Stephen B. Baker, DDS, MD
Orthognathic surgery requires mobilization and fixation of one or both jaws into a new position. The following instructions serve as a guide for post-operative care.
You should have received the following prescriptions:
Peridex rinse-rinse and spit once in the morning and once before bed
Medrol (steroid) dose pack-take as directed
Zofran-take as directed for nausea
Pain medication-take as directed for pain
Antibiotics-take as directed
The following “over the counter” medications are recommended
Saline nasal mist (Ocean Spray)-use to moisten nose as much as desired
Afrin-TRY TO AVOID. Definitely, do not use more than 3 days duration.
Pseudoephedrine-take 30mg every 6 hours as needed
You will be sore after your surgery and limited to a soft diet. High calorie fluids such as Carnation instant breakfast, Ensure, Sustacal, GNC protein shakes, etc. are recommended for maintaining nutrition. Liquid yogurt such as “Gogurt” and “Danimals” are both easy to ingest and good sources of protein. It is not unusual to lose 10-15 pounds after surgery. You should minimize this weight loss by forcing yourself get as many calories as possible. When your body is healing, it requires extra nutrition. Soft foods such as scrambled eggs, yogurt, ice cream, oatmeal, pudding, soup, are all okay. Initially after surgery, it may be helpful to put the fluids in a 60cc syringe and use a red catheter to feed yourself. The nurses in the hospital will aid you in this technique.
The typical patient does not have his/her jaws wired shut. Usually, rubber bands are used to allow the patient to be guided to his/her new occlusion. These are tight at first and are gradually loosened up to 2 weeks after surgery at which point they are removed. Once the rubber bands are removed, it is not uncommon for the patient to experience more pain. This is because the previously immobilized jaws are now starting to open and close under more pressure. This is normal and the patient should limit activity to as tolerated.
Nausea and Vomiting
It is not unusual to experience nausea and vomiting postoperatively. Usually, this is limited to the immediate postoperative period and is related to either blood that was swallowed during surgery or the medications that were used in anesthesia. Zofran is one of the medications that you have that will help minimize this problem. If nausea/vomiting persist for more than 3 days, call Dr. Baker’s office.
It is not unusual to have some blood come out of the nose immediately after surgery. If this becomes significantly worse or seems to be actively bleeding, call Dr. Baker’s office immediately.
Surprisingly, this procedure is not very painful compared to other procedures. The nerves that cause you pain in your cheeks and lower jaw are going to be temporarily numb from the nerve stretching that occurs during this surgery. The prescribed pain medication should be taken as directed for postoperative pain. What does occur is a feeling of malaise and lethargy. This feeling may take several weeks to resolve.
Swelling and Bruising
Swelling (edema) will be significant. Jaw surgery is a major procedure that involves mobilizing facial bones. It is totally normal to experience a large degree of swelling. Most of this resolves by 3-4 weeks; however, subtle degrees of improvement will occur for up to a year. Bruising is minor in teens but can be more prominent in adults.
It is normal for both cheeks and lower lips to be numb for up to several months after surgery. This numbness gradually improves with time, and almost all sensation will return to normal with time.
Because this surgery involves the maxillary sinuses, you will experience some congestion for several weeks postoperatively. Pseudoephedrine will help this. This is an “over the counter” medication that can be taken as directed. Be careful not to use nasal sprays that constrict the mucosa (Afrin, etc.) for more than 3 days. Prolonged use of these drugs can lead to severe nasal congestion.
If you need to contact Dr. Baker’s office use the following numbers as instructed:
After hours call 202-444-7243 and have the plastic surgery resident on call paged. If you do not receive a response, you should have the page operator page Dr. Baker.