Oral & Maxillofacial Surgery Patient Information

• Do NOT eat or drink after midnight the night before surgery.
• You may take your prescribed medications with a small sip of water unless told otherwise.
• Expect to be here 1.5–2 hours. Arrive 30 minutes early. If you are late, your appointment will be rescheduled. No exceptions.
• Under 18: Must come with a parent/legal guardian who must stay the entire time.
• 18+: Must have an adult escort who checks in with you, stays in the waiting room, and takes you home. You cannot be discharged alone.
• No smoking, vaping, cigarettes, cigars, marijuana, or nicotine products for 24 hours before surgery.
• Wear loose, comfortable clothing. No tank tops, no flip-flops/sandals. Remove all jewelry.
• No acrylic/gel nails, no nail polish, no lipstick. Do not wear contact lenses. Regular glasses are fine.
• Dentures, partials, and retainers may need to be removed if instructed.
• Parents, guardians, family, and friends may NOT enter the procedure room.
• Audio/video recording is not allowed (HIPAA). If any recording is detected, you will be asked to delete any footage.
• If you take aspirin, ibuprofen, warfarin (Coumadin), apixaban (Eliquis), or other blood-thinning medications, continue them as usual unless your surgeon specifically tells you otherwise. If you have asthma, bring your inhaler on the day of surgery.

• POST ANESTHESIA PRE CAUTIONS- Do not drive, operate machinery, or make important decisions for 24 hours after your surgery.
• PAIN MEDICATION– If instructed by your surgeon, you should take Motrin/Ibuprofen and/or Tylenol continuously for the first 3-5 days.Take the first dose immediately and before the local anesthesia has worn off. You may use the prescription narcotic medication but do not take acetaminophen (Tylenol) with other combinations such as Vicodin, Norco or Tylenol #3. Do not take ibuprofen on an empty stomach.
• GAUZE PRESSURE– Bite down firmly on the gauze packs that have been placed over the surgical areas, make sure they remain in place. Do not change them for the first 30 minutes unless the bleeding is heavy. After 30 minutes, place enough new gauze to obtain pressure over the surgical site for another 30 minutes. The gauze may then be changed as necessary (typically every 20 to 30 minutes). It is best to slightly moisten the gauze with tap water and loosely fluff for more comfortable positioning. Bleeding from oral surgery may take 24 hours to fully stop. Read below.
• PROTECTING THE BLOOD CLOT– Do not rinse, smoke, or drink with a straw for at least 1 week after your surgery. If you have been prescribed an antibiotic mouthwash, you may begin to use it gently at bedtime the night of your surgery.

The chemicals in cigarettes are caustic and will significantly delay healing, increase post-operative pain, swelling, risk of infection, and dry socket.

• ICE PACKS– Swelling is common following oral surgery. Swelling can be minimized by using cold packs, or a bag of frozen peas applied firmly to the cheek nearest to the surgical area. This should be applied twenty minutes on and twenty minutes off during the first 24 hours after surgery. Do not use any ice after the first 24 hours.

If you have been prescribed medicine to minimize swelling, be sure to take it as directed. You should take the first group of pills at bedtime tonight.

• PERSISTENT BLEEDING– Mild bleeding or oozing is normal during the first 24 hours. If necessary reposition the gauze packs directly over the surgical site. If bleeding persists or becomes heavy you may substitute a tea bag (soaked in very hot water, squeezed damp-dry and wrapped in a moist gauze) for 20 or 30 minutes. The tea contains a beneficial chemical that locally constricts blood vessels. If bleeding remains uncontrolled after a full hour of using the tea bags, call our office. Remove the gauze while you eat and sleep. Place an old towel over your pillow, as one drop of blood will turn a mouth full of saliva red. It is completely normal to experience mild oozing of blood from the surgical area for a full 24 hrs. Once the bleeding has stopped you do not have to use gauze anymore.
• MOUTH OPENING EXERCISES– Jaw stiffness is common following oral surgery. You can reduce this stiffness by stretching your mouth open with two fingers each hour.
• MANAGING POST-OPERATIVE PAIN– Unfortunately, most oral surgery is accompanied by some degree of discomfort and you may be given a prescription for pain medication. To best manage your discomfort, you should take the first pill before the numbness has worn off. If you find you are taking large amounts of pain medicine at frequent intervals, please call our office. You must call for a refill during normal weekday business hours, if you anticipate needing more pain medication for the weekend.
• NAUSEA– Nausea can occur after anesthesia or surgery. It generally improves within 4-6 hours. Nausea following anesthesia is best managed by avoiding all foods until you are feeling hungry. Try sipping small amounts of clear liquids to prevent dehydration. If the pain medication is the cause, try taking Maalox immediately before the medication and drink plenty of water. Try to keep taking clear fluids and minimize dosing of pain medications, but call us if you do not feel better. Classic Coca Cola may also help with nausea.
• PAIN MEDICATION PRECAUTIONS– The prescription pain medication given to you by the doctor may cause drowsiness, decreased reaction time, blurred vision and change in mental status. Do not drive, operate dangerous machinery, make important decisions or perform strenuous exercises while taking these medications.
• DIET— Avoid heavy meals for 12 hours after surgery, instead eat several small meals throughout the day. You should always eat something before you take prescribed pain medications to avoid nausea and vomiting unless otherwise advised. Ice cream, jello, yogurt, scrambled eggs, mashed potatoes, and pasta are some foods you may be comfortable eating after surgery. Certain medications including antibiotics can render certain types of birth control ineffective; therefore other methods of birth control should be used. The goal is: soft, cool or lukewarm foods, nothing crunchy, spicy, or requiring heavy chewing.
• Breakfast Ideas: Pancakes, Yogurt and banana, Oatmeal with honey, Cottage cheese and applesauce, Protein shakes, smoothies in a cup.
• Lunch Ideas: Tuna Salad, Egg Salad, Pureed soups, Tomato soup, Mac and cheese, Buttered noodles, Tuna salad and rice, Mashed potatoes, Ramen noodles, Potato soup, Refried beans, Soft pasta marinara, Mashed sweet potato.
• Dinner Ideas: Alfredo pasta, Fish and mashed potatoes, Salmon and mashed peas, Cheese ravioli, Ground beef and potatoes, Soft casseroles, Risotto, Creamed spinach and noodles, Tofu and mashed vegetables, Lasagna soft, Vegetable soup blended.

