First day after the surgery. When the patient wakes up from general anaesthesia he/she is moved to an intensive care unit. All vital functions are monitored there for the first twenty-four hours, necessary medications are administered. Nausea and vomiting is possible during this period which is normal after the surgery with general anaesthesia.
New occlusion is checked when the patient is fully awake. Only then masticatory muscles return to function and lower jaw acquires its physiological position, so the accuracy of surgery may be judged.
Patients may experience a mild nose bleeding for up to two weeks after the surgery. It is a normal occurence since residual blood clots dissolve inside the sinus after some time. After the surgery some amount of blood may be swollen and it may cause nausea and vomiting due to irritation of the stomach. As sson as the reanimation nurse allows, a patient should drink liquids to dilute stomach contents and reduce nausea. Ice packs are usually applied to the nose and cheeks to reduce the swelling and facilitate breathing.
Massive facial swelling and bruises may appear during the first two days. All necessary means and medications are administered to reduce swelling. Right after the surgery a special pressing bandage is applied on the head, cheeks, and chin for the first two days that helps to avoid bruises. Bruises may also be lowered with the help of suction drains – small tubes inserted into the wounds and connected to special containers with negative pressure. The bandage and/or drains are usually removed after 24-36 hours after the surgery.
Mild pain may be present first hours or days after the surgery but it is easily controlled with pain-killers. Intensive antibiotic regimen is prescribed right after the surgery to protect a patient from infection.
Chewing is not allowed after the surgery. One or several rubbers bands are applied on teeth to direct the jaws into correct position upon function. They are tight enough to keep the jaws in occlusion during rest but do not prevent a person from opening mouth slightly.
Nose blowing is not permitted for several weeks after surgery.
Second and third day after the surgery. Patient is transferred from ICU unit to the ward on the second day after surgery. Occlusion check is performed and if nausea is gone some more elastic rubber bands are applied on braces to exert traction on dental arches. Rubber bands allow the patient to open his/her mouth for about 1 centimetre (0.4 inches) – just enough for eating.
Wounds are checked and the patient is trained to rinse the mouth. Facial swelling reaches its maximum on the second or the third day, obviously, these days are the most difficult days both physically and psychologically. Elastic rubber bands are untouched for about 10 days.
Going home. Occlusion and mouth hygiene is checked again upon discharge from the hospital. Oral antibiotics, pain-killers and nasal drops are prescribed as well as rinsing fluid. Agent protecting the mucosa of GI tract may be administered along with the medications
One week after surgery. Facial swelling should be starting to resolve on the third or fourth day. If a patient experiences an increase in amount of swelling it may warn about possible infection and the patient should contact his/her surgeon immediately.
The first postoperative visit should be done on the 6-7th day after surgery. Wounds and occlusion is checked, elastic rubber bands are readjusted if needed.
Removal of stitches. Stitches are usually removed 10-14 days after the surgery. Elastic rubber bands are also taken off for the first time, occlusion is rechecked. The patient is trained to brush teeth correctly and apply rubber bands according to the scheme provided by the doctor.
First two months after surgery. Patient is recalled on a weekly basis first two months after surgery. Every time occlusion is checked and the rubber bands are corrected if needed. Filling material connecting the braces of canine and lateral incisor is kept unremoved for this period. Fillings stabilize the segments of upper jaw and facilitate their consolidation.
The 3rd and 4th months after surgery. Patient is recalled every other week. During this period the skeletal wires are taken out from the upper and lower jaws. This procedure takes only a few minutes and is performed on the out-patient basis. Then the patient proceeds with active postoperative orthodontic treatment. During this period filling material is removed from the braces and continuous wire is inserted for fine tuning of the occlusion. After this the patient is recalled once in 1-2 months until the treatment is completed.
Nutrition. Only particle-free diet is allowed for 10 days after surgery (e.g., yogurts, jams, commercially available food supplements). It is important to receive 2500-3000 kcal a day and rebuild the energy level.
Particle-free diet may be abandoned once the stitches are removed. It is replaced by the soft diet that is continued for 2 months. Patient is not allowed to chew any kind of food during this period since non-union of bones may result in necessity of redo surgery. Patients should understand that it takes a few months for the jaws to heal completely, therefore chewing of hard food should be avoided for that period.
From the beginning of the third month patients are allowed to start chewing soft food such as salad or grinded food. After four months a person may come back to his/her usual nutrition habits.
Activity. About 80% of swelling is gone by the end of the third week. Most of the swelling is gone in two months, however the residual swelling in cheek area may be felt by the patient as long as six months after surgery.
Physical work is not recommended first month after surgery, however office work at home may be started right after discharge from the hospital.
Sports. Exercising may be started after a month. Contact sports may be started 4 months after surgery, whereas fighting should be postponed for about 8 months after the surgery. Sauna or swimming pool should be avoided at least for 2 months.