How to use this brochure
Read through all the information in this brochure and use these blank spaces to record important information.
Names and phone numbers
My orthodontist is:
Phone:
My surgeon is:
Phone:
My nurse is:
Phone:
My craniofacial coordinator is:
Phone:
The date and time of my operation is:
Write where to check in here:
Notes
Remember to bring this brochure with you when you come for appointments and the operation.
Before the operation
A preoperative check-up
About three weeks before the operation, you should visit your family doctor for a physical check-up.
Your will also need blood tests. These can be done during one of the clinic visits to the orthodontist.
Your surgeon's coordinator may also book a time for you to see an anaesthetist before the operation. An anaesthetist is a doctor who makes sure you stay asleep and that you feel no pain during the operation.
What to do if you have signs of illness before the operation
If you have a fever or signs of a cold during the three days before the operation, please call the craniofacial coordinator.
Do not take ASA before the operation
Do not give take ASA or any medicine containing ASA for three weeks before your operation. ASA is also called acetylsalicylic acid. ASA can thin the blood. It can cause too much bleeding during the operation.
Do not take medicines containing ibuprofen.
If you are not sure what medicine you can take, please call your pharmacist or your craniofacial coordinator.
Before coming to the hospital
Pack a bag for your stay
Remember to bring:
- clothes. Bring pajamas and tops that fit very loosely around the neck and are easy to take off.
- slippers or shoes
- portable music players and games and books to keep you busy
- toiletries such as shampoo, soap, a comb and toothbrush
- anything else you may need to spend the night at the hospital
Have a shower or bath and wash your hair before you come to the hospital.
Follow our feeding guidelines
Before the surgery, what you can eat and drink must be restricted.
The midnight before the day of the operation, do not have any solid foods or unclear fluids such as milk or orange juice.
The day of the surgery, do not have any candy or gum.
You may drink clear fluids (such as apple juice or ginger ale) up until three hours before the surgery.
You must follow these feeding instructions. They will lessen the chance of throwing up and hurting your lungs. If you do not follow these instructions, your operation will be cancelled.
Questions about blood transfusions
The risk of needing a blood transfusion during the operation is very low. However, jaw surgery is a major procedure. For this reason, blood will be available in case it is needed.
You can lower the risk that you will need a blood transfusion by giving taking iron supplements for three months before the operation. Iron helps to build up your blood.
Ask your surgeon for more information about blood transfusions at your next visit to the clinic.
The day of the operation
Please check in two hours before your operation. The nurse needs this time to get you ready for the operation.
Before the operation starts, you will be able to talk to your surgeon and anaesthetist about the operation. Write down any last-minute questions and bring them with you.
During the operation
Once you go into the operating room, the anaesthetist will give you a special "sleep medicine" called a general anaesthetic. You may be allowed to choose whether the anaesthetic comes in a mask or from a small needle.
The anaesthetist will also start an intravenous (IV) line. An IV is a small tube placed in a vein that gives medicine and liquids. This tube will stay in after the operation until you are able to drink liquids normally.
About the operation
Operations on the jaw are done through the inside of the mouth. The surgeon makes an incision, or cut, through the skin to operate.
To change the shape of the jaw, the surgeon makes cuts in the bones of the jaw and moves them in different directions. This will put the upper and lower jaws in the best position possible.
The surgeon will take pieces of bone, called bone grafts, from other parts of the jaw to change the shape of the jaw. Sometimes the surgeon has to use extra bone from the hip or rib to fill in spaces in the jaw. These bone grafts heal in about six to eight weeks.
To stop pieces of bone from moving, the surgeon uses tiny plates and screws to hold the bone in place. These plates and screws are put inside the mouth, under the skin. Usually, they are not taken out. You may be able to feel them, but they should not be painful.
When the operation is over, the surgeon uses stitches to hold the incision closed until it is healed. It takes about 10 days for the incision to heal. The stitches will melt away on their own in two to four weeks.
Splint
All patients have a splint inserted during the operation. A splint is a clear piece of plastic that fits onto the upper teeth. The splint is held in place by wire fixed to your braces. You will have to wear the splint for three to eight weeks until the surgeon or orthodontist removes it at a clinic.
If the upper and lower teeth do not meet perfectly, your jaws may need to be held together with wire. If this is needed, your surgeon will talk to you about it.
After the operation
After the operation, you will be taken into the Post Anesthetic Care Unit (PACU) for about four hours.
Taking care of pain after the operation
After the operation, you may feel some pain. To control pain, you will be given medicine as needed. You may use a machine called a Patient-Controlled Analgesia pump, or PCA pump, to help control pain on your own.
If you feel you need pain relief, speak to the nurse about it. The doctors and nurses will do everything they can to make you comfortable.