• ORAL HYGIENE– Keeping your mouth clean after surgery is essential. In addition to any prescription mouth washes you may have been given, use 1/4 teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat as often as you like, but at least twice a day. Avoid commercial mouthwashes, the alcohol they contain may irritate the surgical site. Avoid brushing the surgical area for at least two weeks. However, we do encourage you to brush and floss all other areas.
• HEALING– The first three days after surgery are generally the most uncomfortable, and there is usually some swelling. Temporary numbness of the lips, tongue, or chin may also occur during this time and typically improves as healing progresses. By the fourth day, you should feel more comfortable and, although some swelling may remain, you can usually begin a more normal diet. The remainder of the post-operative course should show gradual, steady improvement. If you do not notice continued improvement, if numbness worsens, or if numbness does not gradually improve, please call our office.
• DRY SOCKET – A dry socket is a painful condition that results from premature loss of the blood clot. Risk factors for developing a dry socket are extracting painful or infected teeth, wisdom tooth surgery, females, smokers, and oral contraceptives. Symptoms of a dry socket typically occur on the 3rd or 4th post-operative day. Severe throbbing pain, which is not responsive to pain medications, and bad breath are the usual complaints. Pain usually peaks around the 4th to 5th day after surgery; after that the site begins to feel better and the discomfort gradually improves. This condition requires an office visit where your surgeon will gently place a medicated dressing into the tooth socket. Pain relief is often immediate once the site is treated. A few visits may be necessary in some cases.
• SHARP EDGES/SUTURES– If you feel something hard or sharp edges around the surgical areas, it is likely you are feeling the bony walls, which once supported the extracted teeth or the ends of the sutures. Occasionally small slivers of bone may work themselves out during the following weeks. This is normal but if they cause concern or discomfort, please call the office. Dissolvable stitches begin to melt away as you heal. Loose ends may be cut short with clean sharp scissors or gently pulled.
• Following these instructions will assist you, but if you have questions about your progress, please call the office. Calling during office hours will result in a faster response to your question or concern.PLEASE NOTE: Telephone calls for renewing narcotic (pain killer) prescriptions must be made during regular office hours as pharmacies do not accept over-the-phone narcotic refills.

Surgery of the mouth is similar to surgery in other parts of the body and requires careful attention to post-operative instructions. Only by doing so, will there be a minimal amount of after effects.

