open your mouth and eat, you must stay on a soft diet. You may eat foods that do not require much chewing. The following are examples:

YES

Baked Fish
Ice Cream, pie, cake
Creamed corn
Oatmeal, Cream of Wheat, Grits
Baked frozen French fries
Refried beans, rice
Smooth peanut butter
Sliced/peeled soft fruit (banana, orange)
Meat loaf, Spam
Shaved beef
Peas, steamed vegetables
Baked potato (peel OK)
Biscuit roll (no crust)
Fruit juices

NO

Fried Fish – Fast Food
Chicken
Corn on the Cob
Cold Cereal
Fast food French fries
Taco
Nuts
Hard raw fruits (apple, pears, pineapple)
Bacon
Deli sandwich
Beef steak
Vegetable salad
French bread

 

Vocabulary

Asymmetry: Uneven jaw

Bone Graft: Bone removed from one part of the body (usually the hip) and used in another region of the body.

Bone Plates: Small metal plates and screws used to hold bones in their new position. These are made of titanium which is an insert metal. They usually remain in place all of your life and do not require removal. They will not set off the metal detectors in airports.

Cephalometric Radiographs: Special X-rays of your skull and facial bones needed before and after surgery.

Intermaxillary fixation: Teeth wired together

Mandible: Lower jaw

Maxilla: Upper Jaw

Occlusion: Bite relationship of your teeth

Orthognathic surgery: Surgery to move the jaws

Osteotomy: Cutting and moving of bones

Paresthesia: Numbness of surgical site (upper and/or lower lips). The numbness may be temporary or permanent

Splint: Small piece of plastic placed between your teeth during intermaxillary fixation.

Study Models: Models of your teeth done by your orthodontist. The models determine if you are ready for surgery. They are also needed before surgery to make a template of your actual surgery.

Surgical hooks: Small hooks or wires placed on your braces by your orthodontist before surgery. These are used for rubber bands and to wire your jaws together.

TMJ: Abbreviation for temporomandibular joint (jaw joint)

Nutrition

Intermaxillary fixation (IMF) requires a change in diet that can be difficult at first. Modification of a simple and pleasurable routine, such as eating, can almost overwhelm the person who is not prepared. It is essential that you try to maintain your weight – this is not the time to diet. Men normally require approximately 2600 calories daily and women require approximately 2000. For proper healing, you may need more calories, protein and vitamins than normally. To help meet these requirements eat more frequently (6-8 times a day). The following suggestions will assist you to a healthy and successful recovery.

  • All food must be blended and strained to remove food particles prior to drinking.
  • Try nutritional supplements such as Ensure, Nutriment or instant breakfast drinks ( all are available in supermarkets and drug stores)
  • Health food stores carry ready made milkshakes such as Rice Dreams, VitaSoy or AmZake. Also available are protein powders such as Weight Gainer 1850 which are easy to add to milkshakes or juices.
  • Other suggestions for on-the-go meals include canned juices (V-8), fast food restraint milkshakes, baby food and fruit in a jar, as well as yogurt.
  • Try to make double batches and freeze in small containers for later use.
  • If you were taking vitamins before, continue to do so. Whole vitamins can be smashed in a cloth, with a hammer and then dissolved in juice.
  • Clean your mouth properly after each meal.
  • If you have lactose intolerance use a milk substitute such as Mocha Mix, Dairy Rich or nut milk.
  • If diarrhea develops try decreasing milk and milk products. Call your surgeon if diarrhea persists.
  • DO NOT USE A STRAW as this could damage the incision or break a wire. Most people prefer to drink liquids from a cup with a lid such as a commuter cup or a tippy cup

RECIPES

Basic Milk Shake (high protein, low fat)
1 cup nonfat dry milk power
1 quart skim milk
Combine ingredients and mix until smooth

Add any of the following
1) 1 jar strained pureed baby food fruit
2) 1 cup ice cream or frozen yogurt
3) 1-2 tbsp. chocolate, strawberry syrup or smooth peanut butter
4) Substitute 1 cup sherbet instead of using dry powder

