After Fracture Repair
The treatment of a jaw fracture is a serious surgical procedure. Post-operative care and regular follow-up are very important. Unnecessary pain and complications such as infection and swelling can be minimized if these instructions are followed carefully.
Immediately Following Surgery
- If you received intravenous sedation or general anesthesia, you may feel drowsy for several hours. Remember do not drive a vehicle, operate any machinery, or undertake important matters for 24 hours following your anesthesia experience and plan to rest for the remainder of the day.
- Avoid vigorous mouth rinsing, sucking on straws, and/or touching the wounds following surgery. This may initiate bleeding by dislodging the blood clot.
- Do not smoke. Smoking will drastically decrease the chances of an uneventful postoperative course.
- Take the prescribed pain medications before you begin to feel discomfort. This will usually coincide with the start of the local anesthetic wearing off which typically occurs 4 to 6 hours after surgery.
- Restrict your activities the day of surgery and avoid exercise. Lie down upon returning home with your head elevated on two or three pillows or sit up in a recliner and take it easy.
- Place an ice pack to the side of your face where surgery was performed to help minimize swelling.
- Drink plenty of fluids – at least five to six glasses of water a day.
A certain amount of bleeding is to be expected following the treatment of a fracture. Slight oozing or blood-tinged saliva is not uncommon for the first 12-24 hours. To minimize bleeding, try to remain relaxed, sit in an upright position, and avoid strenuous exercise. If you feel that bleeding is excessive, you may moisten some of the provided gauze and apply pressure to the site for one (1) hour. If bleeding does not subside, please call our office for further instructions.
Swelling is normally expected after most surgical procedures and is usually proportional to the extent of the surgery performed. Swelling around the mouth, cheeks, eyes, and sides of the face is not uncommon. This is the body’s normal reaction to surgery. Most swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, swelling and discomfort may be minimized by the immediate use of an ice pack. An ice pack (a bag of frozen peas work great) should be applied to the side of the face where surgery was performed. This ice pack should be applied for 30 minutes on and 30 minutes off for the first 24 to 48 hours while awake. After 48 hours ice has no beneficial effect. Instead, the application of moist heat to the sides of the face may be helpful in reducing the size of the swelling more quickly. On occasion, some residual swelling may last a week or longer.
In some cases discoloration of the skin may follow swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues of the mouth and face. This is a normal post-operative occurrence that may occur 2-3 days after the procedure and will gradually fade away over the following one to two weeks. Although rare, this bruising can occasionally extend from the eyes to as far down as the clavicles.
Take the prescribed pain medications before you begin to feel discomfort. This will usually coincide with the start of the local anesthetic wearing off which typically occurs 4 to 6 hours after surgery. Taking pain medication on an empty stomach may cause nausea, so it is recommended to take the pills with food or drink. Pain medication may make you groggy and slow your reflexes. Do not drive a vehicle, operate any machinery, or undertake important matters while medicated. It is also best to avoid alcoholic beverages. If you do not achieve adequate pain relief you may supplement each pill with an over-the-counter pain medication such as ibuprofen. When appropriate you may transition from the prescribed pain medication to an over-the-counter pain medication such as acetaminophen (Tylenol) or ibuprofen (Advil/Motrin).
You will be on a liquid diet for six to eight weeks. Protein and nutritional shakes like Boost or Ensure are a good source of nutrition. Continuing to drink a nutritionally balanced diet is essential for feeling better, regaining strength, experiencing less discomfort, and more rapid healing after surgery. To maintain your caloric intake, you will need to make time for five to six meals a day instead of the usual three. It is understandable that your caloric intake will be limited for the first few days after your procedure. Start with plenty of fluids during the first 24 hours. At least five to six glasses of liquid a day will help prevent dehydration. Many recipes that are made in a blender are available online and can aid with your diet.
Begin gentle, warm salt water rinses (1 teaspoon of salt in 1 cup of warm water) the morning after surgery. Rinsing with salt water at least 3-4 times a day, especially after eating, will help to reduce inflammation and will gently flush food particles away. Dr. Conquest may prescribe an antibiotic mouth rinse to use in place of or in addition t salt water. Continue to brush your teeth, gums, and arch bars 2-3 times a day as best you can – being careful to avoid the surgical sites for several days. This meticulous oral care will help to reduce inflammation, bleeding, and improve healing of your wounds.
Antibiotics may be prescribed for certain patients after a fracture to help prevent or cure an infection. If you have been placed on antibiotics, take the tablets or liquid as directed until gone. Discontinue antibiotic use in the event of a rash or any other unfavorable reaction and contact our office immediately. If you were prescribed an antibiotic and are currently taking oral contraceptives, you should use an alternate method of birth control for the remainder of this cycle.
Nausea and Vomiting
In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least half an hour including prescribed medications. You should then slowly over a fifteen-minute period sip on coke, tea, or ginger ale. When the nausea subsides you can begin taking the prescribed medicine again. Postoperative nausea is most often due to the prescribed pain medication. Remember to take this medication with blenderized food or drink. If nausea persists or you have trouble keeping anything down, notify the office as an anti-nausea medication and/or a change in pain medication may be necessary. Although it is difficult to imagine, patients with their teeth wired together can still get sick without cutting their wires.
Arch Bars, Wires, and Elastics
The arch bars and wires in your mouth are stabilizing your fracture and acting like a cast on a broken leg. It is important to keep these wires in place and your teeth together as tightly as possible for six to eight weeks. The wires will start to loosen over time and the elastics (rubber bands) may need to be replaced on occasion. Regular follow-up will be required to monitor your healing and to maintain your arch bars. Orthodontic wax can be purchased from your local pharmacy and applied to any protruding portion of your arch bars to prevent tissue irritation and pain. If you cut your wires for any reason, please contact our office within 24 hours so that we can replace them. These wires and arch bars will require removal in the clinic 6-8 weeks after fracture repair.
Do not pull on your lips to look at the surgical wounds. This can cause damage to the incision site and tear the sutures free. If a dressing is placed on your chin following surgery, leave this in place for 48 hours. Dressings on your neck should be kept dry and left in place for 48 hours. These dressings can then be removed, the wounds may be cleaned with Dial soap and water, and the dressings replaced. Keep the neck incisions covered in this manner for one week.
You may have sutures in your mouth, on your face, and/or on your neck following surgery. Dr. Conquest will tell you if your sutures will dissolve on their own or if they will require removal. Even if your sutures are dissolvable, a follow-up appointment will be required seven to ten days after your procedure to check your healing.
What Else Should I Know?
You should be careful going from the lying down position to standing, upright position. You may get light headed standing up too quickly. Before standing up, you should sit for one minute, then get up slowly.
Slight elevation of temperature immediately following surgery is not uncommon. If an elevated temperature persists or a fever (>101.5) develops, please notify the office.
Keep your lips moist with chap stick or an ointment such as Vaseline. Due to stretching of the mouth during surgery, your lips may dry out and crack – especially at the corners. Remember, if your teeth are wired together you will not be able to lick your lips for moisture.
A sore throats and pain when swallowing are not uncommon due to swelling and inflammation of the nearby muscles. This will usually subside in two to three days.
If you are involved in regular exercise, please be aware that your normal nourishment intake is reduced and you may be dehydrated after surgery. Exercise may further weaken you. Please avoid strenuous exercise for 4-6 weeks following treatment or while your teeth are wired together. You should avoid all contact sports for 8-12 weeks following surgery and return only when Dr. Conquest approves.