1. DIET – Following extractions a soft cool diet should be consumed for the first 24 hours after surgery. You should have something to drink 1 hour after surgery and something to eat 2 hours after surgery before any medications are taken. Soft foods consist of ice cream, pudding, yogurt, jello, scrambled eggs, mashed potatoes, or pasta. Avoid any foods that have rice, nuts, or seeds for at least 2 weeks after surgery. Some patients may experience nausea and vomiting following oral surgery and/or intravenous anesthesia. Make sure to drink plenty of fluids to keep yourself hydrated, if symptoms persist please call the office for further instructions.
2. BLEEDING – Do not disturb the wound(s) with the finger or tongue. Bite on gauze for 45 minutes without changing it. Remove the gauze after 45 minutes and replace the gauze if bleeding is still present for an additional 45 minutes. Continue repeating this step until bleeding has stopped. If bleeding does not subside, place a moist tea bag over the wound. Continue to maintain pressure on the wound for another 45 minutes. If bleeding continues and does not subside or if it is severe, please call the office. DO NOT RINSE, SPIT OR DRINK FROM A STRAW FOR 24 HOURS AFTER SURGERY.
3. SWELLING – In an attempt to minimize swelling use an ice pack we suggest placing the ice pack on the side of the face where surgery was performed. Use the ice pack for the first 24-36 hours after surgery, place the ice pack 15 minutes on then 15 minutes off the area. Maximum swelling normally occurs 36-48 hours after surgery and can take 5-8 days to go away.
4. MEDICATIONS – Non-prescription and prescription pain medications should be taken as directed on the label, and should be started before the effects of the local anesthesia disappear. Avoid heavy meals for 12 hours after surgery, instead eat several small meals throughout the day. You should always eat something before you take prescribed pain medications to avoid nausea and vomiting unless otherwise advised. Ice cream, jello, yogurt, scrambled eggs, mashed potatoes, and pasta are some foods you may be comfortable eating after surgery. Certain medications including antibiotics can render the birth control pill ineffective. Therefore, other methods of birth control should be used. Antibiotics if given should be taken as directed by your doctor.
5. ORAL HYGIENE – Do not rinse the area for 24 hours after surgery. After 24 hours, brushing of all teeth should be resumed, preferably with a soft brush. For 1 week following surgery, rinse gently 4 times a day especially after meals. Healing will occur more rapidly when good oral hygiene is observed.
6. ACTIVITIES – Keep physical activities to a minimum for the first 24 hours. Active sports should be avoided for 4-5 days unless otherwise instructed. Avoid playing wind instruments for 4-5 days after surgery.
7. NO SMOKING – Smoking causes/promotes poor healing of wounds, you should not smoke for 5-7 days after surgery.
8. SUTURES — Most sutures/stitches used are resorbable. They will loosen, dissolve, or fall off roughly between 5-10 days. Some may last longer or shorter depending on what was used.
9. MISCELLANEOUS – Pain in the area, difficulty swallowing, difficulty opening or closing the jaw, and some bruising are additional symptoms which occur with varying frequency. These symptoms are usually temporary, and should disappear during the normal healing period (7-10 days).In the event of an emergency, the doctor can be reached at either office 24 hours a day.

• Do NOT drink with a straw.
• Do NOT blow your nose.
• Do NOT smoke (cigarettes, cigars, pipes) or play wind instruments.
• Do NOT open your mouth very wide.
• If you need to sneeze, sneeze with your mouth open.
• Use all medications exactly as directed.

Call us if you have side effects or questions.

• Avoid swimming and strenuous exercise for at least 1 week.
• Eat soft or liquid foods and chew on the opposite side of your mouth
• Brush your teeth normally but avoid the surgical site.
• Rinse with warm water 3× daily.

Normal Side Effects

• Slight nose bleeding for a few days.
• Swelling or facial bruising may occur.

Contact Us

• Clinic: (312) 413-9728
• Emergency: (312) 355-4000, ask for the “Oral Surgeon On-Call”
• Hours: 8:30 a.m.–4:30 p.m.

CARING FOR YOUR SINUSES AFTER ORAL SURGERY

Because of the close relationship to the sinus, many times when a tooth is extracted, it will leave a communication between the mouth and the sinus. Due to the close proximity of the sinus to the surgical site, it is important for you to follow these instructions:

1.  Take prescriptions as directed by your doctor.
2.  Do not spit for several days.
3.  Refrain from blowing your nose for two weeks.
4.  Try not to sneeze or cause pressure. If you must sneeze, try to sneeze with your mouth open.
5.  Do not use a straw or smoke.
6.  Eat soft foods and chew on the opposite side of the surgical area.
7.  Follow oral hygiene instructions and avoid rinsing too vigorously.

It is not uncommon to have a slight amount of bleeding from the nose. But you should call the office if it is extensive or reoccurring.

These sinus communications will normally close on their own. However, some do not resolve on their own and may require a secondary procedure, particularly if these instructions are not followed, or due to factors beyond the control of anyone involved. If symptoms persist or reoccur, it is imperative that you call our office so that we may reevaluate the situation.

It is important to understand that failure to follow any of the instructions as indicated above may result in serious complications, significant detriment to your health, and in some cases may be life threatening. Your doctor is available to answer any questions concerning your surgery 24 hours a day.

Bleeding

• Bite firmly on gauze for 30–60 minutes to help stop bleeding.
• Light oozing (pink saliva) is normal for up to 24 hours.
• If bleeding continues, replace with fresh gauze or a damp tea bag and apply firm pressure.
• Avoid spitting, rinsing, or using straws for the first 24 hours.

Swelling

• Swelling is normal and may increase over the first 2–3 days.
• Apply ice packs 20 minutes on and 20 minutes off for the first 24–48 hours.
• Keep your head elevated when resting.

