Post-operative Care for Orthognathic Surgery

Post-operative medications

There will be different medications prescribed to you to aid your recovery after the surgery. Some of the commonly prescribed medications include oral antibiotics/ pain killers/ anti-fever medication, nasal drops for decongestion and lip creams for swelling/ dry lips.

1A: Oral medications

Oral medications should be prepared in the following manner:

• Oral medications should be pounded and dissolved in liquid to form a solution, then taken using the syringes and feeding tubes provided.
  
• Medications can be mixed with syrups/ fruit juice/ honey to improve their taste. Avoid taking medications with milk.
  
• Take your antibiotics punctually and complete the entire course as prescribed.
  
• Take your painkillers and anti-fever medications when needed.

1B: Nasal drops

Apply the nose drops as prescribed if needed, in the following manner:

Take a deep breath as you apply the nose drops to allow the medication to flow into your nose for better efficacy. You will experience a bitter taste as the medication flows down your throat.

1C: Lip creams

There can be significant swelling of the lips after surgery. Do make sure to apply the prescribed creams/ ointments to your lips as instructed.

Do note that you may be prescribed additional medications as deemed fit by the surgical team. Please feel free to check with the surgical team if you have any queries regarding your medications prior to discharge.

Feeding and drinking

You will be required to drink and feed yourself using the syringes and feeding tubes provided in the immediate post-operative recovery period.
It is important to maintain good oral intake during your recovery from surgery.

A good tip for drinking using a syringe is to sit upright and tilt your head back slightly when drinking. This allows the fluid to flow backwards with gravity making it easier to swallow. The syringes and tubes can be washed and re-used.

It is advisable to keep separate syringes for medications, plain water and other feeds.

Refer to the subsequent section on nutrition and hydration under dietary recommendations in the post-operative phase.

Showering

Do check with your doctor about showering after your surgery during your hospitalisation stay. Do ask the nurses for assistance, if you shower.

You may shower with warm, but not hot, water in the first week as it may cause bleeding.

On discharge, you should consider placing a plastic stool in the shower area of your home. This will allow you to sit down in the event you feel giddy to avoid a fall. Inform your caregivers/ family members before you shower and keep the bathroom door unlocked in the event you require assistance.

Wound dressings

Where there is a wound dressing present, do not wash your face with water directly. Use a damp towel to clean your face and pat dry after.

You may remove the jaw bandage (if any) at an appropriate time as advised by your surgeon. Peel it off slowly by pulling along the skin and not away from the skin in an outward direction.

When the jaw bandage is removed, you can gently wash your face.

Maintaining good oral hygiene

It is important to have good oral hygiene as this will reduce your risk of infection as well as decay and gum disease.

• Use a toothbrush with a small head and a small amount of toothpaste/ antiseptic mouthwash (chlorhexidine).
• Gently brush the upper and lower gumline, outer surfaces of the teeth, plastic wafer, metal brackets and rubber bands/ wires 3 times a day.
• Rinse with antiseptic mouthwash after that. While doing so, clean the inner surfaces of the teeth and roof of the mouth by rubbing these areas with your tongue.
• Avoid rinsing with water for at least 30 minutes after using the antiseptic mouthwash to maximise its effect.
• Try to rinse with the antiseptic mouthwash after each intake of feeds.

Remember to brush:

Physical activity

• Slight giddiness and lethargy may occur after your operation due to blood loss/ medications/ stress/ reduced intake/ sleep disturbance.
  
• Sitting out of bed and ambulating will help your body in recovering from the effects of anaesthesia and surgery. Do try to sit out of bed during the day time whenever possible.
  
• However, do note that you should avoid vigorous physical exercises and climbing heights for the first 2 weeks after surgery.
  
• Take care to avoid swimming for at least 3 months until your wounds have healed.

Avoiding injury to your face and jaws

Bone healing requires a period of approximately 6 months. During this time, avoid any trauma/ injury to the face and jaws to prevent accidental fractures of the healing bone.

This includes but is not limited to:

• Avoid wet and slippery floors.
  
• Be careful when playing with children.
  
• Avoid contact sports (e.g. basketball, soccer, rugby, martial arts).
  
• Avoid activities that may result in trauma to the face and jaws (e.g. cycling/ rock climbing).

Nasal congestion and sinus precautions (for upper jaw surgery only)

Some nasal congestion can occur due to swelling and blood clots.

Avoid blowing your nose strictly after surgery as this will cause air to be forced into the soft tissues which can result in additional swelling and potential infections.

Managing nose bleeds (for upper jaw surgery only)

• Do not panic. Tilt your head forward to allow the blood to flow out instead of backwards.
• Then apply pressure to the nostril(s) with a handkerchief/ towel to help stop the bleeding.
• You can also apply ice packs around the nose and face to help stop the bleeding.

If the bleeding is profuse, please refer to "Dealing with Emergencies" below.

Bowel movements after surgery

Due to the lack of solid food, it is expected to have little stools for the first 10 days. The stools tend to be soft and watery. However, they should not be associated with pain or greenish colouration. There should still be gastrointestinal movement and gas emission regularly.

Some constipation is common after surgery. You can do the following to help with any constipation:

• Include fibre-rich foods as part of your diet (e.g. adding pureed fruits and vegetables to your daily diet).
  
• Ensure you are well hydrated.
  
• Incorporate light exercises (if allowed by your doctor) to stimulate bowel movement.
  
• Discuss with your dietician how you may include fibre containing oral nutritional supplements if you are on a full liquid diet.
  
• Discuss with your doctor if laxatives can be prescribed for you if necessary.

Releasing intermaxillary fixation

Your teeth will be tied up using elastics (dental rubber bands) as shown in the diagram.

In rare circumstances, you may be required to cut these rubber bands (e.g. severe bleeding, difficulty breathing).

​	​Part your lips using your nondominant hand. You can also get the help of a family member. Identify the rubber bands.
​	​Use a small, sharp pair of scissors to cut the rubber bands in the front as pictured. Do not worry about the remnant pieces that are stuck.
​	​Move your way backwards and cut the rubber bands at the back.
​	​After you have released the rubber bands, you will be able to open your mouth.

Note: In some patients there may be no occlusal wafer present if deemed unnecessary by the surgeon.

Dealing with emergencies

If it is during office hours, you can call 6324 8802 to inform us of the situation and walk in to National Dental Centre Singapore. Please approach our reception counter at Level 1 for assistance when you are here.
If it is after office hours or during the weekend, please go directly to Singapore General Hospital, Emergency Department. The Oral and Maxillofacial Surgery (OMS) team will then be activated to assist you if necessary.

Examples of emergencies include:

• Severe bleeding
  
• Difficulty breathing
  
• Severe pain
  
• Persistent high fever

Note: In some patients there may be no occlusal wafer present if deemed unnecessary by the surgeon.

*Please inform the A&E/ NDCS staff about the details of your surgery and the name of the OMS consultant in charge. This information can be found in the discharge summary that you receive on discharge.