Jaw Fractures / Trauma
Immediately Following Surgery
- If gauze pads were placed over the surgical areas they should be kept in place for 30-60 minutes. After this time, the gauze pads should be removed and discarded.
- Vigorous mouth rinsing, spitting or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged. This may also dislodge sutures or introduce bacteria into the wound.
- Take the prescribed pain medications when you begin to feel discomfort. This will usually coincide with the local anesthetic wearing off.
- Restrict your activities the day of surgery and resume normal activity only when approved by your doctor. Lying down with your back and head elevated is appropriate for a day or two.
- Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for an explanation.
- DO NOT SMOKE! Do not use straws for several days unless your jaws are wired shut.
- DO NOT drive, operate machinery or any other potentially dangerous items, or be solely responsible for child care for 24 hours after IV anesthesia (or at any time when taking prescription pain medication).
Jaws Wired Shut?
Depending on what type of jaw fracture you have and what kind of treatment was completed, your upper and lower jaws may be wired together. This is done to keep the fracture site(s) from moving since a “cast” cannot be placed. Some patients will not be wired shut, but will have rubber bands holding the jaws stable, yet allowing some careful, small movements and to help guide your bite.
If wires are in place, you were given a wire cutter that must be kept on your person at all times. It is for EMERGENCY USE ONLY. In the case of vomiting you would cut the wires extending vertically (up and down) between the upper and lower teeth to release them. Usually there are four loops of wire which appear as eight vertical wires, but only require four cuts to release them. If you cut your wires or they become loose you should contact us right away for advice. Typically, since you are only eating/drinking items that can go between the wires, the same should be the case if you have to vomit. Cutting of the wires may not be required if there is just small amounts of fluid produced. Bending over with your head down will allow gravity to help direct vomitus out of your mouth.
You should not fight against the wires or bands as this could cause breakage resulting in failure of the procedure. It is very important to keep the wires clean. This is done with a combination of brushing using a small children’s tooth brush and rinsing with the prescription Peridex (chlorhexidine) mouth rinse. It is important to keep the wires bright and shiny. Brush after every time you eat. Rinse with water often. Orthodontic wax can be purchased at your pharmacy and replaced daily after brushing, on any sharp pieces of wire. The wax must be removed and the wires cleaned daily.
You will be on a liquid diet, limited only by what you can’t put through a blender. Remember, good nutrition is important for proper healing.
Use vaseline to keep your lips moist.
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Orbital / Eye Socket Fractures
The most important thing to be watchful for following repair of fractures around the eye is a change in visual acuity. If you notice a change in visual acuity or loss of vision, this could be an emergency and you should contact your doctor immediately. Some patients will have some double vision following surgery in up, down, or lateral gaze. Usually this will resolve during the healing process. Please let your doctor know if you experience double vision in straight forward gaze.
You most likely have a “swiss eye mask”, a clear pliable material that was provided at the hospital. It can be cooled repeatedly by laying it over a bed of ice. Follow the instructions below in the section about swelling.
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing or redness in the saliva is not uncommon. Blood is like food coloring and a small amount will turn the saliva pink or red, possibly for several days. Do not spit as this may stimulate bleeding. Excessive bleeding (blood visibly welling up at the surgery site) may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad (folded to about one inch square) over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, use a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright and avoid exercise. If bleeding does not subside, call for further instructions. We are in the office until 4:30 p.m. – if possible, please call before this if you think there may be a problem.
If blood clots are present in the mouth as may occur after sleeping, wipe them gently away and treat any bleeding as previously described.
The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks and sides of the face is expected. This is the body’s normal reaction to surgery and eventual repair. The swelling will reach its maximum 2-3 days post-operatively. Swelling may be minimized by the immediate use of ice packs. An ice pack or baggy filled with ice and wrapped in a towel should be applied on the face where surgery was performed. The ice pack should be used for fifteen minutes at a time with short breaks while you are awake. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face may be beneficial in reducing the size of the swelling.
