Post Op Instructions

General Information for your Home Care Comfort Following removal of Erupted Teeth, Impacted Wisdom Teeth and other Oral Surgical Procedures.

  1. If present remove the gauze sponges that have been placed in your mouth one hour after surgery unless told otherwise. Place fresh ones as needed – moist them in cold water first.
  2. A certain amount of bleeding is to be expected following surgery. It is often possible to control mild oozing by placing a folded, moist gauze pad, the size of a thumb, over the wound. Bite down firmly and hold for 60 minutes. Sit upright and remain quiet
  3. If bleeding continues in spite of the above, dip a teabag in cold water and place this over the wound, biting firmly. It also helps to stop bleeding if you lie down with your head raised on several pillows. Apply an ice-bag or cold compress to the cheek. Do not become alarmed or excited. If unable to control excessive bleeding call Dr Sharan Naidoo.
  4. Upon reaching home put an ice-bag or cold towel to the face for the remainder of the day of surgery. Nibble on crushed ice or hold ice water in your mouth over the area of the surgery. Do this frequently. In other words, keep the area of surgery as cold as possible as this will help to reduce the amount of swelling which you are going to have. You may even place chipped ice within the gauze packs you are biting on. Continue for at least 24 – 48 hours.
  5. For any discomfort use the prescription that has been given to you. Don’t be afraid to use the medication as it is designed to make those first few days after surgery more comfortable for you. When taking the tablets or capsules (whichever has been prescribed) be sure to drink at least 150 – 250ml of either water or milk. This will ensure rapid assimilation by the body and minimise the amount of irritation to the stomach itself. This irritation may cause nausea and sometimes even vomiting, so drink plenty of liquid when taking oral medicine.
  6. If you have been placed on an antibiotic, please take ALL the tablets as directed. The drugs which you may have been placed on will help to (a) minimise swelling (b) reduce discomfort (c) prevent infection (d) promote healing and (d) aid in oral hygiene and wound cleanliness.
  7. Do very little rinsing until the following morning, rinsing may dislodge the blood clot and initiate bleeding. When rinsing, which you may begin the day following surgery, use ONE of the following; (a) ½ teaspoon of table salt in 250ml of warm water or (b) a mixture of one part of white vinegar with three parts of water. If you have been given a special prescription for a mouthwash, use that as directed instead of the above. Rinse frequently at least 4 times a day. Avoid commercial mouthwashes as they contain alcohol which may initiate bleeding and cause wound irritation.
  8. Drink plenty of fluids such as orange juice, tomato juice, ginger ale, water, tea etc. Drink at least 8 glasses of liquid daily. Dehydration must be guarded against after the oral surgery.
  9. Follow your own inclinations as to diet, but for your own comfort stick to a softliquidy diet. Keep taking nourishment. Try not to skip a single meal. Begin by eating soft foods or liquids such as heavy soup, milk shakes, soft boiled eggs, cereals etc. Change to solid food as soon as you are able to tolerate it. If you are a diabetic, maintain your normal diet and take your medication as usual.
  10. Clean your mouth thoroughly after each meal. Brush your teeth as best as you can. Cleanliness is a ‘must’ for a rapid and uncomplicated recovery. Food left in the wounds retards healing and invites infection. Stitches often trap food and bacteria. Rinsing the mouth will help to keep wounds clean.
  11. If bowel habits are irregular, it is suggested you take a mild laxative such as milk of magnesia.

What To Expect

Surgery within the oral cavity is quite different from that of a normal extraction of an erupted tooth. The following conditions may occur, all of which are considered normal.

  1. The operated area will probably swell. Swelling is most marked on the 2nd or 3rd day and begins to disappear on the 4th day.
  2. Stiffness (Trismus) of the jaws is nature’s way of splinting or resting the parts which need to be repaired and usually relaxes from about the 4th to the 6th post-operative day.
  3. Numbness about the corners of the mouth on the same day of the wisdom tooth removal may develop. This is called “parathesia” and is a temporary condition which will correct itself. It may remain anything from a few days to several months.
  4. Black and blue marks on the face are caused by bleeding internally into the cheeks and chin. This appears first as a swelling, but often on the 2nd or 3rd day it may discolour the face yellow, black or blue. It will gradually disappear within a week or ten days. A hot wet towel, wrung out, may be applied for 10 minutes, 3 times a day. This will be comforting but will not speed up the fading process.
  5. General muscle stiffness is sometimes encountered after surgery. It is caused by an anaesthetic drug called Scoline – this usually disappears after 2 or 3 days.
  6. There may be a slight earache
  7. A sore throat may develop
  8. . Other teeth may ache temporarily. This is sympathetic (or referred) pain and is a temporary condition.
  9. If the corners of the mouth are stretched they may dry out and become cracked. The lips should be kept moist with a cream or ointment
  10. There might be a cavity where the tooth was removed. This area should be rinsed as well as possible following meals. This cavity will gradually fill in with new bone tissue.
  11. During the healing process, small sharp fragments of bone may work out through the gum. This is especially true of multiple extractions and is Nature’s way of reshaping the ridge. This process of ‘shedding’ slivers and splinters or bone may last anything from 2 weeks to 4 months. If there is difficulty with some of these please call the rooms and see Dr Sharan Naidoo. Impressions for dentures should be postponed until the ridge is well healed.
  12. There may be a slight temperature elevation for 24 – 48 hours. If temperature continues, please notify.
  13. Return to the rooms for post-operative treatment and suture removal as instructed and feel free to contact us if any doubt arises as to your progress and recovery.

