After Repair of Traumatic Injury
PAIN: Some degree of pain is normal for all patients after the procedure. Unless contraindicated, we generally recommend ibuprofen (Motrin, Advil) and acetaminophen (Tylenol), or if necessary, a Acetaminophen-narcotic combination painkiller (Norco, Percocet, Vicodin, Tylenol#3 / codeine) to control pain.
Please attempt to control pain with ibuprofen as your first line agent.
If additional pain control is necessary, you may use plain Tylenol OR the narcotic containing painkiller as needed, but not both: Do not mix plain acetaminophen(tylenol) if you are currently taking another medication that already contains it such as one of the painkillers mentioned above. This is to avoid a acetaminophen-overdose.
Please note: Narcotics are habit forming medications, so use as little as possible. Please be aware that narcotics cause drowsiness and sometimes nausea; do not drink or drive while on these medications, or combine with other medications that cause drowsiness without speaking to your doctor first.
Always consult a physician or your surgeon prior to using any additional medications or methods that were not discussed prior to your discharge.
If your procedure was performed in the hospital under general anesthesia while completely asleep, know that a sore throat is extremely common; this is from the breathing tube that was placed down your throat, and this pain should resolve quickly, especially with consumption of cool liquids.
BLEEDING: Slight oozing of blood from your surgical sites is normal for the first day or so after surgery. In the event of excessive bleeding that cannot be controlled; wet plain black tea bags and place it over the site and apply firm constant pressure. If it doesn’t stop, inform your doctor or report to the nearest emergency room.
Remember, slight bleeding is acceptable, and the saliva in your mouth mixed with a small amount of blood may create a more drastic appearance than is actually the case (like a drop of food coloring in a glass of water). Do NOT spit, smoke, or drink from a straw: these will dislodge blood clots in the surgery site. When dislodged; bleeding, pain, and delay in healing can result.
SWELLING: Some swelling is also normal after this surgery. This will peak by about day 3 after surgery and then should gradually resolve on its own. In order to lessen the amount of swelling, please use Ibuprofen unless you are unable to take it, sleep with your head elevated using pillows, and apply ice packs to your face for the first 3 days.
IMMOBILIZATION (THE WIRES AND ELASTIC BANDS): Depending on the type of fracture and your surgery, it may be necessary to have your teeth closed tightly together (fixated and immobilized). This is to maintain the correct position of your teeth and facial bones in the most correct position. The amount of time your teeth remain fixed together will vary from patient to patient.
This strict fixation and immobilization period is CRUCIAL to achieve the desired outcome and prevent complications or re-treatment. The fixation of your jaws will be released gradually over several weeks, by your surgeon. Do NOT cut or remove the wires/elastics unless there is a very compelling emergent need to do so.
Occasionally, wires and elastics break accidentally when you are supposed to be fixated. As long as you cannot open your mouth significantly, this is not a problem and elastics will be replaced at one of your post operative visits. If a large number of elastics are lost and you can open your mouth/jaw, don’t be alarmed, but you should contact us immediately so that new elastics can be placed. If your mouth is able to open, do NOT try to open it. Do NOT move or use your jaws (yawning, speaking, chewing, etc), this will cause complications and/or need for additional surgery.
Following removal of fixation wires or rubber-bands, you will probably only be able to open your mouth a few millimeters. This is normal and due to a prolonged lack of muscle use (atrophy) and swelling around the muscles (edema). The range of movement in your jaw will increase gradually as the stiffness decreases. You should still keep a very minimal chew diet while your jaw rehabilitates.
** If you take other medications to maintain your usual health, you may not be able to take them if your jaws are wired shut. In order to maintain your health, you will need liquid or dissoluble formulas of your medications. NEVER crush or dissolve your medications without speaking to your doctor first; some medications can not be crushed or dissolved in fluid safely, and you will need to be prescribed new and specially formulated liquid versions of your medication. **
NUMBNESS & CHANGE IN SENSATION: This can happen for many reasons. With facial trauma, it is usually the result of direct injury to or stretching of your sensory nerve from the trauma itself. Perhaps even the resultant swelling that occurs around the nerve after the traumatic event. Surgery and proper anatomical re-alignment are meant to correct this issue, but it takes time. In certain instances, complete recovery of nerve function and return to normal sensation does not always occur due to the injury itself. If you had complete and normal sensation after your injury, but then suddenly had a change in sensation, please inform your doctor ASAP, certain medications can be prescribed to alleviate this.
CHOKING: It is unlikely that choking or breathing difficulties will occur, however, we insist that you have scissors or a pocket knife with you at all times while your teeth are fixed together. In the rare event that you actually need to fully open your mouth emergently (for vomiting or breathing difficulties), proceed with cutting the elastics or wires, and then contact your doctor immediately.
CARE OF THE NOSE AND SINUSES: If you had surgery on your upper jaw (maxilla) it is important to know that the necessary surgical treatments occurred in the area in close proximity to your nose and sinuses. You may have even had surgery directly within your sinuses. As such, some degree of swelling and local changes in the area have occurred. This is why many patients complain of sinus congestion and difficulty breathing through their nose. This is normal, though it is important to take certain measures to ensure a good surgical outcome and optimize your own comfort.