Pain Management

• Take pain medication before the numbness wears off.
• You may alternate ibuprofen and acetaminophen if recommended.
• Take all medications as prescribed.

Diet

• Eat soft foods such as yogurt, eggs, mashed potatoes, and soup.
• Avoid hot, spicy, crunchy, or hard foods.
• Do not use straws, as suction can cause bleeding.

Oral Hygiene

• Do not rinse for the first 24 hours.
• After 24 hours, gently rinse with warm salt water 2–3 times daily.
• Brush your teeth as normal, avoiding the surgical site.

Activity

• Rest the day of surgery.
• Avoid strenuous activity for 48–72 hours.

What is Normal

• Mild pain, swelling, and slight bleeding.
• Minor bruising or stiffness.

When to Call the Office

• Heavy bleeding that does not stop.
• Severe pain not controlled with medication.
• Fever, chills, or signs of infection.
• Swelling that worsens after 3 days.

Diet

• Follow a strict soft or liquid diet as instructed.
• Avoid chewing unless cleared by your surgeon.
• Good nutrition is essential for healing. Consider protein shakes or supplements if needed.

Jaw Fixation / Elastics

• If your jaws are wired or secured with elastics, do not cut or remove them unless instructed.
• Keep wire cutters with you at all times if provided.
• If elastics break or come off, contact the office.

Oral Hygiene

• Maintain excellent oral hygiene to prevent infection.
• Use a prescribed mouth rinse or warm salt water rinses several times daily.
• Gently brush teeth if able, avoiding surgical areas.

Swelling

• Swelling is expected and may increase over the first 2–3 days.
• Apply ice packs for 20 minutes on and 20 minutes off during the first 48 hours.
• Keep your head elevated.

Pain Management

• Take prescribed pain medications as directed.
• Begin medication before numbness wears off.
• Complete any prescribed antibiotics.

Activity

• Limit physical activity for at least 1–2 weeks.
• Avoid contact sports or any risk of facial injury.
• Rest and allow your body to heal.

Speech and Jaw Movement

• Limit talking and jaw movement as much as possible.
• Do not attempt to force your mouth open.
• Follow any jaw exercises only if instructed.

What is Normal

• Swelling, bruising, mild bleeding, and discomfort.
• Difficulty opening mouth or speaking clearly.

When to Call the Office

• Difficulty breathing or swallowing.
• Fever, chills, or signs of infection.
• Severe pain not controlled with medication.
• Loose wires, broken elastics, or shifting of the jaw.

Bleeding

• Bite on gauze for 30–60 minutes after surgery.
• Light bleeding or oozing is normal for up to 24 hours.
• If bleeding continues, replace gauze and apply firm pressure.
• Avoid spitting, rinsing, or using straws for the first 24 hours.

Swelling

• Swelling is expected and may be more significant due to bone removal.
• Swelling may increase over the first 2–3 days.
• Apply ice packs 20 minutes on and 20 minutes off for the first 24–48 hours.
• Keep your head elevated when resting.

Pain Management

• Take pain medication before numbness wears off.
• Use medications as prescribed.
• You may alternate ibuprofen and acetaminophen if recommended.

Diet

• Follow a soft diet for several days.
• Avoid hard, crunchy, or sharp foods that may irritate the surgical site.
• For upper (palatal) tori removal, avoid hot foods that may irritate the palate.
• Stay well hydrated.

Oral Hygiene

• Do not rinse for the first 24 hours.
• After 24 hours, gently rinse with warm salt water 2–3 times daily.
• Brush carefully, avoiding the surgical area.
• Keep the area clean to prevent infection.

Suture/Surgical Site

• Sutures may be present and will dissolve or be removed as instructed.
• A white or yellowish appearance over the site may be part of normal healing.
• Avoid touching or disturbing the area with your tongue or fingers.

Activity

• Rest the day of surgery.
• Avoid strenuous activity for 48–72 hours.

What is Normal

• Swelling, discomfort, and mild bleeding.
• Bruising or tightness in the area.
• Temporary difficulty speaking or eating depending on location.

When to Call the Office

• Heavy bleeding that does not stop.
• Severe pain not controlled with medication.
• Signs of infection such as fever, pus, or worsening swelling after 3 days.
• Difficulty swallowing or breathing.

• Eat a soft diet (pasta, soft breads, soft fish, ground meats) for 2–3 days, then return to normal foods as tolerated over 7–14 days.
• If you use a nightguard, wear it at night only. Do not wear it full-time.
• You may shower normally. Keep puncture sites clean and dry.
• You can apply a thin layer of antibiotic ointment (Bacitracin or Neosporin) to the puncture sites.
• Call immediately if you notice increasing swelling, redness, or heat at the surgical site: (312) 355-4000 and ask for the “Oral Surgeon On-Call.”

