Click here for INFORMATION FOR THE ORTHOGNATHIC PATIENT

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INFORMATION FOR THE ORTHOGNATHIC PATIENT

This is a fundamental overview of what you might expect during your surgical
orthognathic experience. We have tried to make this as comprehensive as possible.

We feel that you should be knowledgeable of what you might encounter to avoid "surprises".

MENTAL ATTITUDE

A very important factor in the success of your surgery is your mental attitude.
There has been much interest recently in the effect of attitude on ones overall health
and healing. We do encourage a very positive mental attitude to promote good healing
and a speedy recovery. Support from your family members is essential.

LENGTH OF SURGERY

Most of these surgeries last anywhere from one to five hours, depending on the
amount and type of surgery to be done.

RECOVERY ROOM

Part of what appears to be time in surgery is time spent in the recovery room. You
are released from the recovery room when the general anesthesia has worn off
and you can demonstrate normal reflexes. Sometimes hospitals allow family
members in the recovery room. If not, your family will be able to visit you once
you have returned to your hospital room.

INTENSIVE CARE UNIT

Immediately following surgery, you may be taken to the intensive (or intermediate)
care unit rather than the recovery room. This is not necessarily a cause for
alarm, but is only a precautionary measure following certain surgeries. You will be
returned to a regular room the day after surgery. Any family member waiting for
you will be fully informed of your location.

IMMEDIATE POSTSURGICAL APPEARANCE

Nasal tubes are used customarily with all surgical procedures done using general
anesthesia. One leads to your stomach (nasogastric) and the other, to your lungs
(endotracheal). Commonly these tubes are removed just as you are "waking up"
so you may not remember them. The hospital staff may not have removed the
tubes from your nose when your family members are first allowed to see you.
Please explain this to them, as it may cause them to be alarmed.

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THE INTRAVENOUS APPARATUS

The intravenous apparatus will be attached to your arm for one to two days
following your surgery. Again, this is customary. You will require certain drugs
during that time period, as well as intravenous feeding. This becomes an easy
way to administer both and rarely presents significant discomfort. When you are
consuming adequate liquids by mouth, it will be removed.

NASAL CONGESTION AND THROAT SORENESS

For the first day or two after surgery you may experience nasal congestion.
The nasal tubes used for your anesthesia may cause your nose to feel sniffy
and your throat to feel slightly irritated when you wake up. This is very similar
to the way you would feel if you had a common cold and sore throat.
In a couple of days, both should resolve.

NAUSEA

Patients are concerned about being nauseated and vomiting. First, this does not
happen with everyone. Second, you will have been on a liquid diet; therefore,
anything that "comes up" will be liquid. You may have a suction apparatus near
your hospital bed.Vomiting docs not present as much of a problem as you may fear.
If this happens, you should remain calm. There are also drugs that may he given
to you to help control nausea.

TEMPORARY NUMBNESS

Following surgery, you may temporarily experience small areas of altered
sensations, or partial numbness. During the first three to six months, the small nerve
fibers are regenerating and mending. As healing takes place, you may encounter
sensations of warmth and tingling in the affected areas. It is infrequent that these
remain longer than six months. However, those individuals with small areas of
residual altered sensations find they area able to adjust to them.
In other words, this is an inconvenience of which to be aware, not afraid.

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LENGTH OF FIXATION

A period of time is usually required for fixation of the teeth following most
surgeries. This may be from as short as 2 to 3 days to 6 to 8 weeks.
Dr. Moriconi will discuss your specific time frame with you prior to surgery.
We would like to remove the fixation as early as our judgment will permit,
but the first priority is a stable result.

Your fixation may limit your participating in active sports or over-exerting yourself
(for example, running up stairs). If you will hold your teeth together, you will see
how it might be difficult to breathe deeply should you become winded by exercise.

When the fixation is removed, you may initially experience jaw muscle stiffness
and limited jaw movement. This will resolve with exercise of these muscles.

COMMUNICATION

At first you may have difficulty communicating and may want to have a small
notebook on hand for messages. You may be unable to answer the telephone
in your usual manner. If you will bite and hold your teeth together, you may closely
approximate how you will be able to talk while you are in fixation.

You should warn your friends who plan to call you in the hospital or at home that
they might, have some difficulty understanding you at first. However, most people
are able to communicate relatively clearly. It is probably better if you don't try to
carry on lengthy conversations, as you might find it sometimes fatiguing.

"POST-SURGERY BLUES"

Following any kind of surgery, a patient may go through a stage of mild
depression. This is sometimes associated with a steroid medication given to
minimize swelling. A slight mood-elevating effect is associated with this drug.
Therefore, as the drug leaves your system you may experience a form of depression
(usually on the third day). This is a natural response. We feel that if you are aware of
the potential from the start, you will work at minimizing this by keeping your mind
and body active. By the fourth and fifth day, you should return to good spirits.
You must remember that this represents only a few weeks of discomfort in the
"big picture of life". If you will maintain a good attitude, these first couple of weeks
will soon be over.

