Corrective Jaw Surgery
Undertaking corrective jaw surgery, also known as orthognatic surgery, requires a major commitment from patients. Our team of expertly trained health professionals which includes your oral surgeon, an anesthetist, nurses, residents and hospital support staff will be there for you to assist you in dealing with the processes of this treatment. They will do everything possible to ensure that you have the best possible result from your surgery. To assist you during your experience, before, during and after your treatment, we would like to share crucial information with you as well as communicate the necessary steps that will guide you starting from your initial consultation to the day of your corrective jaw surgery all the way to your last post-surgery follow-up visit with your oral and maxillofacial surgeon.
“ The results of corrective jaw surgery can have a dramatic and positive effect on many aspects of your life.
So make the most of the new you! “ AAOMS.org
Before Corrective Jaw Surgery
Your orthodontist, in most cases, has referred you to meet with your oral and maxillofacial surgeon in order for you to further discuss with him or her about corrective jaw surgery and evaluate whether or not you are a good candidate for this treatment. During this first visit or initial consultation, you will have the opportunity to learn more, discuss about benefits, potential risks involved with your treatment and of course to ask your questions. If and once you have decided to pursue with this life-changing procedure, then you are ready to move to the 2nd step of this treatment process: pre-surgical orthodontic treatment. For more information or if you would like to book an initial consultation: contact us.
Pre-surgical orthodontic treatment | Visit your orthodontist
Corrective jaw surgery is a treatment that involves the close collaboration of your orthodontist with your oral and maxillofacial surgeon. Upon deciding to go through orthognatic 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 6-18 months prior to surgery.) This will allow the alignment of your teeth, moving them in preparation of your corrective jaw surgery treatment. 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 planned required pre-operative position.
Wisdom teeth removal
If you have not removed your wisdom teeth, it is usually better to do so well ahead of corrective jaw surgery (6-12 months before). Read more about wisdom teeth removal: wisdom teeth removal.
-Book an initial consultation with one of our oral and maxillofacial surgeon
Visit your oral and maxillofacial surgeon: 1 month before surgery
Do you or did you have your;
- Initial consultation with your oral and maxillofacial surgeon?
- Pre-surgical orthodontic treatment?
- Wisdom teeth removed?
If you have answered “yes” to the 3 questions above, then one month before your corrective jaw surgery, you will need to meet with your oral and maxillofacial surgeon to:
- Review your dental record provided to us from your orthodontist.
- Take additional X-rays and/or photographs (if needed)
- Get more information about the treatment procedure will be done and demonstrate how your bite will be improved. By using state-of the art computer techniques and three-dimensional models, your surgeon will give you an impression of how your appearance will change post surgery.
As part of the planning process for your orthognatic surgery, your oral and maxillofacial surgeon will carefully map out the jaw movement to create an ideal bite (occlusion) and facial harmony. A precise virtual planning of your surgery will be done. This process is referred to as mock or rehearsed surgery.
– Routine pre-operative medical testing 1 month prior to the surgery (blood tests and physical examination)
Final visit to your oral & maxillofacial clinic: 1 week before surgery
During this planning stage, using a specialized computer program 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 preference(s) about your existing and future profiles. It is recommended that your family, siblings or life partner be present to make them aware of these changes in appearance so that there are no unexpected changes. We are enthusiastic to report that most patients are extremely satisfied both with their new facial profile and appearance and with the improvement in the function of their teeth and jaws.
AFTER CORRECTIVE JAW SURGERY
Welcome to the recovery process!
Allow us to now provide you with all of the necessary information with regards to your post surgery journey with us. By making sure you familiarize yourself with the following information & by ensuring that you follow the guidelines, there is no doubt that you will be shortly recovered & that you will get well soon.
The recovery experience varies from one person to another. Patients may be concerned about certain feelings of pain after surgery. You can be assured that during all steps of your treatment, you will be carefully monitored and extra measures will be taken to ensure that your pain is well-controlled at all times. When you are at home you will be provided instructions on when to take your pain medication to achieve optimal control. Patients can experience minimal to moderate pain, but in most cases less than they had expected. In fact, a significant number of patients have reported report absolutely no pain after jaw surgery.
Your process of recovery after corrective jaw surgery can best be described as a series of four distinct phases which are:
– PHASE I – Your Hospital Stay [Link to section]
– PHASE II – Your First Few Days at Home [Link to section]
– PHASE III – Up and About – 2-4 Weeks After Your Surgery [Link to section]
Phase 1: Your hospital stay
On the morning of your surgery it is essential that you brush all your teeth and appliances. You will meet the anesthetist on the day of surgery. He or she will explain the steps you will go through during the surgery. The length of the procedure varies but generally lasts about 2-4 hours, depending on whether one or both jaws require surgery.
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. These are all normal and temporary changes. You may experience a sore throat from the breathing tube used during the anesthesia. This will usually disappear within 2-3 days.
Generally you will stay in hospital for one night if the surgery involved only one jaw and two nights if both jaws were involved. It is critically important to drink fluids during this period to keep yourself well 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. This will help reduce the swelling and stimulate your circulation. However, too much activity should be avoided because you need to conserve your energy for the healing process.
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, but by the third day more substantial liquids that can be prepared in a blender can be added. Try to vary your diet to make it more interesting. Your choice of foods can include:
- Water, juices, soft drink, sport drink
- 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.