Usually, pain medicine is given through an IV until you can swallow the medicine as a pill or liquid.
During the first 24 hours after the operation, you may feel sick to the stomach or may vomit (throw up). Usually this is not serious, but it can be upsetting. Please ask your nurse for help or medicine if you feel sick.
Eating and drinking
Until you are drinking well, you will get liquids through an IV. Your first drinks will be clear liquids, such as water or ginger ale. It may be a few days before you are allowed other liquids and food.
If your jaws are not wired together, you will be able to have soft foods before going home.
Please ask your surgeon if you have any questions about what you should and should not eat. You will be given more instructions about your diet before you go home.
Wire cutters
If your jaws are wired together, you will be given wire cutters to take home. You will also be shown which wires to cut in case of an emergency, for example, if you are in an accident and needed to be intubated. You must carry the wire cutter on you at all times.
Please note that if your jaw has been wired together, you will continue on a liquid diet until the wires are removed.
Swelling
Your face will swell up after the operation. This is normal. Usually, the swelling starts to go down on the second day after the operation.
To help reduce swelling, here are some things to try:
- Raise the head of your bed.
- Put ice packs for 15 minutes at a time on your cheeks.
- Some exercises like blowing kisses, and exaggerated smiling and frowning, can help reduce swelling.
Ask your nurse for help with these and more solutions to reduce swelling.
Drains and tubes
During the operation, the surgeon will likely put drains in your jaw on both sides. Drains are small tubes that take away extra liquid to help reduce the amount of swelling. They come out through an opening in the skin on your neck, below the ears. The ends of the tubes are attached to small, round containers that collect the liquid.
The nurse will remove these drains two to three days after the operation.
Caring for the incision
After the operation, it is very important that you do not get an infection. To help fight infection, you will get medicines called antibiotics through the IV.
It is important to keep your mouth clean. Your nurse will give you mouthwash to rinse your mouth after eating or drinking.
The nurse will also wash the opening around your tubes every day with warm tap water, a cotton swab and soap. The nurse will put an antibiotic ointment on the area.
If you had a rib or hipbone graft, there will be a bandage on the place the bone was taken. You will be told to take the bandage off three to four days after the operation. Small tapes will cover the incision. Leave these tapes on until they fall off on their own.
X-rays after your operation
Before going home, you will visit the orthodontic department to have X-rays of your jaw.
While you are there, a dental hygienist will talk to you about caring for your mouth. An orthodontist will check the positioning of the upper and lower teeth and answer any questions you might have.
If your jaw is wired, the orthodontist will also check for any wires that may be sticking to the lips.
Leaving the hospital
Patients usually go home from the hospital between three and five days after the operation.
Before you go home, your nurse will give you specific instructions for looking after your mouth and jaw at home. Remember to follow these instructions carefully. If you have any questions, please call your craniofacial coordinator.
Food and drink
For the first six weeks, you should only eat soft foods. It is normal to lose weight because of this.
To avoid losing too much weight, you should eat small meals more often. Instead of three meals a day, try five to six smaller meals.
A clean mouth is very important. Remember to rinse your mouth with mouthwash after all foods and liquids.
Swelling
Most of the swelling will go away in the first two weeks after your operation. But it may take several months for all of the swelling to go away completely.
Although the swelling will go down each day, it may go up overnight. This is because lying down causes a bit of swelling in the face.
Baths and showers
You can take normal baths and showers after going home.
Activity
Your activity must be limited after the operation. For the next six to eight weeks, avoid rough play, gymnastics and any sports that might cause injury to the face, such as hockey or football.
Talk to your surgeon about how active you can be after going home.
Back to school
You may feel well enough to go back to school about a week after the operation. Ask your surgeon when you should go back to school.
Follow-up visits to the clinic
The staff at the Craniofacial Program will make a number of check-up appointments after the operation. If you have to change an appointment, please call the Craniofacial Program as soon as possible.
Signs of infection
Call the Craniofacial Program or the Plastic Surgery Unit if you notice any of these signs of infection:
- The area around the incision is red.
- Liquid is draining from the incision.
- The swelling has increased.
- There is a bad smell that does not go away.
- You have a fever that does not go away.
- There is a sudden increase in pain.
At SickKids
Important numbers
Dr. Forrest's patients, call the Craniofacial Coordinator at: 416-813-7492.
Dr. Phillips's patients, call the Craniofacial Coordinator at: 416-813-8329.
SickKids Plastic Surgery Unit: (416) 813-6932
Craniofacial Program at (416) 813-6013
General hospital information: (416) 813-1500.
Checking in
On the day of your operation, please check in at the Surgical Day Care Unit (6B) two hours before your operation.
The Plastic Surgery Unit is on 8C. You will stay there after spending the night in the Paediatric Critical Care Unit (PCCU).