After Fracture of Jaw
Following these instructions and the instructions the nurses have given to you will result in fewer complications and make your recovery period easier. Failure to follow these instructions could result in unnecessary pain, delay in healing or complications; which could negatively affect the outcome of your treatment.
Following surgery your jaws will be together with elastics. A period of 2 – 6 weeks is usually required for initial bone healing.
WHAT YOU NEED FOR HOME
- Saline (to make your own: dissolve 1 teaspoon of salt in an 8-ounce glass of warm water)
- Child size toothbrush/WaterPik™
- Scissors/pocket knife (for cutting elastics)
- Vaseline or lip balm
- Blender or food processor
If necessary, a prescription for medication will be provided at the time of your discharge. Please take the medication as prescribed until it is finished.
You may be sent home with a prescription for a liquid pain reliever, which can be administered through a syringe as you have been shown, or sipped from a spoon. If your pain reliever is in pill form, you can crush it and mix it with 10 – 20 ml of water or juice, to be sipped or administered through a syringe.
You may also been given a prescription for a liquid antibiotic to prevent infection. It is important to take this medication as prescribed until it is finished. You may also be given a prescription for an antibiotic mouth rinse. It is very important to keep your mouth clean.
An increase in swelling and pain after the first week could indicate an infection, which may require treatment. Should this happen to you, contact your doctor.
CARE OF THE OPERATIVE AREA
SWELLING: For the first 48 hours after surgery you will be given ice packs which will help to minimize swelling. Following this period you will need to use heat (hot, wet facecloth, hot water bottle, heating pad, or microwaveable pack) to help reduce the remaining bruising and swelling. As it takes about 2 weeks for the majority of the swelling to disappear, continue to use heat for 30 – 45 minutes, 4 to 5 times a day for at least 1 – 2 weeks after you are discharged from hospital. A few minutes of gentle massage while using the heat also helps.
You may experience “rebound” or increased swelling 4 – 5 days after surgery due to the decreasing levels of steroid medication in the blood. This swelling usually starts to resolve in 2 or 3 days.
BLEEDING: Prolonged bleeding, such as nosebleeds or bleeding from the incision sites following discharge from hospital is not normal and you should contact your doctor if this occurs.
BRUISING: Bruising is normal. Gravity may cause discoloration (usually a light yellow or green) to extend down to the neck and occasionally on to the chest. This will generally resolve in 2 – 3 weeks.
CARE OF THE NOSE AND SINUSES
Avoid blowing your nose for 6 weeks if you had an upper jaw or cheekbone fracture. Minimize blowing your nose for 2 weeks following surgery if you had only a lower jaw fracture. Some patients may experience nasal stuffiness and sinus congestion. Nasal congestion may create a feeling of not being able to breathe. If this occurs you should stay calm and take an “over the counter” decongestant to relieve it; taking care to follow the instructions on the bottle. A humidifier and propping yourself up on a pillow at night will facilitate breathing.
For the first couple of days following surgery you may experience a sore throat and some nasal congestion. This is normal after anaesthesia and should go away within a couple of days. Drinking plenty of liquids usually helps with the throat tenderness.
You will be unable to keep your lips moist when your jaws are held together with elastics. In addition, cracking of the corners of the mouth does sometimes occur following surgery. Apply Vaseline or lip balm regularly to keep these areas from becoming too dry or chapped.
ORAL HYGIENE/MOUTH CARE
It is important to remember to clean your teeth and rinse your mouth routinely following surgery. A Water Pik™ is an excellent aid. A mild salt solution or a commercial mouthwash (non-alcohol based) will assist you in keeping your mouth clean. It is important to rinse your mouth with 20 to 30 ml of saline frequently (every 2 hours) as well as after meals. You can make your own saline (see above). Use a child toothbrush to clean the outside of your teeth. You can start brushing the front of your teeth as soon as it is not too painful and progress to the back of your mouth when the swelling in your cheeks comes down. You must do this as thoroughly as possible. You will of course not be able to brush the tongue side of your teeth with a brush. The tongue side of the teeth can be brushed by moving your tongue across them while using a mouth rinse. You should avoid carbonated beverages, as they tend to decalcify your teeth.
MUSCLE SPASM AND MOBILIZATION
Occasionally, several elastics will break away during the fixation (teeth together) period. 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, don’t be alarmed. You should however contact your doctor so that new elastics can be placed.
The fixation of your jaws will be released gradually over several weeks. Following removal of fixation, you will probably only be able to open your mouth a few millimeters. This is partly due to the stiffness of the muscles at the surgical site and in part due to the length of time the jaws have been held together. The range of movement in your jaw will increase gradually as the stiffness decreases. Patients may be sent to a physiotherapist after removal of fixation to further assist in improving jaw function if movement of your jaw is slow or difficult.
Following removal of the tight fixation your doctor may have you wear a few light-guiding (functional) elastics to assist maintaining your jaw position. Elastics should be changed as requested by your doctor and jaw exercises can be performed between elastic changes. This would involve opening and closing the lower jaw and moving the lower jaw side to side.