The following information is for healthy adult size patients only with normal liver and kidney function and who are not taking other medications. Please ask your doctor about dosing for children. You may begin taking pain medication as soon as you feel the local anesthetic wearing off. For mild to moderate pain, Ibuprofen (Advil or Motrin) may be taken. Ibuprofen, bought over-the-counter comes in 200 mg tablets: 2-3 tablets may be taken every 6-8 hours as needed for pain. Taking this medication every 6-8 hours for two days or more will greatly enhance the effects of the medication. Patients who do this tend to have less pain than those who do not. Tylenol may be taken instead of Ibuprofen, but be aware that your prescription pain medication may contain Tylenol also. For severe pain, the prescribed medication should be taken as directed on the bottle, in addition to Ibuprofen or instead of regular Tylenol, unless otherwise directed. The prescribed pain medicine will make you groggy and will slow down your reflexes, alertness, and concentration. Do not drive a vehicle, work around machinery or other dangerous areas such as a hot stove, and do not be responsible for child care. DO NOT drink alcoholic beverages. For most patients, pain or discomfort following surgery will subside each day after the 3rd day. If pain persists, it may require attention and you should call the office. DO NOT take any of the above medication if you are allergic, have had a reaction to, or have been instructed by any doctor not to take it.
Maximum dose of Ibuprofen is 800 mg every six hours and 3200 mg in 24 hours.
Maximum dose of Tylenol is 1000 mg every six hours and 3000 mg in 24 hours.
After general anesthesia or I.V. sedation, liquids should be taken initially, ideally water, until you are confident that nausea or vomiting will not be a problem. Do not use straws unless your jaws are wired shut. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. If your jaws are wired shut, you will be on essentially a liquid diet, but anything you can put through a blender is a possibility. If your jaws are not wired shut, you may carefully eat anything soft by chewing away from the surgical sites. Soup, apple sauce, pudding, jello, ice cream/milk shake are easy items to start out with. High calorie, high protein intake is important. Nourishment should be taken regularly. You should prevent dehydration by drinking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. Avoid carbonated beverages for the first few days. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. You may consider using a nutritional food supplement such as Carnation Instant Breakfast drink, Ensure, or for diabetics, Glucerna.
Keep the mouth clean
If you have been given a prescription for mouth rinse, use it as prescribed. Please do not use over-the-counter mouth rinses for the first week after surgery. If desired, you can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing with a cup of warm water mixed with a 1/4 teaspoon of salt. Do this 4-5 times a day, especially after eating. If there are no surgical or injury sites in your mouth, then just perform your normal oral hygiene. DO NOT use and electric toothbrush or water-pik at surgical sites until approved by your doctor.
In most cases, discoloration or bruising of the skin will appear. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may become visible 2-3 days post-operatively. Moist heat applied to the area may speed up the resolution of the discoloration.
If you have been prescribed antibiotics, take your prescription as directed. Antibiotics may be prescribed to help prevent or treat infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction and call the office. Call the office if you have any questions or develop multiple unformed (watery) bowel movements.
Nausea and Vomiting
Nausea and vomiting can occur due to a combination of altered diet, reaction to anesthesia, and medications (especially prescription pain medications). In the event of nausea and/or vomiting following surgery, do not take anything by mouth, if possible, for about an hour, including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking food and the prescribed medicine. Nausea due to medications is less likely if you have some food in your stomach. You may call our office if the nausea and/or vomiting persists.
Occasionally, an allergic reaction can occur to one of your medications. Allergic reactions usually consist of itching, rash, or hives. If such a reaction occurs, you should stop taking the medications and call our office. Over-the-counter Benadryl may help alleviate these symptoms, but also will cause drowsiness. If a severe reaction such as swelling of the face or neck or difficulty breathing occurs, contact your nearest hospital emergency department and/or call 911 immediately.
- Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen may be taken to reduce a fever.
- You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery and it may be difficult to take fluids following surgery. Taking pain medications can make you dizzy. You could get light headed if you stand up suddenly. Before standing up, you should sit upright for one minute then get up.
- If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as vaseline.
- Sore throats and pain when swallowing are not uncommon following surgery. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in a few days.
- Stiffness of the jaw muscles may cause difficulty opening your mouth for a few days or more following surgery. This is a normal post-operative event which will resolve in time, the length of which will depend on your injury. Gently, repeated opening of the mouth wide enough to accommodate at least two fingers placed vertically between your front teeth will help this, as will warm compresses. Headaches may also occur.
Sutures are often placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged soon after surgery and this is no cause for alarm. Just remove the suture form your mouth and discard it. Some sutures will dissolve on their own while others may require removal at a later date.
The pain and swelling may maximize 2-3 days following surgery should subside each day following that. If your post-operative pain or swelling worsens or unusual symptoms occur call our office for instructions.
Your case is individual since no two mouths are alike. Well intended advice from family or friends may be inappropriate. Please call our office if you have questions.
Brushing your teeth is okay – just be gentle at the surgical sites.
If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising. Strenuous activity, exercise, or work is discouraged until approved by your doctor.