Mandible Fracture Post-Operative Instructions
Antibiotics: After discharge from the office or hospital the patient is given prescriptions for antibiotic medication usually in liquid form or to be crushed and placed in liquid. It is VERY IMPORTANT to take these medications after surgery for the prevention of infection. Given the extensive variety of bacteria in the oral cavity the antibiotic regimen usually lasts for 7 days. If the patient develops a yellow or green discharge from the fracture site they must be seen at the office on the next business day or the oral surgery staff must be contacted for evaluation and adjustment of antibiotics. Not doing so may result in A life-threatening condition.
Pain Control: After surgery patients usually require narcotic pain medications for 7 days. Prescriptions are provided for they usually in liquid form. Severe pain lasting longer than 7 days may indicate a serious problem and the patient needs to be evaluated on the next business day or the oral surgery staff contacted. Chronic pain may continue throughout the 6-8 weeks of fixation due to muscular degeneration and spasm.
Swelling: Swelling is normal after mandible surgery. The patient may be given prescriptions for steroids after surgery to aid in limiting the facial swelling. The swelling will be most noticeable on the 3rd and 4th day after surgery. If the swelling has not decreased after 6-7 days the patient should return to the office for an evaluation and contact the oral surgery staff.
Numbness: Numbness may persist permanently after surgery. Often this numbness is attributable to the initial injury. The patient will be evaluated weekly for resolution of the numbness which may often be slow to progress. This numbness may change over time to a “pins and needles” or “burning and itching” feeling. Please let the oral surgery staff know at the next office visit which these changes occur.
Diet: It is important to maintain a liquid or soft diet after fracture surgery. The plates and screws that may have been used are not designed to withstand the forces created by normal chewing and function. It is important to take in a minimum of 1500-2000 calories per day after surgery. This may be accomplished even on a liquid diet with the use of supplements such as Ensure, Slim Fast, Protein shakes, Boost, etc. Decreased calorie intake may lead to a decrease in immune system effectiveness and subsequent infection. A soft diet if recommended is described as nothing harder than the consistency of mashed potatoes. Foods that are included are eggs, soft pastas, pudding, ice cream and obviously liquids and pureed foods.
Oral Hygiene: Patients MUST brush their teeth. Good oral hygiene is especially important after repair of a jaw fracture. Poor oral hygiene may lead to infection and failure of the fracture to heal. The patient will also be provided a prescription for an antimicrobial mouth rinse to be used twice a day. Excess use of the mouth wash may result in staining of the teeth.
Wound Care: In addition to good oral hygiene, patients often have sutures that should be cared for after surgery. For incisions and sutures of the mouth normal saline rinses should be used 4 times a day. Skin sutures should be kept moist and free of scabbing for 5-7 days using bacitracin or antibiotic ointment. Failure to do so may result in significant scarring.
Wire and Elastics: Except for specific cases, wires and/or elastics are used for fixation of the fractures for a minimum of 6-8 weeks. These wires and elastics must remain tight for the fracture to heal. If the elastics or wires are removed or come off the patient, they must be seen on the next business day for re-application. Failure to do so may result in improper healing or unhealed fractures and infection.
External Fixation: In some cases external devices are used to secure jaw fractures. These devices also require care including dressing changes around the pin structures daily and antibiotic ointment to the skin around the pins. A full liquid diet should be maintained while the device is in place. Should the device become loose in any way the patient must be seen in the office on the next business day. Failure to do so may result in complete failure of the appliance and improper healing.
Follow up Visit: The patient needs to be seen one seek after surgery. Appointments are then made in 1 week intervals unless determined on a cases by case basis. Failure to keep follow up appointments prevents the oral surgery staff from ensuring good care for the patient may lead to any number of the above mentioned problems often avoidable by routine visits.