Since your jaws are held together with elastics, you will require what is called a balanced fluid diet (blenderized). It is essential that your body receive adequate fluids and nourishment in order to maintain your nutritional status and promote healing.
You will be limited to a strictly liquid diet until your jaw is no longer tightly held together. During this period, you will become creative with your menu choices. It is especially important to drink adequate amounts of fluids, 3 to 4 litres per day. You can purchase liquid nutritional supplements (such as Ensure™ or Boost™) in a grocery store.
You may continue to use the syringe for feeding or when comfortable, use a straw or drink from a glass. A nutritious dietary intake is important in promoting healing and decreasing the possibility of infection. You can expect to lose about 5 – 10% of your total body weight during the first 6 weeks following your surgery. A rapid loss of weight during the first week is usually due to fluid loss.
Once the tight elastics are removed you can progress slowly to a normal diet. The first 4 weeks following removal of the tight elastics, your diet should involve soft foods (eggs, potatoes, fish, pasta, etc.).
Here are some tips to creating a personal menu:
- You may eat anything that can be thinned into liquid form. Meals may be blenderized until smooth. If food is still lumpy, use a strainer.
- Cold whole milk can be used to thin puddings, yogurt, cereal, sandwiches, ice cream and cakes.
- Warm whole milk can be used to thin cheese, eggs, toast, hot cereal, muffins, pasta, hot main dishes and casseroles.
- Fruit juice can be used to thin fruit, yogurt and ice cream.
It is important to eat a variety of foods and to take into consideration Canada’s Food Guide when choosing meals. Weight loss is a common result of a liquid diet. If you are experiencing weight loss try snacking between meals and adding whole milk cheese or skim milk powder to meals to boost caloric intake.
Constipation may result from the low fibre content in liquid diets, or may be a side effect of some pain medications. To avoid this, try to include a lot of fruit and vegetables in your diet and add prune juice to your daily menu.
Alcohol and smoking can delay wound healing and promote infection. Alcohol and smoking should be avoided until your surgical sites are completely healed.
In the unlikely possibility that choking or breathing difficulties may occur, we recommend that you have scissors or a pocket knife with you at all times. In the rare event that you need to cut the elastics, proceed with cutting the elastics and then contact your doctor immediately. The nurses will instruct you in the “art” of cutting the elastics in the event of an emergency.
Avoid alcohol or foods that may cause your stomach to become upset. Should you experience nausea, you can use “over the counter” Gravol™ (liquid or suppository) as directed on the bottle. If the nausea persists, please contact your doctor.
In most cases of vomiting the elastics do not require removal. It is extremely rare to have to remove the elastics as the stomach contents are of liquid nature and can escape through and around the teeth. If emergency elastic removal (for vomiting or breathing difficulties) is required, please contact your doctor immediately. Remember that during the tight fixation period (with elastics) you should carry scissors or a pocket knife with you wherever you go.
WARNING SIGNS OF COMPLICATIONS
The following symptoms may be a sign of infection or other complications; therefore, you should follow up immediately with your doctor if they occur.
- Increased swelling
- Increased or excessive pain
- Foul odour from the mouth
- Fever and/or chills
- Bleeding inside the mouth (wires may need to be adjusted)
Physical activity should be kept to a minimum for at least 6 – 8 weeks after surgery. It is very important that you realize that you just had a significant operation that requires a well-rested recovery period. Excessive activity (running, exercising, swimming, heavy lifting, house cleaning, contact sports, going up and down stairs quickly, etc.) can cause bleeding and/or dizziness. If you had upper jaw fracture you should avoid bending over for this time period as it may cause dizziness. Excessive fatigue can also slow the healing process as well as increase the chance of infection by reducing your resistance. A gradual increase back to normal activity is the most sensible approach. Contact or other sports where direct physical contact or injury are possible should be avoided for 2 – 3 months to minimize the risk of another fracture. If you have any specific activities you wish to perform following your surgery, please discuss this with your doctor.
FOLLOW-UP WITH YOUR DOCTOR
A follow-up appointment should be arranged with your Doctor’s office prior to discharge. If an appointment has not been made, please call your Doctor’s office during regular business hours to arrange a follow-up appointment.
Please follow any other instructions that have been explained to you by your doctor.
If you have any questions or problems, do not hesitate to call our office at 454-6565 or 1-800-379-9474. If your call is not answered by the answering service, hang up and call again in five minutes. We apologize for this inconvenience as the lines may be occupied by other callers. There is an Oral and Maxillofacial Surgeon on call ALL HOURS OF THE DAY.
WE PREFER THAT YOU CALL OUR OFFICE FIRST RATHER THAN YOUR OWN DENTIST OR FAMILY DOCTOR. However, if you are experiencing severe bleeding or breathing problems requiring IMMEDIATE ATTENTION, please proceed to the nearest Emergency Department or Dial 911.