After Jaw Fracture Repair

After surgery on your jaws (maxilla or mandible) your upper and lower teeth will be held together by either wires or very strong elastic bands for several weeks. Post-operative care is very important. Unnecessary pain and complications can be minimized if the instructions are followed carefully.

Prescriptions

You should receive prescriptions for an antibiotic, pain medicine and a mouth rinse. These will be given to you at the hospital or at the office. Take them as directed. If you have any reaction to the medicines (i.e. rash, itching, nausea, etc.) contact the office.

Activity

• Do not undertake any strenuous activities, such as running, exercising, lifting heavy objects, etc. for two (2) weeks.
• Swimming, boating or being near a pool or lake are strictly forbidden due to the higher possibility of drowning since your mouth is fastened shut.
• DO NOT SMOKE, since it is very detrimental to healing and can contribute to the development of a “dry socket” if you have also had teeth removed.

Swelling

The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes, and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling may not become apparent until the day following surgery and will not reach its maximum until three (3) to four (4) days after surgery. However, swelling may be minimized by following the guidelines listed below.

• Apply a cold compress to the side(s) of the face where surgery was performed. The cold compress should be utilized for the first 24 – 36 hours by leaving it on the face in the area for twenty (20) minutes, then removing it for twenty (20) minutes. A cold compress has no beneficial effect in reducing swelling thirty-six (36) hours after surgery.
• Take two (2) to three (3) tablets of ibuprofen every four (4) hours.
• While in a resting position, it is important to keep your head elevated above your heart.

If swelling has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery.

• Thirty-six (36) hours following surgery, the application of a warm compress to the face over the area(s) where surgery was performed is beneficial in reducing the size of swelling. Apply the warm compress for twenty (20) minutes, then remove it for twenty (20) minutes until swelling subsides.

Diet

Good nutrition is extremely important for healing. Start off with clear liquids after general anesthesia or IV sedation. If you have also had teeth removed, do not use a straw when drinking from a glass. The sucking motion can cause a dry socket by dislodging the blood clot from the extraction site. You may want to confine the first day’s intake to bland liquids or pureed foods (soups, puddings, yogurt, milkshakes, etc.). Avoid foods that require chewing.

Pain

Unfortunately, most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for liquid pain medication, but it may take up to several hours for the pharmacy to prepare your prescribed pain medication. Taking over-the-counter pain medication before the numbness wears off will help you be able to manage any discomfort better. The effects of pain medicines vary widely among individuals. For moderate discomfort, 325 – 650mg of liquid Tylenol may be taken every four (4) hours. Liquid Ibuprofen (Advil or Motrin) may be taken instead of Tylenol unless you are also on Coumadin/warfarin. Doses of 400 – 600mg Ibuprofen may be taken every four (4) hours as needed for discomfort.

For severe pain, take the prescribed medicine as directed. The prescribed pain medicine will make you groggy and slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. If you do not achieve adequate relief from your prescription, you may supplement your prescription with 400 – 600 mg of Ibuprofen every four (4) hours, if you are NOT also on Coumadin/warfarin. Some people may even require two (2) doses of the liquid prescription medicine at a time during the early stages, but that may add to the risk of an upset stomach. The more severe discomfort is usually experienced within the first three (3) days after the surgery. Pain or discomfort following surgery usually subsides more and more each day after that, and your need for medicine should lessen as well. Sometimes, the pain increases as the swelling increases over the next two (2) to three (3) days. If significant pain persists for more than three days, it may require attention and you should call the office. Do not take any of the above medications if you are allergic, or have been instructed by your doctor not to take it.

Oral Hygiene

Mouth cleanliness is essential to good healing. You may gently brush your teeth to the best of your ability beginning the night of surgery, and use the prescribed medicated rinse as directed. The day after surgery, you should begin gently rinsing after meals and additionally, for a total of four (4) to six (6) times a day, with an 8oz. glass of warm water mixed with one-half teaspoon of salt. Continue this procedure until the stabilizing wires or bands have been removed.

Discoloration

In some cases, discoloration of the skin follows swelling. The development of black, blue, green or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur two (2) to three (3) days postoperatively. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

Antibiotics may be given to help prevent or treat an infection. If you have been placed on antibiotics, take medicine as directed. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Antibiotics make birth control pills ineffective. Women who take birth control pills should use another form of contraception for one complete cycle after the course of antibiotics has been used. Call the office if you have any questions.

Nausea & Vomiting

Nausea may occur after surgery and is sometimes caused by stronger pain medications. Nausea may be reduced by preceding each medication dose with a small amount of food, then taking the dose with a large volume of water. If you become nauseated or need to vomit, don’t panic. You do not need to cut your elastic bands or wires. Simply lean over, pull your cheeks away from your teeth with your index fingers, and vomit. Everything you are ingesting is liquid and will come up the same way. Afterward, do not take anything by mouth for at least an hour, including the prescribed medicine. You should then sip tea or ginger ale (after stirring out carbonation). You should sip slowly over a 15-minute period. If you are not on Coumadin/warfarin, you may also try Alka-Seltzer or Pepto Bismol. When nausea subsides, you can begin taking pureed foods and the prescribed medicine. If nausea persists for more than four (4) hours, call the office.

You should carry a small pair of wire cutters or cuticle scissors with you in case you need to cut your elastic bands or wires. They should be cut only in a life-threatening emergency.

Other Complications

• A slight elevation of temperature immediately following surgery is not uncommon. If a temperature of 101°F persists for longer than a day after surgery, notify the office.
• You should be careful going from the lying-down position to standing. Since you may not have been able to eat or drink prior to surgery, and it may be difficult to take fluids after surgery, your body may be low on fluid. Because of this, you could get light-headed if you stand up suddenly. Taking pain medications can also make you dizzy. Before standing up, you should sit for one minute and then get up slowly.
• If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with lip balm or Vaseline.
• A sore throat and discomfort when swallowing are not uncommon. The muscles of the throat may become swollen, so the normal act of swallowing can become painful. This should subside in three (3) to four (4) days.
• On occasion, the wires or braces may irritate your gums, lips, or cheeks. You will be given soft wax that, when applied to the irritating metal, should alleviate the soreness in a day or two (2).
• Sometimes, the wires or elastic bands may become loose or come off completely. This does not require immediate attention. Call the office the next business day to schedule the replacement of the loose or dislodged items.

Finally

The discomfort and swelling should subside more and more after the third day following surgery. If your post-operative discomfort or swelling worsens or unusual symptoms occur, call the office for instructions.

Your case is individual. No two mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with your oral surgeon and the people best able to effectively help you.

If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light-headed, stop exercising.

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, call the office. Please try to call during office hours in order to obtain a quicker result.