Orthognathic Surgery

Post op instructions for Orthognathic Surgery

For maxillary Lefort I (upper jaw) surgery:

Immediately following surgery

Expect significant swelling.  Swelling should peak at about 3 days and start to taper off over the next week or so. Swelling should be worse in the morning and lessen during the day.

Pain

Should be controlled with a combination of Ibuprofen and pain medications. Avoid Ibuprofen if directed by your physician, allergy, stomach ulcers, uncontrolled asthma, or kidney disease. The recommended combination is 400 mg of Ibuprofen and 5-10 mg of hydrocodone. You may stagger this or take together. You may have been given liquid pain medication and/or liquid ibuprofen. If not available you can crush hyrdocodone or pain medication into apple sauce and take it that way. Pain medication is notorious for the side effect of nausea. If you are nauseated with the pain medication, go to the regimen of 600 mg of Ibuprofen and 500 mg of tylenol every 6 hours. Remember the maximum allowable dose of tylenol has been changed to 3000 mg in a 24 hour period.

Nausea

Medications such as zofran (odansetran) can be taken sublingually (placed under the tongue) as directed.   Phenergan may also have been prescribed in the form of a trans dermal cream. This will need to be filled at a pharmacy that compounds this such as Professional Arts, Carmichael’s, or Cashway. Phenergan also is prescribed as a suppository. If vomiting occurs, stop oral intake for 45 min and let the bowels rest. Start back with ice chips, then slowly with ginger ale or sprite with the bubbles stirred out. If this is held down, move to saltines or crackers. If you vomit during any point of this transition, start over back at the ice chips. If you have continued vomiting and have stopped the pain medication and anti-nausea medication is not helping, please call the office.

You will also be given antibiotics. Please take these as prescribed. These medications can cause diarrhea after prolonged use. Other reasons for diarrhea would be an all liquid diet or a stomach virus. If you have continued diarrhea please call the office and let us know.

Your diet will be all liquids for the first week or two, then slowly moved into a soft diet. If you are wired shut then you will have a liquid diet for 6 weeks.

Your teeth may also feel numb. You may have an acrylic splint in place to help guide your bite and help keep the upper jaw in its new position. There may also be rubber bands spanning from the lower jaw to the upper jaw helping you guide your new bite into the correct place. If these pop or come off before your next doctor visit, just let us know.   We can replace them easily and show you how to do it yourself.

You may have a dressing or bandage under your nose. You can remove this if you are not bleeding. This is to keep blood from running down your face in case of a nose bleed. You may also feel very congested. You can have Afrin nasal spray 2 puffs / nostril every 12 hours for bleeding and/or congestion. Saline nasal spray is useful for excess dried nasal secretions. Do not forcefully blow your nose.   This may blow air through the nose to the sinus to the tissue around the incisions.

Your incisions

Are inside your mouth and the stitches should loosen and fall out within 7-10 days. If these open up please let us know. There should be no incisions outside the mouth for upper jaw surgery and you can bathe or shower at your convenience.

Remember you may be very numb after this surgery and this should diminish over time. In some, especially older individuals, it may persist. Your doctor will monitor this and advise you accordingly.

Follow up

Should be within one week after discharge. Please call to make an appointment if not already scheduled. He will see you every week or two until healed. You may call or come in anytime for any concern you may have. Office phone Lafayette Office Phone Number 337-984-0403

Mandibular (lower jaw) surgery:

Also expect swelling with lower jaw surgery. Again, this will peak at 3 days and slowly taper off over the next 7-10 days. You may have a large bandage over your head which helps with swelling. This can be taken off after 24 hours for a short while then replaced for another 24 hours. After 48 hours this can be discarded. Ice your face for the first 24-48 hours. 20-30 min on and 20 off. If you experience swelling after your initial swelling has gone down or fever with your swelling, please call the office and let one of the doctors know.

Expect some bruising and discoloration on the face and neck. This will dissipate over the next week or so.

For pain medication instructions see the reverse page for maxillary surgery.

You will have 2 small incisions on the cheeks to assist in placement of the screws and plates which hold the jaws together in their new positions. There may be bandages over these and they may likely fall off after a few days.   The stitches will be removed on your follow up appointment. You may bathe anytime after surgery as long as no incisions are submerged under water. Showering is permitted after post op day 5 and remember to pat dry any incisions that were wet.

You may be wired shut.

If so you will need liquid pain medications. Pain or discomfort will peak with the swelling at day 3 or so and should taper off over the next week. A combination of ibuprofen and narcotic pain medicine (usually hydrocodone liquid or pills) is sufficient for pain control. Again if you are wired shut you will have wire cutters on you at all times in case of an emergency. It is important to only cut these wires in case of an emergency. There are wire loops that are looped around the upper and lower bars along the gums of the teeth holding the upper jaw and lower jaw together. Just cut one or two loops and opening will be very easy. There may be a total of 4-6 loops. This will also be demonstrated by your doctor or assistant the day of surgery.

Expect some bleeding until the end of the first day and maybe even a little the next morning. Try not to chew on the gauze for this might unravel the sutures. Just apply direct pressure.   The gauze along with the bandage will help stop the bleeding. Profuse bleeding that is not controllable should be brought to the attention of the office and may require a visit for evaluation. Tea bags might be helpful but should be moistened and wrapped in an opened gauze if braces are present due to the possiblity of the braces catching or tearing the tea bag. Place them on the suture areas for 10-20 min, then return to gauze.

Your diet

Will be a liquid or non-chew diet for the next 6 weeks especially if you are wired shut. If you are not wired shut, we would still like you to have a non-chew diet for the first 4-6 weeks so the bones can heal in this new position. Straws are permitted and may be required for those wired shut. Commonly patients will use starches as a base and add protein to this, such as mashed potatoes with meat, broth, and vegetables. Blended soups, smoothies, protein shakes, red beans and rice blended, gumbo blended, overcooked pasta chopped up, orzo, rice, that can be just ingested without chewing is ok.

Remember you may be very numb after this surgery and this should diminish over time. In some, especially older individuals, it may persist. Your doctor will monitor this and advise you accordingly.