Fractured Jaw Surgery
Following these instructions will help you to feel better and recover faster after your jaws have been wired. Please read them carefully and ask questions about anything you do not understand.
- It is recommended that you sleep with your head on two or three pillows. This helps to decrease the swelling in your face and also will make it easier for you to breathe.
- Avoid doing anything that requires heavy lifting, pushing or straining while your jaws are wired together.
- Do not try to work you jaw back and forth against the wires. This will loosen the wires and teeth and prevent the bones from healing.
- Avoid water related activities such as swimming and water-skiing while your jaws are wired because its hard to clear water out of your nose and airway.
- Do not drink alcoholic beverages while your jaws are wired.
- Elastics that are hooked to the wires on your upper and lower teeth hold your jaws together. Over time elastics can loosen, fall off or break. Losing a few elastics is not a problem as long as you cannot open the mouth. If you find that you are able to open your mouth due to loss of elastics, keep your teeth together and call the office so we can add more elastics.
- Use saline nasal spray as frequently as necessary to help keep your nose clear.
Care of Your Mouth & Teeth
Brush your teeth after every meal and at bedtime. Meticulous oral hygiene is extremely important to prevent tooth decay and gum inflammation caused by food build up between the wires and your teeth. These bits of food can also cause bad breath. Thorough tooth brushing is the single, most important part of good oral hygiene; it is best to use a child-sized, soft-bristled toothbrush with toothpaste. The head is smaller and will be more comfortable for you. Brush your teeth and wires by using rotating motions directly on the teeth and wires. Brush until the wires are shiny clean.
Use the Peridex (Chlorohexidine) mouth rinse prescribed by us twice a day after brushing, Swish in your mouth for one minute then spit out. In addition to the Peridex use a dilute mouth rinse (Scope, Act, etc.) after meals and at least four times a day. The rinse will help to clean the inside surfaces of your teeth which you cannot reach with a toothbrush.
Run your tongue along the inside of your teeth several times a day to help clean them. A Waterpik is helpful to loosen food and debris trapped between the wires and elastics. Use a Waterpik several times each day in addition to brushing and rinsing.
If the wires are rubbing against your lips or cheek and causing pain, irritation or burning, you may find dental wax helpful. Dental wax is available at most drug stores. Pinch off a small piece of wax and apply it directly over the wires that are irritating you. The wax will act as a cushion between the wires and your gum. You should remove dental wax before brushing your teeth; then replace it if necessary.
Elastic fixation is released approximately six weeks after treatment (except in cases of condyle fractures where elastics are usually removed 10-14 days after treatment). Wires are usually removed approximately two weeks later.
Approximately four to six weeks after your wires are removed you will need to visit a dental hygienist for a pof your teeth.
A blender or food processor will be required to prepare your meals. Almost any food can be liquefied in a blender. You will need to add enough liquid (juice, milk, water) to liquefy solid foods. You may also need a food strainer if you teeth are very close together with no space between them. The strainer can be metal mesh or cheesecloth. After food has been liquefied in the blender a strainer will remove any small residual pieces of food, which could get caught in your wires or elastics.
Most people prefer foods that are neither hot nor cold. Very hot liquid may injure tender or numb mouth tissues. Very cold liquid may be painful to sensitive injured or fractured teeth. It is easiest and most efficient to drink right out of a cup. Drinking from a straw requires puckering and suction, which is inefficient and difficult when your jaws are wired. Basic good nutrition is essential to keep you healthy, speed up recovery and assist in healing. Even though you cannot chew, you still need a balance of protein, fruits and vegetables, dairy products and grains. It is easier to get proper nutrition if you eat five to six times a day.
It is difficult to maintain your weight on a liquid fracture jaw diet. You should monitor your weight regularly while your jaws are wired together. Commercial nutritional supplements such as Ensure, boost or Sustical are a convenient way to increase calories and protein. You can find them at most drug stores and many grocery stores. These nutritional supplements should not be used to replace other foods; they should be used in addition to other foods. Drink one can of Ensure three times a day in addition to your meals. An over the counter daily liquid multivitamin supplement is also recommended.
If You Vomit
If you feel that you are going to vomit, follow these steps:
- Bend forward or roll onto your side.
- Put your finger inside your cheek and pull your cheek out.
- All the vomit will come out of your nose and mouth while you continue to lean forward.
- It is not recommended that you try to cut your elastics when you think you are going to vomit.
- Remember that everything you are taking in is liquid. If anything comes out it will be liquid as well. The most important thing is to BEND FORWARD AND HOLD OUT YOUR CHEEK to make it easier for the vomit to get out of your mouth.
- Anti-nausea medicine can be prescribed if nausea persists.