High Protein Smoothies: (smoothies are like milkshakes, thin or thick, depending on the temperature)
1 cup cottage cheese
1 cup yogurt
Add one of the following:
1) 1 frozen banana + some strawberries + 1 tsp. vanilla + honey to taste
2) 1 peach + some strawberries + 1 tsp. vanilla + honey to taste
3) 1 frozen banana + 2 tbsp. peanut butter + 1 tbsp. sweet hot chocolate mix (powder) + 1 tsp. vanilla + honey to taste

Orange Juice Shake:
Blend until smooth
1 cup orange juice
1 tsp. lemon juice
1 cup orange sherbet
Strain

Orange Sherbet Punch:
Blend until smooth
1 pint orange sherbet
¾ cup ginger ale
½ cup pineapple juice
¼ cup grapefruit juice
Strain

Orange Julie: (good source of protein, vitamin C, iron)
Blend until smooth
2 cups orange juice
½ cup crushed ice
1 raw egg
2 tbsp. honey
¼ tsp. vanilla extract
Strain

Cranberry Fruit Punch: (good source of Vitamin C)
Blend until smooth
1 ½ cups orange sherbet
1 ½ cups cranberry juice cocktail
1 ½ cups crushed pineapple
½ cup water
1 tsp. sugar
Strain

Hawaiian Lemonade
Blend until smooth
½ 6-oz. can frozen lemonade concentrate
½ can water
1 6-oz. apricot nectar
1 small bottle ginger ale
Strain

Combine juices and water; chill. Divide fruit juice mixture among three ice filled glasses. Fill remainder of glass with ginger ale

Pear Icy: (good source of potassium)
Blend until smooth
4 canned pear halves, drained
1 cup crushed ice
¼ cup sugar
1 tbsp. lemon juice

Strain

Fruit Punch (good source of vitamin C, potassium)
Blend until smooth
1 cup ginger ale
½ cup applesauce, unsweetened
½ cup orange juice
½ cup tea
1/3 cup sugar
½ cup lemon juice
Strain

Tomato Juice Cocktail (good source of vitamin C, iron)
2 cups tomatoes juice
1 cup crushed ice
1 cucumber, peeled, seeded and chopped
1 8” stalk celery finely chopped
1 tsp. lemon juice
½ tsp. salt
¼ tsp. Worcestershire sauce
Put all ingredients in blender. Blend until smooth and strain

Baked Potato Soup (good source of protein, calcium, vitamin C)
1 cup milk
½ cup mashed potatoes
¼ cup shredded shard cheddar cheese
1 drop onion juice
salt, pepper to taste
Heat all ingredients in saucepan. Pour in blender. Blend until smooth. Strain

Cheddar Cheese Soup (good source of all nutrients due to Ensure)
1 11 oz. can cheddar cheese soup
½ cup Vanilla Ensure
½ cup water
1 tsp. Worcestershire sauce
salt, pepper to taste
Heat all ingredients in saucepan. Pour in blender. Blend until smooth. Strain

Gazpacho (good source of vitamin C and A)
2 cups chicken bouillon
1 large tomato, peeled, seeded and chopped
½ cucumber, peeled, seeded and chopped
1 tsp. vinegar
½ tsp. garlic juice
½ tsp. sugar
¼ tsp. salt
1 drop hot pepper sauce
dash of pepper
Put all ingredients in blender. Blend until smooth and strain. May be served hot or cold

BBQ Soup (good source of protein, calcium)
1 cup beef bouillon
¾ cup cooked rice
½ cup milk
1 tbsp. liquid vegetable oil
½ tsp. onion juice
½ tsp. BBQ sauce
½ tsp. chili sauce
¼ tsp. prepared mustard
dash each of salt, pepper and Tabasco sauce
Heat all ingredients in saucepan. Pour in blender. Blend until smooth. Strain

Bean Soup (good source of protein, vitamin C and A)
¾ cup chicken bouillon
½ canned pinto beans, drained
½ cup canned carrots, chopped
1 8” stalk celery finely chopped
1tbsp. deviled ham
½ tsp. onion juice
dash garlic powder
salt, pepper to taste
Heat all ingredients in saucepan. Pour in blender. Blend until smooth. Strain

Beef Stroganoff
¼ cup onion finely chopped
margarine
1 jar strained beef baby food
1/8 tsp. paprika
½ can cream mushroom soup
3 tbsp. sour cream
Sauté onion in margarine then combine with meat, paprika, soup and warm over low heat. Place ½ cup stroganoff into blender with sour cream. Blend until smooth and then strain. Serve with vegetables such as instant mashed potatoes.

