HOME CARE INSTRUCTIONS FOLLOWING CORRECTIVE JAW SURGERY:

MEDICATIONS:

- You may have been prescribed an antibiotic, an analgesic with stool softener, a decongestant and a nasal spray (or any combination). Take all the medications as prescribed except for the analgesic, this may be taken as needed.

- Avoid taking Aspirin, Aleve, Motrin or other over-the-counter medications that may increase your risk for bleeding.  Tylenol and other prescribed pain relievers should only be used.

POSTOPERATIVE CARE GUIDELINES:

- BEING WIRED CLOSED: Very often it is required to have the jaws maintained closed with the use of wires, elastics or both. This is called Maxillomandibular Fixation (MMF). The jaws cannot heal without being maintained closed.

- THE MMF MAY ONLY BE REMOVED IN AN EMERGENT SITUATION!  You have been discharged with wire-cutters and you should keep these with you at all times.  In the rare circumstance that these must be removed, please have someone else aid you in cutting the wires.  The MMF is released by cutting the wires/elastics located on both sides and in front with heavy scissors.  If you feel nauseous you do not need to cut the MMF, as long as you have only eaten liquids you are not in danger (please read below about diet). Do not eat until the nausea subsides.

IF YOU FEEL THAT YOU ARE GOING TO VOMIT, follow these steps:

1. Bend forward or roll on your side.

2. Put your finger inside your cheek and pull your cheek out.

3. Allow the vomit to come out your nose and mouth while you continue to lean forward.

- It is NOT recommended that you cut your wires when you think you are going to vomit.  Remember that everything you are taking in is liquid.  If anything comes out or is vomited it will be liquid too.  If you feel nauseated, make sure to take antinausea medication.  If you need an additional prescription, please call our office.

IF YOU HAVE TROUBLE BREATHING so that you are unable to catch your breath, follow these steps:

1. Go to the emergency department with someone immediately.

2. Place a spoon inside your mouth, in your cheek.

3. Pull the spoon outward.

- If you are not breathing because of nasal stuffiness, you should take a nasal decongestant.

DIET:

- If your jaws are wired closed you MUST maintain a liquid diet ONLY; you should not attempt to eat any foods that require chewing.  Proper healing of your facial fractures require rest from chewing any foods.  Additionally, in the event that you become nauseated and vomit, you will be able to expel liquids through the apparatus safely.  For the first two days after the procedure a clear fluid diet is recommended. Remember to rinse your mouth with Peridex or salt water before and after meals. The third day after the procedure you may begin to eat a full liquid diet with supplement such as milk shakes and nutrient drinks (SustaCal/Ensure). Remember to rinse after every meal.

- Monitor your weight to ensure that you are not losing more than 1-2 pounds weekly.  If you are, please start or increase your intake of meal supplement shakes to ensure that you are receiving your daily caloric requirement. 

- Ensure that you are also staying adequately hydrated.  If you notice that you are urinating less frequently or if your urine is dark yellow and or foul smelling, this may indicate that you are not taking in enough fluids.  Please increase your normal amount of fluid intake

- Avoid eating or drinking anything that may make you nauseated.  We generally recommend that all alcoholic products be avoided.

- Your mouth will be swollen, and for the first 24 hours you will most likely ooze some blood from your mouth incisions. You will need to sleep elevated in the bed on 2-3 pillows to help reduce some of the swelling. Also, for several weeks, expect some numbness in your lips and gums.

- Your lips will be very dry. You can apply Vaseline or Carmex frequently to prevent further chapping.

ORAL HYGIENE:

- You should brush your teeth lightly and thoroughly; be gentle in the area where you had surgery.  You will receive a prescription for Peridex, which is a mouthwash for rinsing several times a day. We recommend using the Peridex for 7-10 days post-op. After that, we recommend you rinse with salt water or half-and-half peroxide and water. (The salt water solution can be made by adding one teaspoon of table salt to an 8 oz glass of warm tap water).  Both Peridex and salt water encourage healing and aid in keeping the bacteria in your mouth to a minimum. It is very important to use these rinses. You should always rinse after every meal.

- The stitches in your mouth are a special kind which dissolves. They require no special care except to keep them clean by following the oral hygiene instructions. It is very important, once again, to keep your mouth clean to prevent bacteria from sticking to the stitches.  The sutures in your mouth will take quite a while to fall out. Do not be surprised if they are still there at three months post-op. If you spit some of these out, understand this is normal and not something to worry about.

ACTIVITY: 

For the first three days stay as quite and relaxed as possible. You may get up to move around the house, but no lifting or moving heavy objects. Keep your head above your heart.  No bending over for the first 10 days.  For children, a minimum of 10-14 days of decreased activities will be required before returning to school.  When you return to school, you can resume normal activities, except for physical education classes. No contact sports are allowed for 3 months. If you need documentation for the school, we would be glad to give you a written excuse. Absolutely NO SWIMMING until advised and wear your seatbelt while in a vehicle at all times.

WHAT TO EXPECT FOLLOWING SURGERY:

BLEEDING: A small amount of oozing or bleeding is common for the first 2-3 days after the surgery and may continue for up to two weeks. Very often the saliva or salt water from rinsing will be pink when expelled from the mouth. If there is question about the amount of bleeding contact our ENT Service; if the expelled saliva/salt water is bright red in excessive amounts go to the nearest emergency room. 

NOSE BLEEDING: DO NOT BLOW YOUR NOSE UNTIL ADVISED THAT THIS IS OK.  If you are having significant congestion, or discomfort contact our office.  You may have been prescribed medication to keep you from getting congested. Take the medication as directed. Blowing your nose can cause significant bleeding and other complications and should be avoided.

SWELLING: The swelling usually reaches a maximum at 48 hours after the procedure. In rare instances you may notice an increase in the amount of swelling after leaving the hospital/office; generally, this is swelling from the procedure, NOT from the infection. Ice packs should be applied to the affected area(s) of the face and jaws, 15 minutes on and 15 minutes off (repeating), for the first 48 hours after the procedure. The head should be maintained elevated for the duration of the post-operative swelling period.  You may experience some bruising of the cheeks, around the eyes, down the neck and even to the level of the chest. This is a result of the venous drainage system of the head and neck, do not be alarmed.

PAIN: Take the prescribed medication as directed. Depending on your procedure and diet, the medication will be in tablet or liquid form (tablet/Elixir). If you have been prescribed a medication with a narcotic and do not desire the narcotic, you may take Tylenol as directed.

If wires are rubbing against your and gums and causing pain, irritation or burning, you may find dental wax helpful.  You can get it at most drug stores or dental supply stores.  Pinch off a small amount of wax and apply it directly over the wire that is irritating you. The wax will act as a cushion between the wires and your gums.  You should remove dental wax before brushing your teeth, and then replace it afterwards.

PLEASE NOTIFY OUR ENT SERVICE IMMEDIATELY IF YOU:

- Must cut the wires for some reason

- The wires have shifted or have come loose

- Have some additional injury to your face or jaw

- Develop clear or bloody discharge from your ear or nose

- Develop any changes in vision or pain with eye movements

- Develop a continuous nasal discharge with a sweet or salty taste

- Develop pain or nausea that your pain medications do not relieve

- Have a temperature of greater than 101F (38C) over 24 hours which does not decrease after increased fluid intake