What to Expect: After Orthognathic Surgery
Once you are at home, it is beneficial that you stay in bed for the remainder of the day. Keep your head elevated either by using several large pillows or elevating the head of the bed with furniture risers. During your first trips to the bathroom it is best that you ask for assistance. If you should become lightheaded while walking to the bathroom, sit down on the floor immediately, lie on your back with your knees up, and take deep breaths. The dizziness and lightheadedness will pass quickly.
Items that should be immediately available at bedside are a large bowl to use if you become nauseated, ointment for your lips, cold water to rinse your mouth out, spray bottles of salt water (ocean spray) and Afrin for your nose.
Ice packs should be placed on your upper/lower jaw continuously for the first eight to ten hours and longer if possible.
(Upper Jaw Surgery ONLY) “DO NOT BLOW YOUR NOSE!” The bony incisions in your upper jaw connect with your nasal passages. The pressure that occurs in your nose when you blow is immediately transmitted to the sinuses and can cause a bad nosebleed or result in air being forced into the tissues of your cheeks. It is best to avoid problems by keeping your nasal passages free of mucous and blood. It is very common to have light nasal bleeding off and on the first day or two of surgery. If the bleeding becomes heavy and concerns you, elevate your head by sitting up straight and put pressure under your nose with a rolled up piece of gauze and your finger. If the bleeding continues and you remain concerned please contact your doctor.
On the first day it is recommended that you use a humidifier next to your bed and spray each nostril with salt water every fifteen minutes. Each spray should be a strong, continuous spray, which should be sniffed afterwards to help clean the nasal passages. The Afrin nasal spray should be used every six hours. Afrin shrinks the nasal lining and helps the saltwater spray keep your nasal passages open. Probably the best adjunct in keeping the nasal passages open is frequent showering. Some patient’s shower three to four times a day during the first week after surgery.
Please minimize talking. It is best not to have visitors the first day. The local anesthetic, which is used for your surgery, is very long lasting. Your lips willbe numb most of the day. Drinkingwith a glass and talking will be difficult. We will provide you with a largesyringe with a soft tip to aid you in consuming fluids. On the day after surgery, you will quickly learn how to use a cup and can discard the feeding aid.
On the day after surgery, it is important that you begin to ambulate. Walk around the house as much as you can tolerate. The more that you are out of bed, the quicker your swelling will go away. Once you are comfortable with your appearance, we encourage you to walk outdoors. Your activity will improve your spirits and the more active you are, the quicker swelling with resolve.
During surgery, you will be anesthetized with a long lasting local anesthetic and you will be given pain medications through your intravenous line that are extremely potent and long lasting. These measures will assure that you are comfortable following surgery. As these medications wear off, however, you will have discomfort from the swelling. To manage your discomfort, your doctor will give you pain medication usually in a liquid form. You should take the medication only as prescribed. Occasionally, patients will complain of pain in the ears after lower jaw surgery. This is a normal complaint and tends to disappear in the first several days after surgery. If this discomfort persists for more than several days or is especially uncomfortable, your doctor should be informed.
For the first six weeks following surgery, you should adhere to a “NO CHEW DIET.” You should have nothing to eat or drink for six hours before surgery. After surgery it is important that you consume adequate fluids: one full cup of fluid every hour that you are awake. It is not necessary for you to eat anything solid for the first couple of days after surgery. It is best to choose something bland to drink following your surgical procedure such as water, ginger ale, or apple juice.
Avoid milk products and nutritional supplements until the second day after surgery. You can confirm that you are taking adequate fluids by weighing yourself when you get home and comparing your daily weight with your immediate post operative weight. You should not lose more than three to five pounds the first week of surgery. If you find your weight dropping, you simply need to increase your intake of fluids.
A full liquid diet is preferred until the post-operative visit. At that appointment your doctor will reduce the tension in your rubber bands so you can open your mouth. Thereafter you can eat anything that you can fit into your mouth that does not require chewing (mashed potatoes, yogurt, pudding, Jell-O, stewed vegetables, or anything else that can be poured.
Swelling of the face and lips after upper/lower jaw surgery is expected. Ice packs will reduce the facial swelling if used regularly. Your lips should be continuously covered with a thick layer of ointment after surgery especially in the corners. This will promote healing and prevent cracking of the lips. It is not uncommon for people who suffer from fever blisters to develop lip lesions due to the stretching of the lips during surgery. Your favorite ointment will help to minimize or treat eruptions.
Minor bleeding after jaw surgery is common. You should expect your saliva to be bloody for several days. Heavy bleeding with clot formation is unusual and your doctor should be called if noted. As mentioned earlier, intermittent light nasal bleeding is to be expected. On the fifth to seventh day after surgery, patients frequently experience a dark water discharge from the nose, which is the result of blood clots in the sinuses dissolving. This is a self limiting discharge and will clear after several minutes.
It is not necessary to take a shower on the day of surgery. However, most patients feel more comfortable if they shower and shampoo their hair the day after surgery. It is best not to take a bath for the first week after surgery. It is much more difficult to get in and out of a bath and the heat of a bath will cause vasodilation which can result in fainting when standing up.
If you have any questions, please call the Fairfax office at (703) 385-5777. If you call after business hours, you will be able to contact a doctor our After-Hours service.