Facial Reconstruction/Trauma/TMJ Surgery

POST-OP
INSTRUCTIONS:

Trauma TMJ Surgery & Facial Reconstruction

GENERAL HEALTH

• Do not stand up quickly during the first 24 hours after surgery – you may faint.
• You should have assistance when you go to the bathroom.
• It is common to run a low-grade fever during the first 48 hours after surgery and anesthesia.
• Most regular prescription medications can be continued after surgery. If you’re not sure, please ask.

SLEEP APNEA

• Unless directed otherwise, you may use your CPAP machine.
• Patients who are taking narcotic pain medication MUST use their CPAP machine anytime they might fall asleep, unless specifically directed otherwise. You are more likely to have life-threatening apnea initially after anesthesia and while under the influence of narcotic pain medication.

NAUSEA

• Sometimes pain medication causes nausea. Nausea can be reduced by eating a small amount of food before each pain pill and taking the pill with a large volume of water.
• Ginger ale, Dramamine®, and Benadryl® may help with nausea.
• A prescription for anti-nausea medication can be issued on request.
• Be aware that almost all anti-nausea medicines cause drowsiness.
• Throwing up after jaw surgery can be from blood that settles in the stomach. It can also cause more bleeding, which lands in the stomach and repeats the whole process again. Please don’t wait until you’re miserable before asking for medication. Sometimes we must admit you to the hospital for IV fluids if you are too dehydrated.

DIET

• Avoid carbonated drinks, alcohol, citrus juices, coffee, and any extremely hot food or drinks for 48 hours (about 2 days) after your surgery.
• Start with foods that are cool and soft during the first 48 hours after surgery.
• After 48 hours you may gradually increase your diet to more firm food based on comfort.
• If you had surgery in your mouth, for 3-4 weeks afterwards it is best to avoid foods like nuts, sunflower seeds, popcorn, etc., which may get lodged in the surgical site.
• Do NOT skip meals. This will slow the healing process. Protein in your diet helps with healing.

• If you have diabetes, maintain your normal eating habits, or follow instructions given by your doctor. Check your blood sugar regularly. Ideally, your blood sugar should stay below 250.
• If you were told to follow a liquid diet for an extended period, you are allowed to eat whatever can go through a straw. If you are having a hard time with your diet through a straw, a special feeding apparatus can be made using a syringe and a tube. This is most successful when the patient is the person handling the syringe, so they don’t choke.
• If you’re not able to maintain your diet, you may have to be admitted to the hospital and a feeding tube placed. Poor healing and bad outcomes happen when people don’t get good nutrition and protein.

HEALING

• Almost every stitch we place in the mouth dissolves. They may take 2 days to 3 weeks to dissolve.
• Stitches or staples on the skin often must be removed in the clinic 1-2 weeks after surgery.

• If your mouth doesn’t open very wide after surgery (and you don’t have limitations like rubber bands), you may stretch your mouth open with either your fingers or tongue depressors (popsicle sticks) if they were provided for you. This is most successful if you apply moist heat over the area for 20 minutes, massage the area, then work on stretching.

• If you have rubber bands holding your jaw closed, please replace each rubber band as it breaks. It is a good idea to get a picture of how the rubber bands were placed by your surgeon before they start breaking. The best way to place a rubber band is to hold it between your thumb and index finger

SKIN WOUND CARE

• At least twice a day mix a little bit of hydrogen peroxide with water, dab a Q-tip® in the mixture, then clean off any scab that has formed on the skin over stitches/staples. The goal is to leave just the skin and stitches without crusting.
• After cleaning the wound, place an antibiotic ointment on the wound and cover with a bandage.
• After 1 week of this regimen, change from antibiotic ointment to Vaseline® to keep the scar moist.

• After 2 weeks, massage the surgery site to break up scar tissue. Warm compresses can help.
• Silicone bandage strips (available at most drug stores) can help keep scars moist. If worn for several weeks, can enhance the healing of a wound into a less-noticeable scar.
• Vitamin E oil or lotion can help smooth out scar tissue when rubbed on the wound. This can be applied starting after the 2nd week when the Vaseline® is done.
• If you have Steri-Strips® covering your wound, there is no wound care until they fall off. Then start the above process based on how far away from surgery you are.

• Avoid getting your skin wounds wet for at least 1 week after surgery. Some people use duct tape and plastic bags to isolate their wounds while showering. Other people prefer sponge baths.
• Skin scars can permanently stain a dark color when exposed to UV light.
• Avoid sun exposure for 1 year (yes, you read that right!). High-powered SPF (greater than SPF 30), broad-brimmed hats, and general sun avoidance is best.

NASAL PROCEDURES

• If you have a splint on your nose, try to keep it in place for 2 weeks. They fall off easily.
• Try to anticipate bumps on the nose from a pet, a child, or a cupboard door.
• The splints inside the nose are stitched in place.
• Holding gauze under the nose may help catch bleeding.

EYE PROCEDURES

• Eye socket repairs have a risk of vision loss. Call us immediately if you have changes in your vision.
• Sometimes we must stitch an eyelid closed to help with healing. This stitch will be removed in the clinic.

NERVE DAMAGE

• Nerves that help move and feel your face may be affected during your surgery.
• Nerves can take months to years to heal.
• If you cannot close your eyes, please call us immediately for instructions. Otherwise, we wait and see how the nerves heal over time.

SINUS PRECAUTIONS

• If you were told to follow Sinus Precautions, please adhere to the following:
  • No blowing your nose. Use a nasal spray to flush your nose instead.
  • No sucking on a straw.
  • Do no strain at a bowel movement (get a stool softener, if needed).
  • If you sneeze, don’t hold back. Sneeze with your mouth open.
  • Avoid doing anything that will make a difference in pressure between your mouth and your nose.
• Usually there is a follow-up appointment set. However, often, if you’re doing well, this can be handled over the phone. Please call the day of that appointment to see if you need to come in and be seen.