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Postoperative advice

Guide on postoperative care in oral and maxillofacial surgery

Foreword

Following an accident or to improve your dental health, you underwent – or you are about to undergo – an oral surgical procedure.

This surgery can affect your chewing, your breathing, the way you speak and, after all, your quality of life.

You will find in this guide practical advice for healthy diet and good care as well as simple and nourishing recipes that will help you go through this surgical step easier.

We wish you a speedy recovery!

 

Surgical care

Most of major procedures in oral and maxillofacial surgery are performed in a hospital setting, under general anesthesia.

Anesthesia

Anesthesia requires the use of tubes and catheters, for which the details of use are provided during the preparatory meetings before the procedure.

Hospitalization

The duration of your hospital stay varies depending on the surgical technique used, the difficulty level of the operation and how fast the patient recovers. Some leave the same day – we call it an outpatient surgery – whereas others must spend a few nights in the hospital. The tendency to shorten the length of hospitalization does not affect the quality of care nor the outcomes of the procedure. The shift in ambulatory care even contributes to refine the techniques and decrease the risks associated with the surgery.

Edema (swelling), numbness

Oral and maxillofacial surgery generally carries along some degree of swelling, bruises or numbness. These phenomenons reach their peak within 48 to 72 hours and disappear after 7 to 10 days. However, numbness could last for a few weeks and even sometimes a few months.

During your hospitalization, the head of your bed is raised to 30° up to 45°. At home, as long as edema will persist, use more than one pillow to sleep if needed. To help the swelling subside, apply ice during the first 48 hours; then, you will have to use moist heat instead: apply hot water pads.

Dry lips

Edema and the inability to moisten your lips cause them to dry out, a source of discomfort. Apply vaseline or any other lubricant to accelerate the healing of cracks at labial commissures (corners of the mouth).

Secretions, breathing

During your hospitalization, it can be necessary to suck out your secretions and your saliva. At first, someone from the nursing staff will take care of it. Afterwards, this person will teach you how to do it. Don’t worry, you will quickly gain the control back over your deglutition and your secretions.

Humidified air helps free up the secretions and relieve nasal congestion. It then facilitates breathing. Using a humidifier, in the hospital or at home, will increase your comfort.

You can use nasal drops: however, there is a chance that they could increase the congestion. Use physiological serum in spray (saline solution spray) instead.

Bleeding

Because of incisions made into the mouth, your saliva might be slightly tinted with blood and your nose might ooze. If bleeding occurs after you leave the hospital, localize the hemorrhage and, if possible, make a compression with gauze or a tea bag.

Does the bleeding seem uncontrollable?

Call your surgeon immediately or go to the emergency room nearest you as soon as possible.

Avoid efforts that increase the blood pressure as well as violent nose-blowing. For instance, blowing your nose with force or frequently can cause bleeding and oozing from your nose or mouth.

Sutures

Surgeons often use sutures to close wounds and incisions inside the mouth. These sutures usually dissolve within the first two weeks following the surgery. However, you will have to have the non-absorbable sutures removed. You will get the necessary instructions before leaving the hospital.

Appliances

If the cutting of bones is necessary during your surgery, the surgeon will put appliances in place, wires or plates and screws which will ensure bone consolidation and healing.

Some items need to be removed after a fixation period, whereas others will stay permanently attached to the bone, under the tissues. The surgeon will inform you about the hardware that best fits your case and that he plans on using.

Wires or elastics?

Depending on the procedure performed, three situations can occur:

Your jaws are completely immobilized by wires or elastics: avoid forcing the fixation appliances by chewing efforts, yawning or by clenching the teeth unduly.

Your jaws are partially fixed by elastics: follow the surgeon’s instructions by wearing your elastics permanently or intermittently, like you will be told so. Do not force your elastics unnecessarily. Remove them to eat if you are allowed to.

Your jaws are free: resume chewing gradually by increasing the efforts progressively, without going to the point where you feel pain. Let healing evolve smoothly.

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In case of problems

 

Elastics or metal wires break?

Contact your surgeon.

 

Sutures or wires irritate your mouth?

Place a little piece of wax on the tip hurting your gum or your lip.

 

As needed, you will receive a small quantity of this wax when you leave the hospital. You will also be able to get some through orthodontists, dentists and in some drugstores.

Technique to use wax

Take about 1 cm long of wax, put it under hot water to soften it: model it with your fingers and apply it to the irritated area.

Nausea and vomiting

Avoid drinking alcoholic beverages, because they can cause nausea and vomiting when associated with pain or medication.