Bleeding 

• A small amount of bleeding or pink saliva is normal for the first 24 hours.  
• If bleeding occurs, place gauze over the area and apply firm pressure for 20–30 minutes.  
• Avoid spitting, sucking through a straw, or vigorous rinsing on the day of surgery.  

Swelling & Discomfort 

• Mild swelling and soreness are expected.  
• Apply an ice pack to the outside of the face for 20 minutes on / 20 minutes off during the first 24 hours.  
• Take prescribed or recommended pain medication as directed.  

Diet 

• Eat soft, cool foods for the first 24–48 hours.  
• Recommended foods:  
• Yogurt  
• Applesauce  
• Mashed potatoes  
• Smoothies (without a straw)  
• Soup (lukewarm, not hot) 

Avoid:  

• Spicy foods  
• Crunchy or sharp foods  
• Extremely hot foods/drinks  

Oral Hygiene 

• Keep the mouth clean, but avoid brushing directly over the surgical site for the first day.  
• Beginning the day after surgery, gently rinse with warm salt water 3–4 times daily:  
• 1 teaspoon salt in 8 oz warm water  
• Continue normal brushing/flossing in other areas.  

Activity 

• Rest for the remainder of the day after surgery.  
• Avoid strenuous activity or exercise for 24–48 hours.  

Sutures 

• If stitches were placed, they may dissolve on their own within several days to 1–2 weeks.  
• Avoid pulling on the lip or tongue excessively while healing.  

Healing 

• A white or yellowish appearance over the area is part of normal healing.  
• Mild tightness during speaking or eating can occur temporarily.  

Call the office if you experience:

• Heavy bleeding that does not stop  
• Severe swelling after 48 hours  
• Fever over 101°F  
• Difficulty breathing or swallowing  
• Uncontrolled pain  
• Signs of infection (pus, foul odor, worsening redness)  

Please contact our office with any questions or concerns regarding your recovery. 

Bleeding

• Bite on gauze for 30–60 minutes after surgery.
• Light bleeding is normal for up to 24 hours.
• Avoid spitting, rinsing, or using straws.

Swelling

• Swelling is expected and may increase over the first 2–3 days.
• Use ice packs 20 minutes on and 20 minutes off for 24–48 hours.

Pain Management

• Take medications before numbness wears off.
• Complete any prescribed antibiotics.
• Use ibuprofen and acetaminophen if recommended.

Diet

• Eat soft foods only.
• Avoid chewing on the implant site.
• Avoid hard, crunchy, or sticky foods.
• No straws to prevent disruption of healing.

Oral Hygiene

• Do not rinse for 24 hours.
• After 24 hours, rinse gently with warm salt water.
• Brush carefully around the site.

Activity

• Limit physical activity for 48–72 hours.

Implant Care

• A small metal healing cap may be visible. Do not disturb it.
• Avoid touching or pulling your lip to look at the site.
• Follow all additional provider instructions.

What is Normal

• Mild swelling, discomfort, and minor bleeding.
• Temporary tightness or soreness.

When to Call the Office

• Excessive bleeding.
• Severe or worsening pain.
• Signs of infection such as fever or pus.
• Swelling that worsens after 3 days.

These instructions apply to the surgical procedure just completed. They are designed to help you minimize post-surgical discomfort and inform you of any situation that may require special attention.

Pain Medications – It is not unusual to have discomfort for at least the first week following your surgical procedure. You will be given a prescription for medication to help you tolerate the post-surgical recovery period. Please take your medications as directed. If necessary, you may take your pain medication more frequently than every 4-6 hours to stay ahead of the soreness. It is advisable to not take pain medication on an empty stomach, as nausea may result.

Note: When taking any prescribed medication containing Acetaminophen (Tylenol), i.e.; Norco, Vicodin, Percocet or Tylenol with Codeine, you should not take additional Tylenol so as not to exceed the safety level of Acetaminophen. Please contact the office with any questions you may have.

Antibiotics – Please alert the office to any allergies or sensitivities that you might have to antibiotics. An antibiotic may be prescribed following your surgical procedure. Take as directed until gone. It is advisable not to take any prescribed medications for this procedure on an empty stomach, as nausea may result. For women taking birth control pills, be advised that antibiotics may interfere with their effectiveness.

Swelling – Swelling may occur following your surgical procedure and will typically increase 3-5 days after the procedure. To minimize the swelling, place an ice pack over the outside cheek area for 20 minutes on and 20 minutes off. Continue using ice for 2-3 days following the procedure as often as possible.

Bleeding – A small amount of bleeding is normal. If excessive or continuous bleeding occurs:

Do not rinse your mouth.

• Elevate your head when lying down.
• Apply moistened gauze to the immediate area with moderate pressure for 20 minutes; repeat if necessary.
• Enclose a moistened tea bag in a gauze square and apply pressure for 20 minutes.
• Call the office if bleeding persists.

Smoking – Do not smoke for at least 2 weeks following your surgical procedure. It will significantly slow healing and can compromise results.

