Surgical Instructions
Orthognathic Surgery
Orthognathic surgery is performed in the hospital operating room under general anesthesia. Most patients will stay in the hospital for 24-48 hours after surgery for initial post-operative care. After discharge, the patient will normally be seen in the office within 72 hours for post-operative x-rays and evaluation.
Pain
The amount of pain and discomfort experienced following orthognathic surgery can be quite variable. However, considering the nature of the surgical procedure performed, many patients relate that their pain levels after the surgery are lower than what they experienced after having their wisdom teeth removed. This is often due to the fact that some of the sensory nerves in the area are stretched during surgery, and many patients have some persistent numbness in their face, lips and gum tissue after the surgery. This helps by decreasing the body’s perception of pain. In addition, IV pain medications are administered while in the hospital (often via a patient controlled pump). Prior to discharge from the hospital, patients are transitioned to oral pain medications. This is often a combination of an NSAID (such as Ibuprofen) and a narcotic to be used as needed. Most patients use the pain medication for 1-2 weeks.
Swelling
Postoperative swelling can also be quite variable, differing from patient to patient. In general, swelling will peak out 24-48 hours after surgery. During and after surgery large doses of IV steroids (Decadron) are administered to help prevent swelling in the face and neck. Steroid cream is applied to counteract swelling of the lips. Pressure dressings and ice packs are also used. Bruising of the face and neck can accompany the swelling. The swelling and bruising will gradually resolve over the course of 2-3 weeks.
Bleeding
Many patients will exhibit some oozing from the incisions on the inside of the mouth for up to one week after the surgery. This is usually intermittent. Rinsing with warm salt water will normally help to cleanse the area and get rid of the taste of blood. Patients that have had upper jaw surgery will often have an intermittent bloody nose for several days after the surgery. They will also notice older clotted blood draining from their sinuses for several weeks. For fresh bleeding, packing the nostrils with small gauze or cotton packs will usually resolve the bloody nose. For drainage of the sinuses, a humidifier or sitting in a steamy shower will often facilitate drainage. If you experience excessive bleeding, please call the office.
Diet
For most orthognathic surgery patients, we will ask you to refrain from chewing for six (6) weeks. A good guide is that any food you can easily break apart with a fork is OK. You will likely need to eat multiple small meals throughout the day. Make sure you get plenty of fluids.
Sore Throat
Many patients will experience a sore throat for several days after the surgery. This is usually related to the breathing tube used during surgery. In most cases the sore throat resolves during the first week.
Stitches
In most instances long lasting dissolving stitches are used. They will usually start to come out after 10 days. If a stitch or knot is hanging and bothering you after 1 week, you may simply cut it off. We will usually remove loose sutures at your post op visits.
Fixation
Most orthognathic surgery patients have small titanium plates and screws inserted at the time of surgery to help hold the bones in their new position. These plates are under the gum tissue and are usually permanent. In addition, some patients who have had upper jaw surgery will have a plastic splint fixated to the roof of their mouth to provide additional stability. This splint is removed after 6 weeks. Elastics or rubber bands are usually placed at the time of surgery. This is to help train you to bite in your new position and to help maintain your new jaw relation. The number and position of elastics will vary and are changed throughout your recovery. Your doctor will advise you on how to change the elastics at your postoperative visits.
Numbness
Many patients experience numbness under their eyes, in their lips, chin, gum tissue and roof of the mouth after orthognathic surgery. This is usually a temporary condition. Over the course of 2-4 months the numbness will gradually improve. There are some patients who may experience permanent numbness or tingling sensation in the distribution of one or more of these nerves. Most patients with this condition adapt quite well without any functional problems. During this time, your doctor will monitor your progress.
Medications
You will be prescribed an antibiotic, pain medications, and an antibacterial rinse. You will be given instructions on how to use your specific medications prior to discharge from the hospital
Restrictions
Most patients will require 2 weeks off of school or work after orthognathic surgery. Due to the effects of anesthesia and general weakness from the surgery and potential drowsiness from pain medication you should not drive for 1 week. Avoid strenuous physical activity or contact sports for 6 weeks.