If You Have Trouble Breathing
If you have so much difficulty breathing that you cannot catch your breath, follow these steps to open your airway as much as possible:
Place a spoon inside your mouth between the teeth and your cheek and stretch the cheek outward to create breathing space.
If you are not breathing well because of nasal stuffiness try an over the counter saline nasal spray. Saline nasal spray can be used as often as necessary with no adverse side effects. If this problem persists, please call our office.
You will be given antibiotic following your surgery. Please make every effort to take them as prescribed. If you were given Keflex elixir, take two teaspoons every 6 hours for ten days. If you are allergic to Penicillin, it is highly advisable to avoid taking Keflex but inform us in advance and we will replace it with Cleocin or Clindamycin. Usual dosage is 300 mg every 8 hours. Developing infection post-operatively is extremely rare but please take your medication as instructed.
Anti-Swelling Medication (Steroids)
To avoid swelling, we will cover you with steroid – usually taken every 8 hours after surgery for 4-5 days. One day after completing a course of steroids you may experience more pain and swelling. This is totally expected and will subside within few days. To minimize swelling, sleep with two pillows and try and prop yourself up a little bit. If you wake up and are swollen, gravity will lessen it during the day. Place ice over the site for the first week and then move onto moist warm heat. Remember that your face will probably be changing each week for 2 months.
Most patients will not need to use major pain medication a few days after discharge from the hospital or from our center. We have been told by hundreds of our patients that their wisdom teeth extractions hurt them more than their jaw surgery. The reason could be that your mouth and teeth are numb after surgery. Although you will get used to the numbness shortly after surgery but the degree of pain is far less than what most people expect. Tylenol with codeine or a similar pain medication will be prescribed for you. Use it with discretion and try to use other over-the-counter medication such as liquid Ibuprofen.
All sutures used inside of your mouth will dissolve by themselves. If there are few skin sutures on the sides of your face they need to be removed within a week.
Generally speaking, we make every assurance to keep you in the recovery area or the hospital until all bleedings has stopped. As with any surgical procedure, there is always the risk of post-operative bleeding. If it becomes excessive then call us or come back to the center the following day. If you had upper jaw surgery try not to bend down to pick anything as this empties the blood in your sinuses out of your nose and may scare you. Do not blow through your nose and do not use straws or smoke cigarettes. You may experience some bleeding when you brush your teeth, but it should be minimal. Nosebleeds are quite common for those who have undergone upper jaw surgery, but usually only last for the first week or so. If you get one, just apply ice over the nose area and it should stop or just pinch your nose until it stops. If for any reason the bleeding becomes excessive call us immediately whether its in your nose or mouth.
Once you are out of surgery you might get dry lips; just make sure you have a product like Vaseline (petroleum jelly) around to keep your lips moist.
It is possible that once you come out of the surgery you will have a sore throat. This is because of the airway tube has agitated your throat. Try gargling with salt water if you can. Throat lozenges will help too. The sore throat will last up to a week.
The amount of bruising varies with each individual. Some people get slight bruising on their face, while others have it running all the way down into their chest area. Bruising may occur one week after surgery and is because of a breakdown of small blood vessels under your skin.
Generally, bruising will disappear in several weeks. Applying moist heat with a towel will help remove most of the bruising.
Very simply stated, keep your mouth area clean! Brush after each meal. It may become tiresome because of the regularity of your meals, but good hygiene is important for proper healing and a speedy recovery. Your mouth, including the lip, chin, gum teeth and part of your tongue could feel numb and quite strange. For few days, your teeth feel like wood. We highly recommend using a water pick or frequent rinsing to help the healing. Remember when cleaning/brushing the teeth, some bleeding might occur, just be careful and not brush over the sutures or else you will bleed.
Generally speaking, your mouth will not be wired together therefore it is easier to brush your teeth. If you are wearing elastics and a plastic splint then you can brush with no problem. Once the splint is taken out of your mouth in a week you can take the rubber bands out to rinse and brush your teeth. During your first week after surgery you might have some sore areas in your mouth and lips and not be able to open your mouth enough to be able to brush on the insides of your teeth, but it will get better. Just remember to keep those bristles away from the stitches and keep them on your teeth/braces. A baby toothbrush will work well at this time. After you brush, rinse thoroughly with a small amount of salt water and/or mouthwash mixed with water.
Avoid rinsing your mouth immediately after surgery and only up to 24 hours after surgery. Starting 24 hours following your procedure, you must rinse as often as possible to keep your mouth in as good of an oral hygiene as possible. You can use warm salted water or any over the counter mouth washes you like. If you were given a special prescription mouthwash such as Peridex, you must use it twice a day only. This is an antibiotic containing prescription oral rinse. If you rinse more often than twice daily it will stain your teeth.