Alcohol – Do not drink alcohol while taking prescription pain medications.

Rinsing – Do not rinse for the first 24 hours. Thereafter, use prescription mouth rinse as directed by your doctor.

Brushing – Do not brush the surgical site as directed by your doctor.

Suture Removal – You may notice increased discomfort 3-4 days after the surgical procedure. As the tissues begin to heal, they may pull against the sutures and dressing. You may choose to take some form of pain medication one hour prior to your suture removal appointment to minimize tenderness.

Diet – See recommended diet.

Contact us with any questions or concerns during regular office hours, please do not hesitate to contact our office or the treatment coordinator.

Please use the following information as a strict guideline.

The following foods are recommended that do NOT require chewing.

For example:

• Pudding, Jell-O, Applesauce, Protein Drinks (Ensure), Milkshakes, Clear Broth and Milk
• Creamy Mashed Potatoes/ Sweet Potatoes/ Squash
• Mildly Seasoned Broth or Creamy Soups
• Scrambled Eggs
• Cottage Cheese
• Yogurt (WITHOUT strawberries or other fruit containing seeds)
• Mashed Banana or Avocado
• Cream of Wheat (avoid oatmeal due to large oat pieces)
• Blended Smoothies (WITHOUT strawberries or other fruit containing seeds)

AVOID THE FOLLOWING:

• Spicy, Citrus and Tomato based foods
• Steaming Hot foods
• Fruit/Berries with seeds (such as strawberries and raspberries)
• Drinking through a straw

You can now introduce “Easy to Chew” foods to your diet. Anything you can easily cut with the side of a plastic fork. For example:

• Soft/Tender Fish
• Soft/Tender Chicken
• Over-cooked Pasta (Spaghetti / Lasagna)

AVOID THE FOLLOWING:

Hard crunchy foods INCLUDING BUT NOT LIMITED TO:

• Nuts/Seeds
• Popcorn (Hulls)
• Hard candy
• Chips/ Pretzels
• Hard Crusts (French bread)

DO NOT use the front or side teeth for tearing into foods. Shearing forces are likely to cause fracture of teeth from the prosthesis. Foods to be aware of:

• Brats/ Hot dogs
• Hamburgers
• French bread

From this point, until the definitive prosthesis is made, it is important for you to follow these instructions. The Interim (Temporary) Prosthesis is NOT meant to withstand the strength of chewing forces. The definitive prosthesis will be fabricated with a titanium bar which can withstand the forces of normal mastication.

Once the definitive prosthesis is in place, you will be able to resume a normal diet with minimal limitations.

The hospital will contact you at least 24 hours prior to let you know exactly what time and where you should report. You will be asked to arrive about two hours prior to your scheduled surgery.  The length of your actual surgery is approximately 2-5 hours. Remember not to eat or drink anything for 8 hr prior to surgery or the anesthesiologist may cancel the surgery.

Immediately post-op

Immediately after the surgery you will likely recover from the anesthesia in the Post Anesthesia Care Unit (PACU) for an hour or so. You will then be transferred to a room for further recovery. Single jaw surgeries do not usually necessitate an overnight hospital stay and will be discharged when certain criteria are met.  Double jaw surgeries will likely go directly to the Intensive Care Unit (ICU) for an overnight stay.

During your care in the PACU/Hospital

A hospital nurse will monitor and assist you.  You will be provided medications for pain, congestion and nausea as needed.  You will receive antibiotics and steroids at scheduled intervals. You should be able to open your mouth, but you will have some light guiding rubber bands in place.  You will have a light gauze dressing wrapped around your face. You will have an IV in your hand or arm providing you with fluids and medications. You may also have a catheter in your bladder so that you will not have to get out of bed to urinate.  These tubes are usually taken out early the next morning for overnight stays.

A hospital nurse will care for you as directed by your surgeon. Intravenous fluids and medications for pain, congestion, and nausea will be provided as needed.

An important step to keep you healthy involves drinking liquids. This will prevent you from becoming dehydrated. It is also important to walk around with assistants. This helps with keeping your blood moving and your lungs working well.  You will be instructed on oral hygiene, oral and/or facial wound care and breathing exercises to assist in your recovery from general anesthesia. All these things are important to be able to go home.

Medications

Take your medications as instructed.  You will be receiving an antibiotic to reduce your chances of infection.  A steroid will reduce inflammation and swelling.  Ibuprofen or a similar NSAID will reduce discomfort and inflammation.  Lortab (Hydrocodone with Tylenol) or a similar narcotic analgesic will reduce pain and discomfort. Sudafed or a similar decongestant will help you breathe through your nose easier.  Saline nasal spray will keep your nasal passages moist. Chlorhexidine Gluconate or a similar disinfectant mouth rinse will help keep your mouth clean and reduce the chances of infection. Most patients prefer liquid medications.

