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Post operative care instructions

Introduction

In majority of cases, surgery to the mouth, jaw and face heals quickly and with few side effects. Individuals respond after surgery differently and knowing what to expect after surgery and how to identify and take care of these side effects have been outlined.  As the surgery involves the mouth, jaws and face, it is involved in function immediately after the surgery and this can cause discomfort during the healing period. You should endeavour to keep your mouth clean with frequent oral rinses and use of a small soft toothbrush, avoiding the surgical site or extraction socket. Smoking increases your chance of having an infection as well as “poking” the wound area with your fingers or objects. After surgery, often you will have a numb lip from the local anaesthetic, please avoid hot food and drinks to prevent injury to the lips, cheeks and tongue.


Swelling

Swelling is normal after surgery. Maximum swelling occurs around 24 to 48 hours after surgery and generally subsides rapidly afterwards. The more complex the surgery the greater the swelling. Due to the swelling you may have difficulty in closing your mouth in the first few days. To reduce the amount of swelling, ice packs should be used straight after the surgery. Ice packs should be used for the next 1- 3 days, apply intermittently 15 min on and 15 min off. Ice packs are available at pharmacies. Ice cubes held in the mouth can also be used to reduce the swelling.


Pain and discomfort

This is dependent on the complexity of the surgery. This discomfort is the worse during the first 2 to 4 days after surgery and then should gradually subside. Long acting local anaesthetic is used at the time of surgery to make you comfortable immediately afterwards. Strong painkillers are prescribed for you. You should take them as soon as you get home before the local anaesthetic wears off. For most people painkillers over the chemist counter would be sufficient. Your surgeon may prescribe a stronger painkiller if you need it. Make sure you take these tablets with some substantial food in stomach. The need for pain killers usually stops about 7 to 10 days after surgery. If you develop a rash, nauea or vomiting, or if your pain increases after 48 hours, please contact your surgeon for further advice.


Bleeding

Although rare, haemorrhage may occur. This may be caused by too much exertion or by vomiting. More commonly, a slight pink ooze results from the wound site. This just enough to pink your saliva. If there’s continued bleeding after surgery then you should take the following steps.

  • RINSE out any existing blood clots with salt water or mouthwash.
  • APPLY a piece of gauze over the wound or a small folded handkerchief over the wound and applying pressure by biting gently on the gauze for 30 minutes.
  • SIT STILL and maintain this pressure for 30 minutes. Keep your head elevated with at least 2 pillows when lying down, this decreases the blood rushing to your facial area.
  • AVOID exercising for at least 2- 3 days after surgery.
  • AVOID hot foods/ drinks in the next 2 days as it may make the wound prone to bleed.
  • If the above methods do not stop the bleeding , you should contact your surgeon immediately for further advice.

Wound Care

Do not brush the area near the wound for 3-5 days. Use a chlorhexidine based mouthwash (Savacol or Curasept are available from pharmacies and supermarkets) after meals to keep the wound clean. The rinse should be diluted 1:1 with water. Alternatively, salt water rinses (1 teaspoon in warm water) can also be used. The stitches will start to dissolve 7 to 10 days following surgery. The stitches should be totally dissolved after 2 weeks. Sometimes, your surgeon may use non dissolving stitches to keep the wound tight. This will be removed on your follow up visit.


Infection

An infection in the gum or bone is usually treated with antibiotics. If a course of antibiotics is prescribed for you, take the complete course. Please tell your surgeon if you are allergic or had any adverse reaction to any antibiotics. All surgery has a risk of infection, especially in patients with diabetes. Antibiotics are often prescribed at the time of surgery to prevent infection. If infection does occur after surgery, the symptoms appear with increased pain, swelling, raised temperature and a bad taste in the mouth. Rarely, the wound site may need to be re-opened, cleaned and restitched. If infection occurs, it can make things worse by spreading to adjacent areas or make the wound healing difficult. Please call your surgeon immediately for further advice and management.


