Post-operative care is very important. Unnecessary pain and the complications of infection and swelling may be minimized if the instructions are followed carefully. Sometimes the after effects of surgery are quite minimal, so not all of these instructions may apply. Common sense will often dictate what you should do. However, when in doubt, follow these guidelines or call our office any time for clarification.
Immediately Following Surgery:
- The gauze pad placed over the surgical area should be kept in place for 30 minutes and changed at regular intervals until the bleeding subsides. Usually within 45 minutes to an hour, the bleeding will subside to a trickle. After the subsidence of bleeding, you can quit using the gauze.
- If there is oral trauma, vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged. Gentle rinsing is encouraged BEGINNING THE DAY AFTER SURGERY. Warm water rinses are fine or ½ teaspoon of salt in 8 oz of warm water can also be used.
- Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
- Restrict your activities the day of surgery and resume normal activity when you feel comfortable. It is not unusual to require 7 to 10 days before you are feeling back to normal, before you can resume strenuous physical activity, and normal eating patterns.
- Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for further explanation.
- Caution: If you suddenly sit up or stand from a lying position, you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing. Stand up slowly to provide time to steady yourself. If you feel dizzy when you sit or stand, you should lie back down immediately to minimize the possibility of fainting.
BLEEDING
A certain amount of bleeding is to be expected following surgery. For skin lacerations, place a moist gauze over the sight that is oozing and apply direct pressure. This will usually cause the bleeding to subside. With trauma inside the mouth, slight bleeding, oozing, or redness in the saliva is not uncommon up to 72 hours after surgery. Excessive bleeding may be controlled by first wiping any old clots from your mouth if present, then placing a gauze pad over the area and biting firmly for 30 minutes. If the gauze needs to be changed, the new gauze should be moistened with cold water, with excess squeezed out until the gauze is slightly damp, then placed in the mouth. Dry gauze will absorb any forming clot and will stimulate bleeding. As the bleeding subsides, each change of the gauze should be whiter and less red. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. Avoid bending over and lifting anything greater than 3 pounds. Smoking, forceful spitting, and use of a straw can cause the bleeding to start again and they can also cause dry socket. Do not hesitate to call our office if you have any concerns about bleeding.
SWELLING
The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes, and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, ice packs, or small bags of frozen corn or peas should be applied to the sides of the face where surgery was performed. The ice packs should be used for 20 minutes on, 20 minutes off for the first 48 hours following surgery while awake. After the 48 hours, either ice or heat is permitted. Drinking plenty of cold fluids with crushed ice is also advantageous. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling. Please note that it is important to keep your head elevated for 2-3 days following surgery to minimize swelling. A reclining chair works well to keep your head elevated.
PAIN
For mild pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours. For moderate pain, take the Ibuprofen 800mg as prescribed. As a substitution for the prescription Ibuprofen, you can use over the counter ibuprofen (Motrin or Advil) by taking two to four 200 mg tablets every 3-4 hours. You should not take more than 2400 mg of ibuprofen in any one 24-hour period, which equates to three 800 mg tablets or 12 of the 200 mg tablets.
For severe pain, take the narcotic pain medication as directed. This prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages as they will enhance the effect of the narcotic. This is a dangerous combination. Pain or discomfort following surgery should begin to subside after the first three or four days. If pain persists, it may require attention and you should call the office. Some patients will develop significant pain 3 to 7 days postoperatively and this may indicate a dry socket, which is described below. Do not routinely take Tylenol with prescription pain medications. Many prescription pain medications already contain Tylenol.
DIET
After general anesthesia or I.V. sedation, clear liquids should be initially taken. Do not use straws; drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft but try to avoid chewing directly over the surgical sites. High calorie, high protein intake is very important. Nourishment should be taken regularly. You should prevent dehydration by drinking fluids regularly. Your food intake will be limited for the first few days, so you should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Keeping well hydrated also prevents nausea and vomiting. Try not to miss a single meal. You will feel better, have more strength, less discomfort, and heal faster if you continue to eat. We recommend caloric supplements such as Ensure or an equivalent product. Two to three cans per day will help keep your strength and promote healing. Blenderizing the Ensure-type products over ice usually makes them tastier, and the ice is usually soothing to the tissues. Remember, if gauze was placed in the mouth, to remove the gauze before eating. It is also advisable to avoid very hot foods for the first 24 hours. If the oral cavity was traumatized, avoid foods such as nuts, popcorn, sunflower seeds and any other food where particles can get into the surgical sites (such as pretzels, potato chips, corn chips) for 2 weeks.
KEEP THE SURGICAL SITE CLEAN
If there was intraoral trauma, no rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but do not rinse with any force. Gently place the water in your mouth and let it swirl around and drip out into the sink. Do not spit as this may dislodge the blood clot that has formed and could result in a dry socket. The day after surgery you should begin rinsing gently at least 5-6 times a day, especially after eating, with eight ounces of warm water mixed with one-half teaspoon of salt. The important thing is to keep the surgical areas as clean as possible. If salt water is not available, warm water is very acceptable. You may also use diluted mouthwash in at least a 4:1 dilution. Following one week, vigorous rinsing should be done to keep the surgical sites very clean. The use of a WaterPik is generally avoided in the surgical area for several weeks.
Facial lacerations should be kept moist with bacitracin for the first week after repair. Daily care includes going over the suture line 3 times a day with hydrogen peroxide on a Q-tip. After this, with a Q-tip, apply a liberal amount of antibiotic ointment. Bacitracin is preferable, but Neosporin or Polysporin are acceptable. You may shower the second day following your repair. Use a gentle shampoo such as Johnson’s baby shampoo. Be sure to report immediately any signs of bleeding that persists more than 10 min., infection, redness, fever, unusual drainage, or excessive pain. Stitches, if present, will be removed in 5-7 days after repair. You should supplement your diet with a multivitamin and take 500 to 1000 mg of vitamin C daily.
DISCOLORATION
In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. In some patients, this is a normal occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration. In younger patients, bruising is rare and sometimes is represented as a slight yellow discoloration. In older patients, especially the elderly, bruising can be quite significant and is represented as black and blue discoloration. This can cover a larger area, sometimes even involving the neck and upper part of the chest. Bruising of this degree can take approximately two weeks to resolve.
For facial lacerations, you must cover the laceration with sunscreen and try to stay out of direct sunlight on the laceration. Sunlight can cause the scar to become discolored and more obvious. Place Vitamin E, cocoa butter, or Mederma over the laceration for about 9 months. Do this after the sutures are removed and do it at least 2 times a day. After a full year, we will reevaluate your scar. At that time, we may consider either a dermabrasion procedure to smooth your scar or scar revision to revise it. We will discuss these more fully at that time.
ANTIBIOTICS
If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given when there is a clinical reason for their use, such as if there is an infection already present. Discontinue antibiotic use in the event of a rash or other unfavorable reaction, and notify the office of the reaction. We invite you to call the office if you have any questions or concerns. Sometimes taking antibiotics with yogurt can help prevent diarrhea. If you take birth control pills, the birth control may become ineffective; use back up form of birth control.
NAUSEA AND VOMITING
In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour, including the prescribed medicine. You should then sip on flat coke, tea, or ginger ale. You can also purchase coke syrup over the counter, which can have a soothing effect on the stomach. You should sip slowly over a fifteen-minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medicine. Please call if the nausea does not subside within 3 hours. There are medications we can call in to your pharmacy that work very well to control nausea and vomiting.