Reduce swelling

Keep with your head elevated above the level of your heart. Apply ice to your face for at least 30 minutes out of the hour. Expect a good amount of swelling despite our best efforts.
Keep any dressings around the face intact until your surgeon sees you the next morning. Your steroid, NSAID and pain medication will all help to decrease swelling.

Diet

• Take in as much fluid as is tolerable while awake to prevent dehydration. A full glass of water (8 oz.) every 3 hours (if an IV is not running) (= 64 oz./day = -1/2 gallon/day = 2 liters/day)

• Avoid sugary liquids (sodas, juices, etc.) as they may make you dehydrated.
• You will be placed on a clear liquid diet (water, light juice, broth etc.) to start and advance to full liquids (milk, etc.).

You should use the restroom as needed. The nurse may be available to assist you.

Expect

• Minor bleeding and oozing from the surgery wounds and nostrils for the first 24-48 hours.
• A mild sore throat from the endotracheal tube.
• Numbness of your lower lip, chin, cheeks, tongue and teeth (for lower jaw surgery) and your upper lip, cheeks, nose, and teeth (for upper jaw surgery).
• Nasal congestion from upper jaw surgery and the endotracheal tube.
• Limited jaw mobility due to the surgery.
• You may be required to obtain an X-ray or CT scan at the hospital (or later at the office)

Oral Hygiene

Use a baby toothbrush to keep your teeth clean. Be careful around the incision sites, which will be in the upper vestibule of the mouth (for upper jaw surgery) or in the cheeks near the molar teeth along the back-sides of the lower jaw (for lower jaw surgery).

Rinse with Chlorhexidine Gluconate solution twice a day & brush your teeth at the same time. You may wish to brush your tongue during your hygiene periods.

Rinse with warm salt water (one teaspoon per 6-8 ounces) every hour or so. Wounds heal faster when they are clean and moist.

Depending on your specific surgery, you may be asked to use elastic (rubber bands) around your braces to help guide your teeth/jaw into the right bite.

For upper jaw surgery: do not blow your nose or sneeze through your nose for the first 2-3 weeks. Take any additional antibiotics/medications (nasal decongestants, nasal sprays) as directed by your surgeon.

You should have prescriptions and instructions for:

• Strong pain medicine (a narcotic analgesic)
• Antibiotic
• Anti-nausea medicine (if it was necessary)
• Chlorhexidine Gluconate mouth rinse (an antibacterial mouth rinse)

Swelling

Expect significant swelling.  Double jaw surgeries will swell more. It will maximize during the 1st week and diminish thereafter.  Keep your head elevated above the level of your heart at all times.  Do not lay flat.  Sleep in a recliner if possible or propped up with three pillows.  Ice should be used for the first 48-72 hours. You may place crushed ice in a Zip-Lock ® bag or use a bag of frozen baby peas. Wrap the bag in a towel prior to placement on your face. You may use the ice pack for 20 minutes at a time, and then remove to give the skin some rest from the cold. Direct placement of ice to the skin for prolonged periods of time may produce a burn. Remember, your face will be numb. You will be given some form of steroid to reduce swelling, usually an injection prior to leaving the hospital.  Your nasal passages will also be swollen resulting in congestion and difficulty breathing through your nose.  Over the counter decongestants, expectorants and nasal sprays will help.  A steam humidifier placed next to you at all times will also make you feel better.  Similarly, some patients feel better sitting in a steamy shower.  Heat in the form of a warm moist washcloth may be used after 72 hours. You may experience “rebound swelling” near the end of the first week as the effects of the steroids wear off and you begin to use heat.  This is a minor increase in swelling and should not be of concern.

Bleeding

Minor oozing from the incisions inside of the mouth should be expected in the first 72 hours. Upper jaw surgeries usually experience some minor trickling of blood through the nose. Although less common, lower jaw surgeries may experience this also due to the tubes used during surgery. This should not be concerning.  Your nasal sprays and decongestants will help with this. Your surgeon should be notified for a sudden or prolonged gush of bright red blood.  Dark blood clots may be coughed up or expressed through the nose toward the end of the first week for upper jaw surgeries.

Bruising

Expect bruising along with swelling. The bruising should begin to dissipate as the swelling subsides. The bruising may travel in the skin as it dissipates. It will likely change colors from black/blue/purple, to green, to yellow and may travel down the neck to the upper chest. This is normal and will resolve in 1-2 weeks.  Firm, swollen, painful bruising (hematoma) should be reported to your surgeon immediately.

Numbness

The numbness in the face and lips may persist for weeks, sometimes months. This is a normal outcome of this type of surgery. Usually the upper face and lip sensation resolves before the lower face and lips. Younger patients resolve faster.  Motor nerves are usually NOT affected-you should have normal face and lip movement. Ask your surgeon about this outcome if you have further questions.