Hydration and Nutrition

General

Keep your fluid intake adequate with plenty of water or sugar drinks. Non-dairy/ water based ice blocks can also help hydrate and supplement your fluid requirements. Adequate nutrition is essential for wound healing. In the early stages, it may be easier to eat smaller portions 5- 6 times a day and gradually increasing your portion size. Normally, soft foods which require minimum chewing such as soup, mashed vegetables, vegetable/ fruit juices, soft scrambled eggs would help. Your surgeon can advise you on the dietary advice for you. In the later stages of healing, you can gradually return to a normal schedule of meals. Remember to rinse your mouth immediately after each meal.


Major jaw surgery

You will unfortunately have to reduce your food or even fluid intake for up to 6 weeks. This may result in loss of weight which is not ideal for optimal healing. You should keep a record of your weight throughout this period.

It is recommended to have 6 -8 small meals a day instead of regular 3 meals a day to reduce discomfort. This is because often it is very uncomfortable to eat a lot of food and fluid at once.

Jaw stabilisation with elastics and hooks.

  • Generally you may be wearing elastic bands for up to 2 - 6 weeks. Your surgeon will advise you on the duration.
  • This is where your jaw maybe held together tightly or lightly by elastic bands which prevents you from moving or opening your jaws. You will be only able to suck fluids or vitamised liquid food between your teeth with a straw. Later on you will be able to place vitamised liquid through the gap between your teeth.
  • You will be on the CLEAR FULID DIET for the first day or two and then on the FREE FLUID DIET for about 4- 5 days.
  • Then you progress on to VITAMIZED DIET for 4 to 15 days.
  • Then a slow re –introduction of soft food can start. As you get better, the texture of food can increase until you are back on normal diet.
  • It is essential during this period that you include all major food groups in the diet . Maintain a variety in your diet throughout this time to entice your appetite to eat.

Clear Fluids ( 1-2 Days)

This will be your first form of nutrition immediately after surgery. This includes liquids or liquified food at room temperature or colder and includes.

  • Water/ cordials
  • Clear soups
  • Broths
  • Beef / chicken / vegetable stock
  • Black tea/ coffee with sugar
  • Fruit drink
  • Plain jelly
  • Strained fruit juice
  • Water based ice blocks

Free Fluid Diet ( 4- 5 days)

This is made up of food that is liquid or partially solid and should be at room temperature or warm. It should be high in energy, protein and other nutrients 

  • Milk drinks / ice coffee
  • Thin soups
  • Broths
  • Yoghurt
  • Fruit juice
  • Milk shakes/ fruit smoothies
  • Strained vegetable stock
  • Ice cream
  • Thin custard

Vitamised Diet(Weeks)

This diet is required to allow adequate nutrition to be consumed while the jaw has limited movement. All foods should be blended until they are smooth and free of lumps.

  • Sweet
    • Semolina with milk
    • Porridge
    • Fruche/ yoghurt
    • Cheese cake filling
    • Mashed fresh or canned fruit
    • Cereal well soaked in warm milk
    • Creamed rice pudding
    • Mousse
    • Fruit purees
    • Sustagen / Ensure
  • Savoury
    • Moist creamy scrambled eggs
    • Soft cooked legumes and lentils
      • Eg baked bean, three bean mix
    • Soft cooked / mashed vegetables
    • Canned vegetables
    • Grated cheese that has been melted
    • Pureed mince / pasta
    • Mashed potato, pumpkin or turnip

Nourishing drinks are useful between meals. Milkshakes, sustagen/ ensure are useful during the vitamised stage.

  • Work /Activity/ Exercise

In the immediate 24 hours after anaesthetic, you should not drive, operate machinery, and do not drink alcohol. You should avoid excessive or vigorous exercise in the first 3 days after surgery. Strenuous exercise may increase your blood pressure causing the wound site to bleed. 

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