You are on page 1of 6

Recovering from jaw surgery

This leaflet gives you some information about what will happen in the weeks after your surgery and how you need to care for yourself. After jaw surgery, you need time to recover both physically and emotionally. Your body has to recover from the general anaesthetic and some blood loss which happens during the operation. Your face may be quite swollen and your mouth may be sore. You may have elastic bands fixed to your upper and lower jaw braces, guiding your teeth into your new bite. You may even have a plastic splint temporarily fixed to your teeth. It is perfectly normal for you to feel tired and weak for the next two to three weeks.

When will the swelling go down?


After jaw surgery, your face and mouth can swell quite significantly and look bruised. To help the swelling to come down, you should try to sleep in a slightly more upright position, for example using a second pillow if you normally only sleep with one. Having your head raised in relation to the rest of your body helps the swelling to drain away more easily. The swelling may be slightly worse in the mornings when you get up but should improve during the day. Usually most of the swelling should go down within two weeks but this can vary quite a lot between different people. After two weeks, there may still be a little swelling which will settle completely over the next few months. Your tissue fluid levels should slowly settle to a stable level about six months after your operation.

Will I feel any pain?


Your jaw area will be painful after your operation but we will give you pain relief medicine (painkillers) to control this. We will also prescribe medicine(s) for you take home. You may only need to use them for a week or so after the operation. Please let us know if you are allergic to any medicines.

October 2008

October 2008

Page 2 of 6

Take your pain relief medicine regularly. This will keep it at a constant level in your body, so it will control your pain better. If you run out of medicine, please contact your GP who will be able to prescribe more for you.

Will I be able to talk?


You will find it difficult and awkward to talk after your surgery, but this is temporary and it will get better. This is because your mouth movements will be limited and you will not be able to open your mouth very wide. You may sound as if you are mumbling. You may sound more nasal than you did before the operation. This will often improve after the initial healing process. You will see a speech and language therapist at your clinic appointments who will check on this and give you advice.

How will my face feel?


The skin on your face may feel a bit numb after your surgery. The numbness is because your sensory nerves will be irritated by swelling caused by the operation. The numb feeling should go within a few weeks or months after the operation. It is important during this time to take care with hot foods and drinks to avoid accidentally burning yourself. Nerve recovery can be a slow process and it could take about a year to recover, but you should feel an ongoing improvement during this time.

What can I eat?


On the first day after your surgery you may find it easier to mainly have fluids. Clear fluids are best. For the first few days it is sensible to avoid very acid juices, such as orange juice, because they can make the operation wound sore. If you want to drink fruit juices you should dilute them with water. If you have difficulty coping with a cup, a syringe may be useful. Your gums will take about two weeks to heal. During this time, you should try to avoid milk products as much as possible. This is because they are sticky and do not clear away from the operation site. This can create a breeding ground for bacteria and lead to infection. As your jaw is only kept in position with small titanium metal plates, you should only eat very sloppy (pureed) food for the first two weeks. This soft diet means that you do not need to move your jaw to chew. It takes about six weeks for your jaw bones to heal and get back to their usual strength. Continue to only have soft food for the first four weeks after your operation, so that you do not overstretch your jaws. We recommend dishes such as eggs, mashed potatoes, spaghetti, soft boiled or pureed vegetables. There is a page of ideas for soft meals at the end of this leaflet. After four weeks you can gradually change your diet back to normal. There are no foods that you need to avoid, as long as you do not have to chew very much. You may lose weight in these six weeks following surgery because you will not be eating the way you are used to. Please try and rinse out your mouth after every meal, brush your teeth and use

Guys and St Thomas NHS Foundation Trust St Thomas Hospital, Westminster Bridge Road, London SE1 7EH Guys Hospital, Great Maze Pond, London SE1 9RT Switchboard: 020 7188 7188 www.guysandstthomas.nhs.uk
2008 GUYS AND ST THOMAS NHS FOUNDATION TRUST. ALL RIGHTS RESERVED Childrens Services/PPG 2170. For review October 2010

October 2008

Page 3 of 6

mouthwash. Follow the instructions in the next section of this leaflet.

How do I clean my teeth?