Activity

Do not overexert yourself during the first week. You may return to light house-work or daily activities during this first week. Slowly resuming your activities will help speed your recovery and should make you feel better. Walking is highly encouraged.  Avoid sunbathing or other activities in the sun so as not to become dehydrated.

Diet

A full liquid diet should be enforced during this first week. Although you are not allowed to chew, it is very important to remain hydrated (see above hospital course). Suggestions for a full liquid diet include: milk shakes, smoothies, juices (not very acidic types, as they may irritate the stomach), Jell-O, blended foods (use the liquefy setting on your blender). Ensure, Sustacal, Carnation Instant Breakfast and Protein Shakes are good sources of much needed calories.  Avoid alcohol and carbonated drinks. Carbonated drinks may distend the stomach, leading to nausea, etc. Avoid very sugary fluids as they may promote dehydration. You may remove the elastics to eat, but replace them as instructed by your surgeon.

Hygiene

Use a baby sized, soft bristled toothbrush to clean the teeth, splint and adjacent gums (avoid the sutures and wounds) at least 2-3 times per day. Keeping the mouth clean will also help prevent a wound infection. The sutures should start to dissolve in the first week as the gum tissue starts to heal. You may rinse with warm salt water often to help soothe the wounds. Avoid mouth rinses with alcohol (a majority of commercial OTC mouth rinses) as they may burn and irritate the healing wounds. Avoid smoking as it will slow or prevent healing and may result in an infection. Avoid directing water picks to the incision wounds in the first week as fluid may become trapped in the wound.

Medications

Take ibuprofen (Advil or Motrin) 600 mg every 6 hours for the first week to help reduce pain and swelling. If you are still in discomfort, you will use a stronger narcotic pain medication, follow instructions on your prescriptions. Remember, most narcotic pain medications already have Tylenol in it, so do not take any extra Tylenol as it may cause a serious problem. Avoid alcohol while taking any of these medications.

Take your antibiotics as directed. If you also take birth control pills, antibiotics may alter the function of birth control pills and it would be strongly advised for you to take other necessary precautions to prevent pregnancy while on antibiotics simultaneously. Take any other prescribed medications as directed by your surgeon. Should you have any questions please contact our surgeon on call.

Follow up

You will return for a post op visit with your surgeon within the first week to evaluate your healing progress. At this visit, you will have an opportunity to discuss any questions. We will review hygiene and medications. X-rays may be taken if they were not taken the week prior.

Swelling should start to resolve and will lessen significantly by the end of the 2nd week.

Bruising should start to resolve and be gone by the end of the second week.

Numbness

Upper lip and face sensation should begin to return.  Lower lip and chin may remain numb.  You may experience tingling sensations in both upper and lower lips.

Mouth opening

You will begin “physical therapy” to re-establish your mouth opening and range of motion.  This is important as scarring can in rare instances lead to permanent restriction of opening.  You will be instructed to remove rubber bands at least 4 times daily and stretch your mouth open.  This can be coordinated with your dosing of ibuprofen.  Waiting 30 minutes after ibuprofen while applying heat to the jaw joints can allow for increased comfort.  Applying ice to the same area for 20 minutes immediately following will reduce inflammation and decrease discomfort.  The goal should be to open greater than 30mm or two fingers by the end of the week.

Activity

You may start to resume more of your regular activity as you see fit. Longer walks are encouraged. Still do not overexert yourself. Exercise is not recommended at this time.

Diet

Continue a full liquid diet and you may add or advance to a soft mechanical diet (scrambled eggs, flaky fish, well cooked (soft) pasta, grits, and oatmeal … foods you can squash with your tongue and swallow without much chewing action).  You must maintain a good protein intake along with plenty of hydration.

Hygiene

Continue hygiene as above. Frequent (every hour if possible) warm water or saline mouth rinses are encouraged.  Continue to use Peridex twice daily. Sutures may begin to dissolve and loosen toward the end of this week. They may trap food.  If they are bothersome, your surgeon may remove them. You may resume your pre-operative hygiene routine with toothpaste, etc. A waterpik can be safely used at this time.

Medications

You will probably continue to use ibuprofen every 6 hours. The discomfort should be greatly reduced. Narcotics will probably not be needed-remember they can be habit forming, cause sleep problems, nausea and constipation.  Consider using Tylenol if the ibuprofen is not quite enough. Your antibiotics should be finished and no more should be needed after the initial course.

Follow up

You will be seen at the end of the second postoperative week. You may request bothersome sutures be removed. If everything appears to be normal, you may be scheduled to return two weeks later.

Diet
Continue a soft mechanical/non-chewing diet.

Activity
You may begin to resume light, non- impact aerobics such as walking then biking or running on the treadmill. Start slow.

Mouth mobility
Increase range of motion exercises as needed to increase your opening.  By the end of the fourth week you should be able to open your mouth as wide as before your surgery. If there is still a significant restriction, you may be referred for physical therapy.