Your Pain Control
During your hospital admission you will initially receive strong pain medication by injection (morphine) to ensure that you do not have any major discomfort. This medication is provided to you when you need it, by the nurses in both the recovery room and the hospital ward. After the first 24 hours this is usually changed to an oral anti-inflammatory medication that is very effective in relieving discomfort. Our goal is to provide you with the correct combination of pain medication to keep you very comfortable.
Your Dental Hygiene
You should not attempt to brush your teeth initially as it will be very difficult due to the swelling after surgery. You should refrain from doing so for the first week. As soon as you feel able to you should:
- Rinse you mouth with warm salt water (1 teaspoon in one 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 toothbrush.
- Two weeks after surgery patients often find the use of a waterpik to be very beneficial.
It is very important to keep your mouth clean in this way. You will receive new instructions for keeping your mouth clean when you return home. If you are prescribed Peridex, an anti-bacterial mouthwash, use it as recommended.
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 cheek and down your neck. This is maximal on the fourth day after surgery and then slowly subsides. However, it is not unusual that 5 – 10% of the swelling still remains two months-post surgery, so you should only assess the final esthetic result after at least three months. In the long-run, when your facial muscle tone and function return completely, this small amount of residual swelling will disappear. You should apply ice to your face during your waking hours for the first 3-4 days to help numb the area. Do not apply the ice directly to the skin as this may result in frostbite or burns.
Bruising is normal and expected after jaw surgery. This can extend to your upper cheek and eyes and your lower cheek down to your neck, depending on whether one or both jaws were involved in the surgery. Be assured, that although it is unappealing, you should not be concerned in any way as the bruising is temporary and should disappear within two weeks.
You may walk around but should limit your activity and not attempt to do any physical exercise for the first week regardless of how you feel. This is not the time to get in shape. 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.
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 some clicking sound in the jaw on both sides as your joints are getting adjusted to their new position.
Should you have any problems or questions please contact our clinic.
PHASE II – Your first few days at home
During this initial period at home your swelling and bruising will generally peak on Day 4 after surgery and then will begin to diminish.
Dr. Chehade, Dr. Shenouda or Dr. Bonin will continue to see you every two weeks during the first two months after your surgery.
You should maintain the liquid diet you were given in the hospital until the first few days after your surgery. By the third day, continue all the liquids you consumed while in hospital and add some of the following foods to make your diet more substantial:
• Egg products (scrambled, boiled, omelets…)
• Pureed vegetables and meats with texture of baby food (e.g. peas, carrot)
• Mashed potatoes, rice and pasta
• Other proteins such as minced meat and white fish.
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. It is essential that you avoid any hard foods such as tough meats, candies, nuts or popcorn.
It is very common for your surgeon to apply elastics to the hooks on your braces to control the way your teeth meet as well as the movements of your jaw. Usually, patients are allowed to remove and reapply these elastics in order to allow for drinking and cleaning and flossing their teeth. Elastics are usually used during the first month after surgery.
Your Pain Control
Your surgeon will prescribe anti-inflammatory medication such as ibuprofen or other strong pain medication containing codeine. You should take these as needed to control your pain. 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.
Your Dental Hygiene
It is critically important to keep your mouth clean:
• Rinse your mouth with warm salt water (1 teaspoon in one glass of warm water.
• Loosen any food particles from your teeth, using a child-size soft 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 anti-bacterial mouthwash. Please use it as recommended.
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.
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. Spending time outdoors is recommended. However avoid any possibility of contact accidents. You should refrain from sports such as cycling for the first two weeks and basketball, hockey, skiing or football for at least 4-6 weeks. Walking outdoors will provide you with the gentle exercise you need at this time.
We suggest that you remain in town during the first two weeks. 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.
Your nerves may have been affected by stretching during the procedure and as a result of swelling of the soft tissues in the vicinity of the surgical site. As your nerve function returns to normal, you can expect to experience some tingling sensation in the middle area of your face area as well as 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 sound from your jaw joint also known as the “temporomandibular joint” (TMJ). This may subside with time.
PHASE III – Around 2-4 WEEKS AFTER YOUR SURGERY
In this phase you need to begin exercising your jaws to increase the range of motion of your jaw so you can get back into normal activity.
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.
Your Dental Hygiene
You can begin brushing the metal braces, using a new toothbrush with a small amount of toothpaste, for a period of at least 15-20 minutes in the evening before bedtime. You should take care to clean all the teeth and brackets as thoroughly as possible, but avoiding injuring your healing wounds with the head of the toothbrush. However, 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.
By the second or third week after surgery most of the swelling will have disappeared. Still, as discussed previously, in some cases, 10% of the swelling is maintained for two months. Ice is no longer effective at this stage but warm water bottles can be applied to the area.
You will continue to notice small changes in your appearance during the healing period and friends and family will likely recognize the transition. You may want to talk to them about these expected changes you are experiencing.
Students may resume going to classes if they feel ready. They should not however, participate in any after school activities. In particular all sports should be avoided. It is important to maintain a regular sleep schedule and ensure you are getting adequate rest to allow your body to heal. You will still feel somewhat weak at this point. However you may slowly resume your activities. Avoid any heavy impact activities or running that involves motion of the head and neck.
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 colored 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.
PHASE IV – YOU HAVE RECOVERED!
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.
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.
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 3-4 weeks you should be able to open your mouth 3 finger breaths. 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 range of motion. These will be reviewed with you at the four week point in your recovery.
“Although the goal of this surgery is to improve your bite and function, some patients also experience enhancements to their appearance and speech. The results of corrective jaw surgery can have a dramatic and positive effect on many aspects of your life. So make the most of the new you! » AAOMS.org