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After Orthognathic Surgery of the Jaws
Postoperative hemorrhage requiring surgical intervention is rarely encountered following orthognathic surgery. A small amount of bleeding is to be expected following the operation. Some bleeding or redness in the saliva is normal for 48 hours. Excessive bleeding which results in your mouth filling rapidly with blood can frequently be controlled by biting with pressure on a gauze pad placed directly on the bleeding wound for four hours, changing the gauze every hour if the jaws are not wired together. If excessive bleeding continues after biting firmly on the gauze for 4 hours, it may be controlled by first rinsing or wiping any old clots from your mouth and then biting on a moistened tea bag wrapped in gauze for one hour. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. Nasal bleeding can usually be controlled by placing pressure along the side of the nose that is bleeding and tilting the head back for one hour. A drip pad using gauze placed under the nostrils may be necessary for the first 2-3 days to catch any oozing that is present. If the bleeding does not subside following the above measures, call the office immediately at 770-396-8860.
Swelling of the face and neck is a normal occurance following major orthognathic surgery. Swelling of the cheeks and side of the nose may last for 4-6 months after surgery, and swelling of the lower jaw and neck may last for 4-5 weeks. Use ice packs (externally) on the same side of the face as the operated area continuously for the first 48 hours only while you are awake, then switch to heat to the side of the face for the next week to help reduce swelling.
For mild discomfort use Tylenol 500 mg 1-2 tablets every 6 hours or Ibuprofen (Advil, Motrin) 200mg (2-4 tablets) every 4 hours as necessary for pain. For severe pain use the prescription given to you. If the pain does not begin to subside in 2 days, or increases after 2 days, please call our office. If an antibiotic has been prescribed, you must finish your prescription regardless of your symptoms. A steroid, such as Medrol Dose Pack, may have been prescribed for swelling. If a rash or itching developes, stop taking the offending medication and call Dr. Anderson at 770-396-8860 immediately.
Restrict your diet to liquids and pureed foods with one can of Boost, Ensure, Carnation Instant Breakfast or Slim-Fast between meals for six weeks following surgery. You should be having 6-8 small meals a day of a high protein, high calorie, high fat diet. You should be ingesting a minimum of 150 grams of protein and 2500 calories per day. Powdered food supplements (Meretine, Sustagen, Provimalt, or Carnation Instant Breakfast) may be added to whole or 2% milk for extra protein. Use a food processor to puree any food that you want to have and then dilute the puree to the consistency that is necessary for you to drink. If your jaws are not wired together, you do not need to dilute your foods and can have anything the consistency of mashed potatoes. It is important to drink plenty of fluids following surgery to help your body replace blood loss during your surgery. Drink at least six glasses of liquid per day in addition to your dietary intake.
If you become nauseated, lay down and elevate your feet. If the nausea subsides by the maneuver, the nausea is caused by a drop in your blood-pressure. To minimize this condition, when standing-up, do so slowly. If you become dizzy or nauseated, lay down. If your nausea is related to taking any of your prescribed medication, you will need to take Phenergan 25 mg every 4-6 hours. Call Dr. Anderson if you require this medication.
If you had maxillary (upper jaw) surgery, use two squirts of Afrin Nasal Spray in each nostril four times per day to reduce nasal mucosal edema and congestion for the first two weeks following your surgery.
The pressure dressing over the extra-oral incisions may be removed after 24 hours. The extra-oral incisions are to be cleaned with a 1:1 solution of hydrogen peroxide and water to remove gross crusting along the incision after the third day and twice a day there after. The incision should then be covered with a thin layer of triple antibiotic ointment, and a band-aid placed over the sutures. You may shower after two days and then follow the above instructions concerning care of the incisions.
After the first post-operative day, use a warm salt water rinse (1 tsp salt to 8 oz. water) or mouthwash every 4 hours and following each meal to flush out particles of food and debris that may lodge in the operated area. You should also begin brushing your teeth after each meal or diet supplement the day following surgery. However, only brush the teeth, braces or arch bars, and wires. Do not brush the oral soft tissues or any sutures present within the mouth. The use of a Water Pik to clean the teeth may be resumed after 7 days to avoid opening any intra-oral incisions that are present. Superb oral hygiene is required in order to prevent infections of the surgical site, breakdown along the incisions, or periodontal infections of the gums.
Whether your jaws are wired together or not, the hardware may cause painful ulcerations of the mucosa of the lips or cheeks. The placement of bees wax used to cover braces will relieve this problem and can be obtained from any pharmacy.
If your jaws are wired together, you cannot moisten your lips normally. Use Chapstik or Vasoline Intensive Care Lip Balm 5-6 times per day to keep the lips soft and pliable and to prevent cracking.
Atlanta Office:
4721 Chamblee Dunwoody Road, Ste 301
Atlanta, GA 30338-6000
770-396-8860 O 770-395-6546 FAX