Your doctors may recommend additional treatment for complications caused by cleft lip and cleft palate. Additional treatments may include:

  • Surgery to correct bone growth and/of the connection between the mouth and nose
  • Hearing aids or other assistive devices for a child with hearing loss
  • Speech therapy to correct difficulty with speaking

Before the Procedure

You will meet with a specialist community nurse soon after your child is born. They will help you find the best way to feed your child before the surgery. Your child must gain weight and be healthy before surgery. Your child’s surgeon may

  • Test your child’s blood (do a complete blood count and “type and cross” to check your child’s blood type)
  • Take a complete medical history of your child
  • Do a complete physical examination of your child

Always tell your Maxillofacial and Oral Surgeon or nurse what drugs you are giving your child. Include drugs, herbs and vitamins you bought without a prescription.


About 10 days before the surgery, you will be asked to remove the plate, stop giving your child aspirin, ibuprofen (Brufen, Myprodol), warfarin (Coumadin) and any other drugs that make it hard for your child’s blood to clot. Usually, on the day of the surgery, your child will not be able to drink or eat anything for six hours before the procedure. You can, however, give your child a small sip of water with any drugs your medical team told you to give your child. You’ll be told when to arrive for the surgery.


After the Procedure

Your child will probably be in the hospital for five to seven days right after surgery. Complete recovery can take up to four weeks. The surgery wound must be kept very clean as it heals. It must not be stretched or have any pressure put on it for three to four weeks. Your child’s nurse should show you how to take care of the wound. You’ll need to clean it with a special cleaning liquid, and keep it moist with ointment.

Until the wound heals, your child will be on a liquid diet. Your child will probably have towear arm cuffs or splints to prevent picking at the wound. It is important for your child not to put hands or toys in the mouth. Most babies heal without problems. How your child will look after healing often depends on how serious the defect was. Your child might need another surgery, at a later stage, to fix the scar from the surgery wound. A child who had a cleft palate repair may need to see a dentist or orthodontist. The teeth may need correcting as they come in.

If you have any questions at any time and at any point in the process – before, during and after surgery – make sure you ask your doctor, Maxillofacial and Oral Surgeon or nurse.

Hearing problems are common in children with cleft lip or cleft palate. Your child should have a hearing test early on, and it should be repeated over time. Your child may still have problems with speech after the surgery. This is caused by muscle problems in the palate. Speech therapy will help your child. Some children may also need psychological treatment due to the stress associated with the surgery.


CRANIOFACIAL ANOMALIES

Craniosynostosis

Craniosynostosis is a birth defect in which one or more of the joints between the bones of a baby’s skull close prematurely, before the baby’s brain is fully formed. Treating craniosynostosis usually involves surgery to separate the fused bones. If there is no underlying brain abnormality, the surgery allows a baby’s brain adequate space to grow and develop.

Sagittal Synostosis

Sagittal synostosis accounts for about 50% of all synostosis cases. Premature fusion of the sagittal suture restricts the growth of the skull, which results in an increased skull length to accommodate the growing brain. Sagittal synostosis treatment may involve reconstruction and reshaping to normalize the anatomy and expand the volume of the intracranial space

Metopic Synostosis

The second most common single suture fusion is Metopic Synostosis, which occurs when the suture in the midline of the forehead fuses. reatment involves surgery to reshape the forehead and orbital rims, and expand the volume of the intracranial space.

Coronal Synostosis

There are two types of coronal synostosis. Unicoronal synostosis leads to a flattening of the forehead. Bilateral coronal synostosis results in a tall, wide and flat forehead.

Lambdoid Synostosis

The rarest of premature suture fusions is the lambdoid suture synostosis, which can result in the flattening of the back of the head. Surgery reshapes the area to allow proper intracranial space.

Complex Craniosynostosis

Complex craniosynostosis is the fusion of multiple cranial sutures.


COMPLEX CRANIOFACIAL PROBLEMS

Children with craniofacial problems often require complex, long-term surgical and medical care. Some complex craniofacial conditions include:

  • Apert Syndrome, which is characterized by craniosynostosis, midface deficiency, fusion of fingers or toes, and other abnormalities
  • Crouzon Syndrome, which is characterized by craniosynostosis, maxillary hypoplasia, shallow orbits, and a bulging eye.
  • Pfeiffer Syndrome, which is characterized by craniosynostosis, midface deficiency, broad thumbs and/or great toes, and other anomalies
  • Saethre-Chotzen Syndrome, which is characterized by a misshaped head, low-set frontal hairline, facial asymmetry, deviated nasal septum, and various skeletal anomalies.
  • Treacher Collins Syndrome is a congenital disorder characterized by down-slanting eyes, underdeveloped or absent cheekbones, small lower jaw, small or unusually formed ears, and cleft palate. It is usually diagnosed at birth by the appearance of the infant.

A prenatal ultrasound can show the facial features typical of a child with Treacher Collins syndrome. Children with Treacher Collins Syndrome should be evaluated by an experienced, interdisciplinary craniofacial team. No single specialist can manage patients with this condition, and treatment usually involves doctors who specialize in many areas. Depending on the severity of the disorder, a child may require one or more surgeries, which the craniofacial team will discuss with you.

  • Pierre Robin Sequence is a rare congenital condition in which an infant has a smallerthan-normal lower jaw which can cause difficulty breathing and feeding. Some patients also have a cleft palate. In addition to these physical characteristics, a child may have breathing problems, feeding problems in infancy, cleft palate, ear infections and hearing loss. Depending on the severity of the disorder, a child may require surgery and other treatments. The craniofacial team can discuss these treatments with you.
Endoscopic Surgery