Tomato Rice Soup (good source of protein, calcium, and vitamin A)
1 10 ½ oz. can tomato soup
½ cup milk
½ cup chicken bouillon
1/3 cup cooked rice
1 tbsp. sautéed onion
1/8 tsp. salt
dash of pepper

Heat all ingredients into a saucepan and pour into a blender. Blend until smooth and strain.

Vegetable Medley

1 can mixed vegetables
1 can cream mushroom soup
1 tsp. onion flakes
2 bouillon cubes dissolved in 12 oz. water
1 tsp. Worcestershire sauce
½ tsp. A1 sauce
¼ tsp. pepper
*1 cup rice, cooked (optional)
Blend bouillon with mushroom soup. Add seasonings and vegetables, sire in rice over low heat. Pour in blender and blend until smooth then strain. Rice may not blend and strain fine enough for some. If so, this dish is just as tasty without the rice.

Sweet Potato Soufflé
3 cups cooked mashed sweet potatoes
¼ tsp. salt
2 eggs
1 tsp. vanilla
3-4 tbsp. margarine
1 cup milk
1 cup sugar
Mash and combine all ingredients except milk and sugar. In a saucepan melt sugar in milk over low heat. Add ½ cup potatoes to blender followed by ¼ cup milk and sugar mixture. Blend until smooth.
Spaghetti Sauce and…
1 can whole tomatoes
1 8 oz. can tomato sauce
1 3 ½ oz. can tomato paste
1 tsp. onion salt
1 ½ tsp. oregano
1 bay leaf
Spaghetti or instant mashed potatoes

Put tomatoes into blender until smooth. Add to other ingredients and simmer 45 minutes. Remove bay leaf. Place ½ cup cooked spaghetti or instant mashed potatoes followed by one cup sauce. Blend until smooth and strain.

Barbeque Sauce
1 stick butter
1 cup sugar
2 large onions, diced
1 oz. bottle catsup
2 tsp. lemon juice
1 tbsp. sage and pepper
½ cup water
1 cup mustard
1 tbsp. red pepper

Mix all ingredients and simmer for one hour. Blend until smooth then strain. Excellent over boiled chicken, beef or mixed with warmed meaty baby food.

Stuffed Potato liquid style
1 medium baked potato, cooked
¼ cup milk
¼ cup cream of chicken soup
¼ cup sour cream
3 tbsp. grated cheddar cheese
1 tbsp. margarine
¼ tsp. onion salt
1/8 tsp. pepper

In saucepan blend milk with soup and sour cream over medium heat until smooth. Add grated cheese and margarine and stir until both are melted. Then add onion salt or table salt and pepper. Place well mashed hot potato in blender. Add very hot mixture from saucepan and blend for 15 seconds, blend until smooth. Strain. If necessary, add additional hot milk to dilute to desired consistency. Make certain milk is hot so potatoes do not lump. When diluting, it may become necessary add more seasoning.

Tasty Turkey Supreme
1 large jar turkey baby food
1 chicken bouillon cube dissolved I 1 cup hot water
3 tbsp. margarine
¼ cup flour
¼ tsp. salt
¾ cup milk

In saucepan melt butter and blend in flour and salt. Add chicken bouillon and milk all at once. Cook over medium heat and stir until thickened and bubbly. Pour sauce over jar of meat that has been warmed. Place in blender and blend until smooth. Strain

Apple Pie a la Mode (good source of protein and calcium)
1 cup apple pie filling
1 cup vanilla ice cream
½ cup milk
dash cinnamon

Put all ingredients in blender and blend until smooth. Strain