Our Corrective Jaw Surgery Centre

Braces

• Upon deciding to go through corrective jaw surgery, your orthodontist will plan your pre-surgical orthodontic treatment with braces.
• Please note that it is important to have your braces on for a period ranging from 6 to 18 months prior to surgery.
• This pre-surgical process may last on average from 1 to 2 years. This time period may vary depending on how long it takes for your teeth to move into their required preoperative position.

Wisdom teeth removal

• If you have not removed your wisdom teeth, we recommend removing them 6 to 12 months before the surgery.
• Read more about our wisdom teeth removal procedure.

A month before your corrective jaw surgery, you will need to meet with your oral and maxillofacial surgeon to:

• Review your dental records provided to us by your orthodontist.
• Routine preoperative medical testing including blood tests and a physical examination.
• If needed, take additional x-rays and/or photographs.
• By using three-dimensional models, your surgeon will provide you with a preview of how your jaw functionality will change after surgery.

A week before your corrective jaw surgery, you will need to meet with your oral and maxillofacial surgeon to:

• Your surgeon will provide you with some images that will predict what your facial profile will look like after the surgery.
• At this time you have the opportunity to share your concerns and preferences about your existing and future profiles.

The following are all normal and temporary changes:

• On the morning of your surgery it is essential that you brush all of your teeth and appliances.
• You may notice some swelling and feel groggy when you wake up from the surgery.
• Your teeth may be held together by elastics, which will be changed during the first week.
• Your face may feel totally numb so you will probably experience minimal pain.
• You will be provided pain medication to ease any discomfort.
• Your bite and gums will feel very different and you will have difficulty speaking.
• You may experience a sore throat from the breathing tube used during the anesthesia. This will usually disappear within 2-3 days.

Also note the following:

• It is critically important to drink fluids during this period to keep yourself adequately hydrated.
• You are encouraged to get out of bed and walk around as soon as possible, but the first time you get out of bed should be done with assistance and under supervision. However, too much activity should be avoided because you need to conserve your energy for the healing process.

Nutrition

After the surgery you will be given a liquid diet.

• For the first two days this should be restricted to clear fluids such as water and juices.
• By the third day more substantial liquids that can be prepared in a blender can be added to your diet.

Your choice of foods can include:

• Water, juices, soft drinks, sport drinks
• Milkshakes, carnation instant breakfast, yogurt drinks, ice cream and milk
• Protein drinks and supplements (Ensure, Boost or pre-mixed protein drinks)
• Soups, consommé, custard, pudding, Jell-O.

Pain Relief

• During your hospital admission you will initially receive morphine to ensure that you do not experience any major discomfort.
• After the first 24 hours this is usually changed to an oral anti-inflammatory medication that is very effective in relieving discomfort.

Dental Hygiene

You should not attempt to brush your teeth for the first week, as it will be very difficult due to the swelling. As soon as you feel able to you should:

• Rinse your mouth with warm salt water (1 teaspoon in a glass of warm water) or the antibacterial mouth rinse that will be provided to you.
• Loosen any food particles from your teeth, using a child-size soft bristle toothbrush.
• Two weeks after surgery patients often find the use of a waterpik to be very beneficial.
• If you are prescribed Peridex, an antibacterial mouthwash, use it as recommended.

Swelling

The most apparent event immediately after surgery is facial swelling, the extent of which can vary from patient to patient. You should expect a significant amount of swelling over your cheeks and down your neck.

• Swelling typically peaks on the fourth day after surgery and then slowly subsides.
• It is not unusual for 5 to 10% of the swelling to still remain 2 months post-surgery.
• You should apply ice to your face during your waking hours for the first 3 to 4 days to help numb the area. Do not apply the ice directly to the skin as this may result in frostbite or burns.

Bruising

Bruising is normal and expected after jaw surgery. It may extend to your upper cheeks or eyes and from your lower cheeks down to your neck.

• Be assured, that although it is unappealing, you should not be concerned in any way as the bruising is temporary and should disappear within 2 weeks.

Physical Activity

You may walk around but should limit your activity.

• Do not attempt to do any physical exercise for the first week regardless of how you feel.
• It will take at least a month for you to recover the strength you have lost as a result of the surgery, so be patient and give your body the necessary healing time.

Other Perceived Changes

• Your sense of hearing may seem altered if the swelling extends into the area of the ear.
• You can expect a sense of numbness or muffled sound.
• You may also experience a clicking sound in the jaw on both sides as your joints are getting adjusted to their new position.

**Your swelling and bruising will generally peak on Day 4 post-surgery and will then begin to diminish.**

Follow-up

• Your oral surgeon will continue to see you every two weeks during the first two months after your surgery.

Nutrition

• You should try to increase the amount of food you eat to compensate for the weight loss you sustained after the surgery. You also have greater nutritional needs at this time as your body is healing.
• By the third day you should try incorporating the following foods into your diet:
  • Egg products (scrambled, boiled, omelets…)
  • Pureed vegetables and meats with the texture of baby food (e.g. peas, carrots)
  • Mashed potatoes, rice and pasta
  • Other proteins such as minced meat and white fish

Orthodontic Elastics

It is very common for your surgeon to apply elastics to the hooks on your braces to control your bite.