For the next 4-6 weeks, you should avoid blowing your nose, sneezing through your nose, or bending over.
Remember, Nasal congestion may create a feeling of not being able to breathe. If this occurs, stay calm, and take an “over the counter” decongestant to relieve it, like a nasal spray or pill, (if this OK with your MD). Simply follow the instructions on the label. A humidifier and propping yourself up with pillows at night will also help.
Sometimes slight/minor nose bleeding can occur after nose or sinus surgery; this is common and nothing to be concerned about. The bleeding should be minimal and resolve on its own with some light squeezing of your nose. If the bleeding is excessive or is not stopping, call us immediately.
DIET: If your jaws are wired or fixed together you will be on a strict liquid diet. Yes, it is possible to get liquids in between teeth edges and behind our last molars.
Since your broken bones are still very fragile they can not tolerate a diet with chewing. Most patients will also have wires or elastics fixating their jaws together, making chewing and solid foods impossible. In summary, you will require a strict and balanced fluid diet. It is essential that your body receive adequate fluids and nourishment in order to maintain your nutritional status and promote healing and prevent excessive weight loss. During this period you will become creative with your menu choices.
Here are some tips to creating a personal menu:
- Liquid nutritional supplements (such as Ensure, Muscle Milk, or Boost) are a great way get protein and vitamins in your diet.
- Anything you can liquefy in a blender is fair game! Simply add whatever you'd like, strain, and enjoy.
- Whole milk is a great way to keep up with calories and nutrients; substitute Skim or 1% varieties with full fat milk.
- Fruit juice or chicken/vegetable stock can be used to thin out blenderized meals .
- Mixing in protein powders to smoothies/shakes great for getting in protein.
- Peanut butter is great for iron
- Bananas are great for potassium
- Fresh fruit and vegetables are a great source of vitamins and fiber.
- The most common reason for feeling weak/fatigued/nausea is dehydration; it is the #1 reason why patients return to the hospital in the first days following surgery.
- You can expect some weight loss, but this should not be excessive. A rapid loss of weight during the first week is usually due to fluid loss from inadequate fluid intake and dehydration.
- Weight loss is a common result of a liquid diet. If you are experiencing weight loss try snacking between meals, adding dietary supplements, and substituting skim milk for whole milk.
- Constipation may result from the low fiber content in liquid diets, or may be a side effect of narcotic pain medications. To avoid this, try to include a lot of high fiber content fruit/vegetables in your diet, or add prune juice to your daily menu.
- Alcohol and smoking can delay wound healing, cause nausea/vomiting, and promote infection. Alcohol and smoking should be strictly avoided until your surgical sites are completely healed.
Once your doctor removes your fixation, you will only be able to have a very soft/minimal chew diet for some time. Foods that are safe to eat include yogurts, shakes/smoothies, ice cream/sorbet, pasta, mashed potatoes, scrambled eggs, etc.
** Always remember to rinse your mouth out gently with water after every meal**
HYGIENE: This will be challenging since you may have surgical braces (archbars) and very swollen gums, but keeping your mouth clean is vital for a successful outcome.
After one day, resume your regular brushing routine; You must brush your teeth, the metal/braces, and your gumline ... just be gentle near the site of surgery. Your gums will probably bleed/ooze slightly when you do this for the first few days; this is normal but should improve over time, just keep with brushing gently. You may use mouthwash as long as it is alcohol-free and do NOT spit (just lean over the sink and let the fluid fall out of your mouth).
ACTIVITY: You should avoid the gym and/or any strenuous activity or exercise for the next 7-10 days. Light out-of-bed activity (walking, shopping, etc) starting the day of your surgery is mandatory to prevent blood clots and other pulmonary issues. Most patients who undergo this procedure are able to return to work/school after two days. Remember, a gradual return to your normal daily activity is the most sensible approach, but remember your facial bone are not healed yet, and are very susceptible to injury; choose your activities wisely. Smoking is strictly prohibited; smoking will jeopardize the success of your case and can result in delayed healing, infections, implant/graft failure, and pain.
FOLLOW UP: You will have several follow up appointments with the surgeon. Be prepared to present to the office weekly for approximately six weeks. This is very important to ensure a successful outcome. Please make sure to come to all appointments. Please let your school or employer know the situation. We can provide and excuse-note if need be.
WARNING SIGNS OF COMPLICATIONS: Please be aware of these possible complications and inform your doctor if you encounter them. In the event of a life-threatening emergency, or if you can not reach your doctor, please call 911 and report to the nearest hospital emergency room.
- Excessive bleeding not controllable by constant pressure over the site (Call ASAP).
- Pus or foul odor/taste from surgical sites.
- Fevers/Chills (Although can be normal up to 2 days after general anesthesia).
- Progressive severe pain and/or swelling after the first day of surgery.
- Nausea/diarrhea (especially while taking antibiotics)
- Difficulty breathing or swallowing liquids (Call ASAP)
- Change in the way your teeth come together.
Feel well, and if you have any questions or concerns please feel free to contact us at any time.