You need to make sure that you keep your mouth as clean as possible. This will help your gums and jaw bones to heal properly. We will give you some mouthwash during your stay in hospital and it is important to use this for about a week after your operation. The mouthwash reduces the amount of bacteria in your mouth, but does not replace tooth brushing. If you continue to use it for longer periods, temporary staining of your teeth may occur. You should start to brush your teeth as soon as possible, ideally the day after surgery. Clean your teeth carefully in front of a mirror with a soft small-headed toothbrush, like a baby toothbrush. You can easily buy these in chemists. If you still have elastic bands or a plastic splint in your mouth it may be more difficult to clean your teeth. You should still try and keep them as clean as possible by brushing them carefully and using mouthwash. You will find it difficult to open your mouth as widely as before your operation, due to the swelling around your face. This will improve significantly over the next few weeks. You can use lip balm on the corners of your mouth and your lips if they are dry.

When can I return to work or school/college?


We advise all patients to take two to four weeks off work or school/college. This will vary from patient to patient, but you will need to take things a bit easy after the operation. You should avoid strenuous physical activity for about six weeks. In our experience, those patients who slowly but steadily reintroduce themselves back into their normal routine recover more swiftly than those who lie in bed for days at a time.

When can I do sports again?


After your jaw surgery you should avoid any contact sports (such as rugby or martial arts) for the first six to eight weeks. Your bones will need this time to fully heal. You can start some light exercise after about two to three weeks, depending on how you feel. Even during light exercise, you will increase the blood supply to your face. This may cause increased swelling or even pain. If this happens, it is a sign from your body that you are not ready for sports yet. You should stop and wait a little longer before trying again.

How might I feel after the operation?


Recovery from jaw surgery is a long process and it is important to be aware that you will have ups and downs. Different people respond in different ways. Some people feel relieved at first that the operation is over and that they can go home, but it is normal to feel low at some point after surgery. Some people describe feeling helpless and angry. Some people even question why they had the surgery done if they are feeling uncomfortable and swollen. These feelings are normal and will not last forever. Try to talk to family and friends about how you are feeling. How you feel will also depend on your physical recovery. After surgery, your face will be swollen and parts of your face may feel numb. As the swelling goes down, you will see more and more how your face has changed after the jaw surgery. These changes can be
Guys and St Thomas NHS Foundation Trust St Thomas Hospital, Westminster Bridge Road, London SE1 7EH Guys Hospital, Great Maze Pond, London SE1 9RT Switchboard: 020 7188 7188 www.guysandstthomas.nhs.uk
2008 GUYS AND ST THOMAS NHS FOUNDATION TRUST. ALL RIGHTS RESERVED Childrens Services/PPG 2170. For review October 2010

October 2008

Page 4 of 6

quite significant and should give you a better balance between the different parts of your face. You may feel shocked when you first see your face, as it is difficult to imagine how you will look after your operation. Your appearance will change throughout the first few months after your operation as the swelling goes down and your face is healing. Adjusting to your new appearance can be difficult but it is important to remember that there are people to help. In the cleft team, we have clinical psychologists who are here to help you. These are trained healthcare professionals who can help you to talk through your feelings and offer some suggestions to help you get used to your new appearance. Once surgery is over and the surgical wounds have healed, orthodontic work (treatment to straighten or move your teeth) continues and you may have times when you feel fed up. It is important to look ahead and remember that most people are very happy with the outcome of surgery and are pleased that they made the commitment.

Will I need follow-up appointments?


We will need to see you regularly after your surgery, to continue your treatment. Usually you will need to come to the cleft clinic once a week for the first month and then once every two weeks for another month. Your first appointment will usually be about one week after your operation. This is to make sure that everything is healing as it should be. We will usually give you an appointment before you leave hospital. If you have not been given an appointment, please call the cleft clinic receptionist on 020 7188 1321. You will need to give the receptionist the name of your surgeon and orthodontist, so that you are booked into the correct clinic. After two months, we will continue to see you regularly; usually appointments will be at the same intervals you were used to before your operation. This may seem like a lot of hospital appointments but we may need to make small but important adjustments to your elastics and perhaps your brace. Regular appointments will help us to get the best possible results.

Will I need to continue my orthodontic treatment?


Yes, your jaws will now be in a much better position in relation to each other but the position of your teeth is likely to need some more orthodontic treatment to adjust them. It may take about six months before treatment is complete. Please make sure you have an appointment with your orthodontist booked soon after your surgery. The sooner we restart the orthodontic treatment, the sooner we can take your braces off.