• Patients can remove and reapply these elastics to facilitate drinking, cleaning, and flossing their teeth.
• These elastics are usually used during the first month after surgery.

Pain Relief

Your surgeon will prescribe an anti-inflammatory medication such as ibuprofen or another pain medication containing codeine.

• Your need for pain medication will likely decline over time and by the end of the first week after surgery, 90% of patients stop them completely.
• In the event that you continue to experience severe pain, please contact our office at (514) 931-7077.
• Do not be alarmed if you experience headaches or muscle spasms. These are normal and temporary after-effects following your surgery.

Dental Hygiene

It is critically important to keep your mouth clean:

• Rinse your mouth with warm salt water (1 teaspoon in a glass of warm water).
• Loosen any food particles from your teeth, using a child-size soft bristle toothbrush.
• If you have a plastic splint attached to your upper teeth – keep it clean by rinsing your mouth frequently with warm salt water.
• You will receive a prescription for Peridex, an antibacterial mouthwash. Please use it as recommended.

Swelling & Bruising

During these first few days after surgery, your swelling will decrease very quickly. The bruising will also disappear.

• You will begin to notice changes in your facial appearance. Give yourself a chance to get used to your new look.
• As your muscle tone and function improve during the healing process, your face will begin to feel normal again.

Physical Activity

It is very important to get as much rest as possible in the initial few days after your surgery. This will stimulate the healing process.

• You should refrain from sports such as cycling for the first two weeks and basketball, hockey, skiing or football for at least 4 to 6 weeks.
• Walking outdoors will provide you with the gentle exercise you need at this time.
• You may consider taking a vacation during your recovery period by the third or fourth week following your surgery, provided that you are healing well.
• It is preferable to limit your travel to one week at a time so that you don’t miss any of your scheduled follow-up appointments with your surgeon. These are extremely important for the monitoring of your progress.

Other Perceived Changes

• As your nerve function returns to normal, you can expect to experience some tingling sensation in the middle area of your face as well as in the lower lip and chin.
• You will likely not be able to open your jaw fully. This is normal, so do not be concerned.
• You may also notice clicking and popping sounds from your jaw joint. This may subside with time.

**In this phase, you need to begin exercising your jaws to increase their range of motion so they can get back normal functioning.**

Nutrition

You should continue the diet of liquid and puréed foods as described in Phase II.

• Be patient and do not get discouraged. We understand that this is reported by patients as the hardest part of their experience, but it is essential for proper healing.

Dental Hygiene

You can begin brushing the braces, using a new toothbrush with a small amount of toothpaste, for a period of at least 15 to 20 minutes in the evening before bedtime.

• You should take care to clean all the teeth and brackets as thoroughly as possible, but avoid injuring your healing wounds with the head of the toothbrush.
• Do not be concerned if you do hit the wound and see a bit of bleeding.
• The brushing will also help diminish the swelling around your gums.
• Warm salt-water rinses should be continued at least twice daily.

Swelling & Bruising

By the second or third week after surgery most of the swelling will have disappeared.

• As discussed previously, in some cases, 10% of the swelling is maintained for up to two months.
• Ice is no longer effective at this stage but warm water bottles can be applied to the area.

Physical Activity

• Students may resume going to classes if they feel ready. They should not, however, participate in any sports.
• It is important to maintain a regular sleep schedule and ensure you are getting adequate rest to allow your body to heal.
• You may still feel somewhat weak at this point.
• Avoid any heavy impact activities or running that involves motion of the head and neck.

Other Perceived Changes

• Patients who have had upper jaw surgery may experience a sense of itchiness or pins and needles in the upper lip as the numbness subsides. A similar sensation in the lower lip can last up to 6 months post-surgery.
• Upper-jaw surgery patients may also experience a red-brown coloured discharge from the nose.
• However, if you experience uncontrolled bleeding and the blood is bright red, please contact our office immediately at (514) 931-7077.

**At this stage, your body has recovered from the surgery!**

Nutrition

After your splint has been removed between 4 to 6 weeks after your surgery, you may start adding soft foods to your diet including soft fish, cooked vegetables, soft pasta and rice.

• Remember that you are “relearning” to chew at this stage. You must give your muscles the time to regain their strength, so be patient with yourself.
• You can expect to return to your normal diet, enjoying most of the foods you are accustomed to within about two months after your jaw surgery.

Weight Loss

As a result of your limited food intake, it is normal to experience weight loss of up to 10 % of your original body weight during the first two to three weeks after jaw surgery.

• It is critically important to maintain adequate nutrition, taking in sufficient calories from protein as well as carbohydrate sources.
• This is not a good time to diet. You will gain this weight back, as everyone does. Your body needs the energy or “fuel” derived from these food sources to allow your muscles and bones to heal.

Physiotherapy

You will learn exercises to improve your jaw joint function, that is, the opening and closing of your mouth.

• In the initial 2 weeks you should aim to be able to open your mouth 2 finger breadths.
• By 3 to 4 weeks you should be able to open your mouth 3 finger breadths.
• This is accomplished by placing warm packs over the area of your right and left jaw joints and gently massaging the joint, followed by opening your jaw as wide as you can in a slow and passive manner.
• You will also learn jaw opening exercises to improve their range of motion. These will be reviewed with you at the four week point in your recovery.