P K Patel MD
12. Recovery: The First Month After Jaw Surgery
With our current approach to surgery, over 95% of our patients are well recovered between the 2nd and 3rd week after surgery. Our patients are returning to school and back to work much earlier. It is typically the first 3 days after surgery that is the worst, when the face is swollen, managing the pain and discomfort and figuring out how to eat.
Facial swelling peaks after about a day and half after surgery. Swelling gets worse before it gets better. We suggest using ice cold compresses (wash cloths soaked in ice water) or 'frozen peas' or any commercial product as much as possible during these early days after surgery. Many patients feel more comfortable having something cool next to their face. Keeping the head elevated and being up and active will help decrease the swelling faster. Facial swelling is worst in the morning because of lying down, and one side maybe more swollen than the other. Also the lips will be swollen, use vasoline or any lip moisturizer.
Pain and discomfort from the surgery is best managed by staying on top of a medication regimen. It is easier to control the pain before it gets worse. Many of parents have found that best way of managing this is by alternating the prescribed narcotic medication with an over-the-counter ibuprofen (motrin, advil type) every 3 hours for the first 3 to 7 days after surgery. After 7 days, use the prescribed narcotic occassionally. By the end of the first week or the second week after surgery the only medication needed is the over-the-counter ibuprofen. Do not drink alcohol, smoke or drive while taking narcotics.
As we do not wire or rubber band the jaws together, we encourage drinking liquids and eating as soon after surgery as possible. This is important. Keeping up with fluids will help prevent becoming de-hydrated. Beginning with soft foods first and then gradually increasing your diet will help maintain your weight and importantly begin to re-train your bite and exercise your jaw muscles. You must remember that your new bite is in a completely different position from before the surgery. It will take time to adjust how your teeth meet, how you chew and how you swallow. The more that you use your mouth to eat and to talk, the faster your recovery will be. Try to eat smaller portions more frequently (4 to 6 times a day).
This will help keep the mouth clean and allow the mouth wounds to heal. For the first 2 weeks after surgery, please swish and rinse your mouth as frequently as possible, as much as 6 times a day. Use a salt water or a mixture of equal amounts hydrogen peroxide and water. Peroxide will help remove any blood clots at the beginning, after that you can use saltwater. Begin brushing the teeth 1 week after surgery. Beginning gently brushing the gums 2 weeks after surgery. A child size brush with soft bristles will be easier to use at the beginning. The gums may bleed initially but will improve with time. As you continue to brush the gums, the sutures will come out on their own.
For upper jaw surgery, it is equally important to care for the nasal lining. To help it to heal, begin using a salt water nasal spray. Use this at least 3 times a day, and more frequently if possible for the first 3-6 months after surgery. Spray the salt water into each nostril to help decongest and loosen any dried blood. There are various products in the drug store. Buy the least expensive.
Guiding Dental Elastics
Generally 2 weeks after surgery, guiding dental elastics are placed to help guide the teeth into their new bite. Remember that your bite has been completely cahnged with the jaw surgery. Think of the dental elastics as tiny 'muscles' that train you into your new bite. These dental elastics are then adjusted as needed to begin to optimize the bite. You can take off the dental elastics to eat and brish your teeth.
You will find difficulty in fully opening your mouth. This is because of the facial swelling and the limited jaw muscle activity. Beginning 2-3 weeks after surgery, start exercising your jaw to maximize your mouth opening. The best way to do this practice opening and closing your mouth (without dental elastics) in front of a mirror, 10 times each morning and evening. Begin slowly and gradually to increase the amount of opening. This will take 2-4 weeks.
From the 2nd day after surgery, we would like you to try to begin to sit in a chair and then begin to walk. You can take a shower the following day. This will make you feel better and will help with the recovery. Each day you should continue to be as active as you can be. Each day push yourself a little more and when you are tired, rest. The sooner you try to return to your normal activities, the faster you will recover from surgery. There is minimal pain and most of the discomfort comes from the facialswelling which typically peaks between 2-3 days after surgery
The appointments after surgery are as important as the surgery itself.
Please make an appointment to see Dr. Patel 2 weeks, 4 weeks and 6 weeks after surgery.
Please make an appointment with your orthodontist 3 weeks, 5 weeks and 7 weeks after surgery.