If you vomit while your maxillas are immobilized, stay calm. Lean forward, or if you are in bed, turn your head to the side to facilitate the discharge: everything that you ingested will be able to come out through the intermaxillary fixation. In an extreme case, cut the fixation appliances and call your surgeon or the on-call physician.

To cut the wire fixation

Wire cutters are the best instrument, but nail clippers will be sufficient in case of emergency: even though they are rigid, fixation wires are easy to cut. Elastics do not cause any problems, because they can be removed easily.

Bandages

If bone or skin was removed, a bandage has probably been put in place.

It seems defective? Consult your surgeon. He will tell you if you have to remove it, if it needs to be redone or modified.

In all cases,

with or without braces

with or without appliances

with or without fixation appliances

and even without teeth,

**A good oral hygiene is essential.**

Mouthwash

Starting 24 hours after the surgery, rinse your mouth after each meal or snack. Use salt warm water (15 mL of salt in one litre of water) or mouthwash (diluted with an equal part of water).

Chlorhexidine turns out to be the most efficient and least irritating agent. Your surgeon will prescribe it to you if needed to reduce risks of inflammation.

If your maxillas are not immobilized, complete your oral hygiene by brushing your tongue to remove deposits that built up.

Good hygiene improves your comfort and increases your chances of healing. It decreases risks of infection, pain and bleeding.

Toothbrushing

Starting the sixth day, clean your teeth thoroughly after each meal. Use a soft-bristled toothbrush for children and toothpaste. Proceed gently by being careful with wounds. Elastics are more fragile than braces, but they are easier to replace than treat a major complication caused by bad hygiene. Do not forget to rinse your mouth.

You can use the water flosser appliance, but never directly on the wounds for the first fifteen days. This device must never replace brushing: it only helps to remove food particles stuck between braces.

Allergies

If you suffer from allergies or if you have already had a hypersensitivity reaction to a medication, inform your surgeon and the nursing staff about it.

Analgesics (painkillers)

To avoid pain, take painkillers as needed. The posology (dose and frequency) varies depending on the types of analgesics, but do not take them in excess. Indeed, they can cause drowsiness, nausea and constipation. In case of dizziness and drowsiness, reduce the dose by half.

Antibiotics (against infection)

Take them as indicated by your physician and throughout the duration and quantity prescribed, even if the infection seems to have healed.

Other medications

Follow the prescription.

Important – It can be dangerous to drive or drink alcoholic beverages after taking medications. Get informed.

How to take your medications easily

If your maxillas are wired together, of if you prefer doing so, crush your medications to powder. Do not try to dissolve them: this could take too much time.

Capsule: open it to extract the powder.

Tablet: crush it between two spoons or in a mortar.

Mix the powder thus obtained with water, juice or strained food.

Consult your pharmacist or your surgeon in case of doubt, if you have a bad reaction, or to get better informed.

Physical activities

If your surgery necessitated the cutting of one or several bones, remember that you will have to wait about two months to reach a good calcification and complete healing.

You are not constrained to stay inside nor avoid drafts. You can do light sporting activities and moderate exercises. Besides, you are strongly encouraged to move.

However, you must give up on contact sports. If you go to school, you will be able to get a ticket exempting you from physical education activities.

Medical leave of absence

Depending on the type of procedure that you underwent, the recovery and rest time will vary from a few days to several weeks. Your surgeon can justify your medical leave of absence by completing the form required by your employer or the administration of the school you go to.

Take the time to get well informed on what to expect. Inform your family, your friends and your employer about the steps of your recovery. Good planning will help you recover better.

It is convalescence, not holidays… The duration of your leave of absence will depend on the procedure that you underwent and your ability to recover.

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Postoperative follow-up visit

Your surgeon and his treatment team will give you an appointment for the postoperative visit. This one is important, because it allows the surgeon to properly follow how healing evolves. Before you leave the hospital, ensure to have all the details regarding this visit.

If, for any reason, you cannot make it to this appointment, inform the oral and maxillofacial surgery service. They will give you another appointment.

A complication appears suddenly? You need information?

Do not hesitate to communicate with your surgeon.

 

Source

This guide was prepared at the Centre hospitalier affilié universitaire de Québec, Hôpital de l’Enfant-Jésus, by the following services:

Clinical nutrition
Oral and maxillofacial surgery
Nursing

Have participated in its development:

Suzanne T. Simard, dietician
Louise Brochu, dietician
Pierre-Eric Landry, oral and maxillofacial surgeon
Régine Leblanc, nurse

The authors thank Julie Morency, dietician, who participated in the first version of the original edition and Odette Couillard, nurse, who contributed to the fourth edition.

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