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LOSS OF WEIGHT

Following your surgery, you may lose as much of 10 of your body weight.
Prior to your surgery, you may want to gain a few pounds in anticipation of
this weight loss. Once your fixation is removed, you may easily gain
back your original weight.

RECOMMENDATIONS FOR EATING

Most types of orthognathic surgery require some fixation of the jaws, of varying
lengths of time, The hospital may provide a large plastic syringe with rubber tubing.
The end of the tubing can be placed in the back of the mouth to allow passage
of liquids or pureed food. By lubricating the rubber plunger of the syringe with
cooking oil, the syringe should function throughout the fixation period.

DIET

During the first week after your surgery, your dietary intake is critical!
Your tissues will be in a state of healing and your nutritional requirements
will be great. This is no time to go on a diet. You will lose weight regardless.
You will also be seen by a dietician while you are in the hospital, and he/she
will counsel you about your diet during the fixation period.

If your teeth are fixated together, you will be limited to a strictly liquid diet.
We recommend that you fortify your diet with liquid vitamins and other
dietary supplements. There are many nutritional supplements on the market.
As examples. Ensure and Sustacal, available in assorted flavors, are excellent
canned preparations found in most drug stores. Many grocery stores carry
"instant breakfast" nutritional supplements.
Essential nutrients must all be present to promote complete soft tissue healing and
bony union at the surgical site. Calcium, iron, vitamins A,C, and D, and protein
will be especially important in your diet. At times, you may not feel like eating,
but please remember that good healing requires a sufficient dietary intake.
A blender may be used to puree almost, any food. Fruit and raw eggs are
excellent nutritional additions to milk shakes. Experiment with a variety of foods!
One of our patients even blenderized a Thanksgiving dinner, including the
turkey and dressing.
You will also receive a recipe book at one of your pre-surgical visits.

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YOUR HOSPITAL STAY AND RECALL VISITS

You should anticipate a total hospital stay of two to three days.
Plan to return to see us once a week for the next six weeks for
routine observation. Once we are satisfied with your surgical stability,
your recall visits will be less frequent.

YOUR APPEARANCE DURING THE FIRST WEEK

After the surgery, there is always temporary swelling (especially of the lips and
cheeks) and perhaps bruising. At first your appearance might
cause concern to your family, but this is to he expected. You should warn your
family or any other visitor so that they will not be overly surprised.
Remember, this is a normal healing response and should resolve greatly in one
or two weeks. Should you look in a mirror, remember this is only a stage of transition.

You will also notice that with the swelling that follows this type of surgery it
may be difficult to make facial expressions the first few days.
You might explain to those around you that although you might,
have smile's on the inside, you may not be able to project your smiles to
the outside for a couple of days.

YOUR RETURN TO WORK OR SCHOOL

You are encouraged to return to school or work as soon as you feel up to it.
Each individual will differ in speed of recovery. Some patients return to
their regular activities as early as 6 or 7 days after their surgery.
Reasonably, you should not be absent from school or work longer than two weeks.
By this time you should have adequately regained your strength.

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DENTAL HYGIENE

During dental fixation, oral hygiene will be more difficult. You will be unable to
clean the tongue side of your teeth. It is, therefore, essential for you to make
an effort in applying the following recommendations.

You must brush your teeth as thoroughly as possible.

1. A childs size soft toolhbrush is more efficient. Since your cheeks may
become swollen, the smaller toothbrush head permits easier access.

2. A toothpick device called the Perio-Aide is a helpful adjunct to tooth-brushing
since flossing your teeth will be impossible. Perio-Aides facilitate cleaning
along the gumline. These come with instructions and can be
found in most drug stores,

3. Stimudents made of soft balsa wood are also good for cleaning and are
used similarly to Perio-Aides.

4. We recommend the use of a Water-Pik, after 10 days of healing.

a. Fill the water bath with mouthwash diluted with water for a
fresher taste.

b. Diluting hydrogen peroxide in the water bath can be very helpful
to clear the mouth of debris with its foaming action.

CAUTION: Do not use the Water-Pik on high pressure. Use the Water-Pik
on the lowest pressure setting. If used on high pressure, food debris
could be forced through the incision sites. If you keep your teeth relatively
free of food debris, you will feel more tolerant of the wires and elastics.

FAMILY SUPPORT

Prior to you surgery, you should review this information with your family to inform
them of the natural course of your surgery You might also consider reviewing
this with close friends, such as people at work or teachers at school, so that they
might develop appropriate expectations. You will need their understanding and
support throughout the weeks following the surgery. This will help you to make a
quick and easy adjustment to your surgical experience.

If you have any unanswered questions, we will be happy to clarify any of this
information. We want to make your hospital stay and the subsequent weeks as
pleasant as possible. Please let us know what we can do.

E. Steven Moriconi, D.M.D,
609 Harper Avenue
Jenkintown. Pa 19046
(215) 884-8263

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