Snoring Treatment Post Operative Instructions

Dr. Mansoor Madani

One of the most important parts of your surgery is the postoperative recovery. Thanks to our patients we have some great advise bellow and hope they help. During the healing phase it is very important to follow the instructions given to you by our team. You can expect temporary swelling especially of the lips, cheeks, and perhaps bruising, but this is a normal healing response and will disappear over the first 7 to 14 days. In the first few days after surgery you may experience sore throat or nasal congestion due to the nasal tubes used for anesthesia. This postoperative discomfort is not usually significant and it may be controlled with medications.

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.

During this time you might experience a drop in weight, however, this can be regained after the initial bone healing has been completed. During the first week after surgery your dietary intake is very important and we will advise you on different supplements, which are available for you. You will receive a dietary consult while in the hospital and supplementary information in this page of our web site explaining what you can and can’t have while healing. As always, if you should have any questions during this time, please feel free to call us.

Antibiotics- 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-tea spoon 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 medications as instructed.

Anti-swelling medications (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.

Pain- Most patients will not need to use major pain medications 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 medications such as liquid Ibuprofen.

Sutures- 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.

Bleeding 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 straw or smoke cigarette. 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.

Soreness/Dry lip 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 moisten

Sore Throat 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. Sore throat will last up to a week

Brushing /oral hygiene 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 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 they 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.

Rinsing- Avoid rinsing your mouth immediately 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. If you were given a special mouthwash such as Peridex you must use it only twice a day. This is an antibiotic containing prescription oral rinse. If you rinse more often than twice daily it will stain your teeth.

Nasal Congestion 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 and your 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.

Bathing All incisions are internal so you can take shower (as long as you are not taking narcotics and someone is keeping an eye over you).

Exercise/Physical ability – 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.

Jaw Motion 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.

Depression- It is not unusual to feel depressed after your surgery. Could be because of swelling and bruising, numbness of lips and chin or many other factors. Patients must have realistic expectation. 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. Madani’s team who are all courteous, understating and will answer every question you may have in great detail.

Food and 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 totally 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.

Healing process 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.

The post-surgical orthodontic treatment phase will start approximately four to eight weeks post surgery. The orthodontist will be able to make minor adjustments to ensure that your new bite and your teeth are in the best possible relationship. Usually this phase requires 3 to 12 months after which your orthodontic appliances will be removed.

Here are few other recommendations:

1. Avoid doing anything that requires heavy lifting, pushing or straining while your jaws are wired together.

2. 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.

3. 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.

4. Do not drink alcoholic beverages while your jaws are wired.

5. 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.

6. Use saline nasal spray as frequently as necessary to help keep your nose clear.