If you are having any upper jaw procedures your nose could be congested. For the first 3-4 days you can use a nasal decongestant as well as oral decongestant. But then discontinue the nasal decongestant and use saline irrigation and steam your face, nose and mouth. Bleeding, mucous discharge out of the nose is very common. Do not blow through your nose; this will cause significant harm as it could lead to opening of your sinus cavity into your mouth. This can cause fluid reflux out of your nose.
All incisions are internal so you can take a shower (as long as you are not taking narcotics and someone is keeping an eye over you).
You can walk the day after surgery if you had both jaws operated on. You can walk the day of surgery if you just had one jaw surgery. No contact sports for 6 months after surgery. Any trauma to a recently operated jaw will mean repeat procedure and possibly failure of surgery.
It is highly recommended to start moving your jaw and trying to open as wide as you can starting two weeks after surgery. Do not apply any excess pressure on your teeth or your jaw. Applying a warm moist towel to the sides of your jaw may be helpful. Approximately a month after your surgery you can apply some pressure over your teeth to open even wider.
It is not unusual to feel depressed after your surgery. This ccould be because of swelling and bruising, numbness of lips and chin or many other factors. Patients must have realistic expectations. This procedure involves delicate incisions in the gum and bone and re-approximation to a new position. Going through any surgical procedure is not a pleasant and desired situation. But in order to solve the problems there are steps to bypass and several weeks of recovery. Please be patient and prepared. The final results are usually great. One of the normal frustrations is the diet restriction. We have discovered that at these times family support and your positive attitude will make this transition a smooth one. Just remember why you went through with this procedure, and most importantly feel good about who you are. You have undergone a major reconstruction of your face, your look and your bite. In our center we have hundreds of patients who have gone through the orthognathic surgery procedures and will answer your questions and you can also count on Dr. Madanis team who are all courteous, understating and will answer every question you may have in great detail.
Food & Diet
Dehydration and lack of proper nutrition can make you weak and interfere with the healing process. The first two to three weeks after surgery you must be on a full liquid diet such as high protein drinks (Ensure & Boost) milkshakes, blended food, soft whipped potatoes with gravy, avocados, applesauce, juices and soup. Try to avoid using straws. The first few weeks after your surgery your jaw will tire quite easily when eating, so it is important to eat frequently (a small amount of food every 3-4 hours) to maintain sufficient calorie intake. No major chewing for two months after surgery is recommended.
Starting in your second month after surgery you can move to soft foods like soft rice dishes, chicken noodle soup, baked fish cut up into very small pieces, scrambled eggs, pie, and heartier soups. Because in most cases the inside of the mouth including the roof of your mouth is slightly numb your tongue plays an important role in helping you to move the food around your mouth and swallow. Stay away from pizza, chewy steaks, apples, and carrots until your jaw has completely healed and that is about 6 months.
It is important to try and drink from a cup if you can. It will feel weird because your lips could be numb, and you will dribble and drool. Just take it slowly and you will get used to this in a week. You must make sure that you take in a lot of liquids. To drink from a cup put a towel bib around your neck and place your head slightly back and try and open your mouth a bit while pouring the liquid into your mouth. Then try and swallow. Usually most of our patients resume their normal drinking in a week.
The initial healing phase will take approximately six weeks; however, the completed healing process will require approximately 9 to 12 months. During this healing phase it is very important that you practice the best possible oral hygiene.
Notify Our Office if You
- Must cut your elastics to open your mouth for some reason.
- Think the elastic have shifted or have become loose enough to allow you to open your mouth.
- Have discovered an additional related injury to your face, jaw or body.
- Develop nausea that your prescriptions don’t relieve.
- Have a temperature of 101 degrees or more.
What are the complications after fractured jaws?
Complications following repair of a mandibular fracture are rare. The most common complication is infection or osteomyelitis. Malunion and nonunion of the mandible occurs because of failure to maintained jaws wired together. Malunion is or delayed, incomplete, or faulty union following a fracture also occurs if you cut the wires prematurely after your surgery.
Other factors contributing to malunion or none union include:
- Infection (the greatest factor)
- Injury severity
- Lack of fracture stability, (being able to move the lower jaw freely while wired together!
- Metabolic and nutritional deficiencies
Contributing factors may include (1) poor oral hygiene and dental or periodontal infections, (2) teeth in the fracture line, (3) alcohol abuse and chronic disease (4) poor patient compliance, and (5) displacement of fracture fragments.
Please note that in case of infection, non or malunion we may have to repeat the procedure, bone grafting may be required and more extensive type of surgery may be needed as well.