Any oral-maxillofacial surgery is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be avoided if the instructions are followed carefully.

Immediately Following Surgery

• The gauze pad placed over the surgical area should be kept in place for one hour. After this time the gauze pad should be removed and discarded. It can be replaced hourly if desired.
• Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
• Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished. Take all pain pills with food to avoid nausea.
• Restrict your activities the day of surgery, and resume normal activity when you feel comfortable.
• Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.
• Do not smoke! Smoking GREATLY increases post-op pain.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for another sixty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.

Swelling

The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes, and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice or ice packs should be applied to the sides of the face where surgery was performed. A ladies’ stocking with an ice baggie on each side can be tied above the head. The ice packs should be left on continuously while you are awake. After 48 hours ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Forty-eight hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain

For severe pain take the tablets prescribed as directed. The prescribed pain medicine will make you drowsy and will slow down your reflexes. Do not drive an automobile or work around machinery. A work excuse has been provided. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. Motrin, Advil, or Ibuprofen (if not allergic) can be taken between pain pills. Please DO NOT SMOKE! Smoking markedly increases pain after surgery. Apply a heating pad after 48 hours to decrease swelling which will decrease pain.

Diet

After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. High calorie, high protein intake is very important. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort, and heal faster if you continue to eat. Caution: If you suddenly sit up or stand from a lying position, you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing. Do not stand in a hot shower or fainting may occur.

Keep the mouth clean

No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing at least 5-6 times a day, especially after eating, with a cup of warm water mixed with a teaspoon of salt. Brush teeth daily after surgery. Be gentle near the surgical sites.

Discoloration and Bruising

In some cases discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area after 48 hours may speed up the removal of the discoloration.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.

Nausea and Vomiting

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour, including the prescribed medicine. You should then sip on coke, tea, or ginger ale with ice chips. You should sip slowly over a fifteen-minute period. You can advance to saltine crackers or plain toast but no butter. Then advance to a banana. Then advance to soft foods. Do not take any pills until the nausea resolves. If nausea continues, contact the office nurse for further instructions.

Other Concerns

• Numbness of the lip, chin, or tongue is common for 8-12 hours after surgery. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful. Chew slowly. Call Dr. Brown if you have any questions.
• Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or Ibuprofen should be taken to reduce the fever.
• You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute then get up. Do not stand in a hot shower or fainting can occur.
• If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as vaseline.
• Sore throats, earaches, and pain when swallowing are common. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.
• Stiffness (Trimus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time. After the initial 48 hours use a heating pad to alleviate jaw stiffness and pain.

Finally

Multiple dissolving sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged; this is no cause for alarm. Just remove the suture from your mouth and discard it. The sutures will dissolve approximately 3-7 days after surgery. All sutures dissolve and fall out. They do not need to be removed.

The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur, call my office for instructions.

There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the mean time the area should be kept clean, especially after meals, with salt water rinses or a toothbrush. Do not use a water pik.

Your case is individual; no two mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with the persons best able to effectively help you: Dr. Brown or the nurse.

Brushing your teeth is okay – just be gentle at the surgical sites.

If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising. Do not exercise if taking narcotic pain pills.