What happens after my braces have been taken off?


At the start of your treatment, your orthodontist will have talked with you about the types of retainer brace you will have after the treatment is complete. You should also have been told how long you will need to wear the braces for. We will make you some suitable retainers to hold your teeth in their correct positions. At first, you will need to wear these all of the time. You will usually be able to wear the retainers less often over the course of a year until you are wearing them one or two nights a week, while you are sleeping. You will then need to continue to wear the retainers for one or two nights a week, indefinitely. This should allow you to keep the result you see when your braces are first taken off.
Guys and St Thomas NHS Foundation Trust St Thomas Hospital, Westminster Bridge Road, London SE1 7EH Guys Hospital, Great Maze Pond, London SE1 9RT Switchboard: 020 7188 7188 www.guysandstthomas.nhs.uk
2008 GUYS AND ST THOMAS NHS FOUNDATION TRUST. ALL RIGHTS RESERVED Childrens Services/PPG 2170. For review October 2010

October 2008

Page 5 of 6

The orthodontist will need to see you once a year for about five years after your braces are removed to follow-up on your progress.

Further information
If you have any questions or concerns about your recovery or you need more orthodontic elastics, please contact the South Thames Cleft Service on 020 7188 1321 between 9am and 5pm, Monday to Friday or email cleftservices@gstt.nhs.uk PALS. To make comments or raise concerns about the Trusts services, please contact our Patient Advice and Liaison Service (PALS). Ask a member of staff to direct you to PALS or call 020 7188 8801 at St Thomas or 020 7188 8803 at Guys. Email pals@gstt.nhs.uk Language Support Services. If you need an interpreter or information about the care you are receiving in the language or format of your choice, please call 020 7188 8815, fax 020 7188 5953 or email languagesupport@gstt.nhs.uk Knowledge & Information Centre (KIC): For more information about health conditions, support groups and local services, or to search the internet and send emails, please visit the KIC on the Ground Floor, North Wing, St Thomas Hospital. Call 020 7188 3416, email kic@gstt.nhs.uk or visit www.kic.gstt.nhs.uk NHS Direct offers health information and advice from a specially trained nurse over the phone 24 hours a day. Call 0845 4647 or visit www.nhs.uk

Guys and St Thomas NHS Foundation Trust St Thomas Hospital, Westminster Bridge Road, London SE1 7EH Guys Hospital, Great Maze Pond, London SE1 9RT Switchboard: 020 7188 7188 www.guysandstthomas.nhs.uk
2008 GUYS AND ST THOMAS NHS FOUNDATION TRUST. ALL RIGHTS RESERVED Childrens Services/PPG 2170. For review October 2010

October 2008

Page 6 of 6

Ideas for soft-diet meals


First two weeks after surgery: Use a blender to puree your meals Scrambled eggs Smooth vegetable soups Spaghetti hoops Soft pasta with tomato based sauce or olive oil dressing Mashed potato Pureed meat (not minced meat) Flaked fish (not fish fingers due to the crumb coating) Pureed vegetables (for example, squash, sweet potato, swede, carrot, parsnip) Jelly Pureed fruit Fruit smoothies, for example banana. For extra calories, add honey. Avoid smoothies with yoghurt or dairy products in them. Fortisip fortified drinks if you are losing weight

From two weeks after surgery: Cereals such as porridge or mashed up cornflakes mixed with warm milk. Baked beans White bread without crusts Mashed avocado Creamy soups Minced meat Soft pasta with white or cheese sauces Tinned ravioli and spaghetti Bolognese, already cut up Rice with finely chopped vegetables and pieces of meat Mashed potato - for extra calories, add cream/full fat milk/butter/crme frais/grated cheese Soft cooked vegetables Rice pudding Jelly and custard Mashed banana Smooth yoghurt and fromage frais Ice-cream Trifle Soft desserts such as blancmange and mousse Milkshakes with ice-cream Yoghurt smoothies

Guys and St Thomas NHS Foundation Trust St Thomas Hospital, Westminster Bridge Road, London SE1 7EH Guys Hospital, Great Maze Pond, London SE1 9RT Switchboard: 020 7188 7188 www.guysandstthomas.nhs.uk
2008 GUYS AND ST THOMAS NHS FOUNDATION TRUST. ALL RIGHTS RESERVED Childrens Services/PPG 2170. For review October 2010