surgical instructions

Orthognathic Surgery

Surgery Information

  • Patients who are undergoing surgical procedures on only one jaw usually go home the same day. Patients who are having surgery on both jaws will generally stay overnight.
  • Patients often ask if their jaws will be wired together after surgery. Most of the time, it is unnecessary to wire the jaws together after orthognathic surgery. In general, the jaws are immobilized securely with rubber bands for the first 1-2 weeks and then loosely for an additional 3-5 weeks.
  • It is very important to discontinue any medication which are "blood thinners" or which may increase your tendency to bleed. Please stop taking the following medications at least 2 weeks before surgery:
    • - Aspirin
    • - Any non-steroidal anti-inflammatory drug (NSAID) - i.e. Advil, Aleve, Motrin, naprosyn or arthritis-type medications
    • - Coumadin/Warfarin (Notify us if you are taking this medication)
    • - Plavis/Clopidogrel (Notify us if you are taking this medication)
    • - Certain herbal supplements
    • - Phentermine (must stop this medication 2 weeks before surgery)
  • You may take Tylenol/Acetaminophen for minor pain or headaches before surgery. Tylenol is not a blood thinner.
  • If you get sick with a cold, flu, infection or illness or any kind within 2 weeks of your surgery date, please contact our office.
  • If you are a smoker, please make sure to let us know. It is extremely important for you to stop smoking at least 2 months before surgery. You will not be able to smoke after surgery!
  • Arrive at the hospital 2 hours prior to your surgery time.
  • Nothing to eat or drink 8 hours prior to your surgery time.

Post-Operative Instructions: Orthognathic Surgery

  1. Go to your nearest emergency room if you are having trouble breathing!
  2. Notify our office if you have increasing drainage from your incision or recurring fever (101.5 F) for more than 12 hours.
  3. Facial swelling will increase for the first 48-72 hours. Apply ice packs (15 minutes on; 15 minutes off) and keep your head elevated (extra pillow or recliner). Most of the swelling will resolve within the first few weeks; however, healing will continue for 4-6 months.
  4. Bruising may occur after a few days. In some cases, the bruising may extend onto your upper chest.
  5. You may shower, but try to keep the bandages dry. A small band-aid may be applied if they come off.
  6. No Smoking!!
  7. Avoid alcoholic beverages.
  8. Brush your teeth gently with a child size soft bristle brush. You may use toothpaste as well.
  9. You may use mouth rinse.
  10. If your teeth are rubber banded together, please try to limit your jaw motion. The rubber bands may be cut with scissors in case of a true breathing emergency (notify the doctor afterward).
  11. The liquid antibiotic should be taken as directed for 5 days. The first dose may be taken when you arrive at home.
  12. The liquid pain medication can be taken every six hours as needed.
  13. While the teeth are rubber banded, meals may include liquids such as juice, broth, milk products (including soy & rice), and liquid supplements (instant breakfast, Boost, Ensure). No chewing. Your doctor will advise you when it is safe to begin chewing. Most large pharmacies carry a variety of supplements in different flavors. It is generally easier to sip directly from a cup, but you may use a straw if you like. You should try to have 4-6 "meals" a day to be sure that you are receiving ample nutrition and hydration.
  14. Do not lie in bed all day. This can lead to pneumonia and blood clots. Light activity is acceptable, even good. Try to be out of bed during the daytime.
  15. You should not drive if you are taking pain medication.
  16. Please notify your doctor if you feel that your bite has shifted.
  17. Our surgeons may be reached 24 hours a day at 310-842-4811, if there are any questions or concerns.

In addition to the instructions above, for UPPER JAW SURGERY patients:

  1. Your upper gums will have reduced sensation. Be careful not to injure the gums while brushing.
  2. Nasal congestion and minor nosebleed are expected. You may "sniff back" or wipe the nose, but do not blow. You may use saline nasal spray to loosen clots and mucous. Afrin nasal spray may be used for severe congestion, but no more than two consecutive days.

Post Surgical Aftercare

  • We understand that the first week after surgery can be difficult. Although the swelling peaks at 2-3 days after surgery, it does not really start to come down until after the first week. At 2 weeks after surgery, usually 70% of the swelling has resolved. For the final swelling and numbness to resolve, it will take weeks to months after surgery. It is common to be more swollen or numb on one side vs. the other.
  • One week after surgery, you will follow up with one of our surgeons. If you need to be seen sooner it will not be a problem. During your follow up, Dr. Kupferman, Dr. Walline, or Dr. Relle will change out your rubber bands and answer any questions you may have. One week after your surgery the swelling should be starting to come down and at this point, you should still be on a liquid diet.
  • Two weeks after your surgery, you will begin to take off and put on the rubber bands yourself. We will show you where we want the rubber bands to go. The doctor may change the pattern of your rubber bands over the next 8 weeks.

You will take the rubber bands off for three reasons:

  1. Eating — Your diet can advance to very soft foods such as mashed potatoes and very soft pastas. No chewing. You can have anything you want, but no chewing.
  2. Mouth Opening Exercises — With the rubber bands off you will now begin to stretch the mouth open. You will need to do this 6 times a day for a period of 5-10 minutes. We do not want you to hurt yourself. Stretch the jaw open so you can regain your normal mouth opening.
  3. Brushing Teeth — After eating and doing your mouth opening exercises, you should thoroughly brush and clean your teeth. If you have a splint on the upper jaw, do the best you can. We understand that this can be difficult.
  • 3-4 weeks — If you have a splint in the upper jaw it will usually be removed 3-4 weeks after surgery. After the splint is removed, you will need to see your orthodontist within a couple of days to get a continuous arch wire placed in the upper brackets.
  • 6 weeks — You can blow your nose 6 weeks after surgery. We will assess your bite and change the elastic pattern if needed.
  • 8 weeks — You may begin chewing food at 8 weeks after surgery. Start with softer foods and over the next 4 weeks you can transition to a normal diet. If you still have rubber bands, you will likely only need to wear them at nighttime now.
  • 12 weeks — You will need to be seen 12 weeks after surgery and then every 3 months until your braces are off. After your braces come off, you will need to come in the office for final records.