ABSCESS DRAINAGE PROCEDURE AND INSTRUCTIONS.
Abscesses in the mouth may occur due to septic teeth, injuries in the mouth or after surgical procedures in the mouth. Food and fluid entrapment in the tooth socket after tooth removal, are the most common causes. After tooth removal, the overlying gum will heal, enclosing debris in the socket. This causes an abscess resulting in facial swelling after a couple of weeks after the removal of the tooth. This abscess will have to be drained and a drain must be placed. Failing drainage of this abscess can result in the patient being hospitalized.
The following instructions are applicable:
- Under a local anesthetic, the abscess will be drained, and the socket will be rinsed. In severe cases, a general anesthetic will be necessary.
- A drain, in the form of an anti- septic gauze, will be placed in the socket. This gauze will stick out from the socket, and must be left in place for 3 – 4 days.
- After 3 – 4 days, remove the gauze by pulling it out.
- Use the syringe and the needle supplied, to rinse the socket after every meal. This is done, by placing the needle in the socket, through the hole left after the gauze has been removed. Rinse with mouthwash, water etc. Avoid materials containing alcohol, or chemically active materials, which can damage the bone.
- Carry on doing this procedure until the hole has closed.
- Remember, this procedure can only be done after the gauze has been removed.
- Antibiotics, painkillers and a mouthwash will be prescribed.
- Apply a heat pack and pressure on the affected area afterwards.
- If any queries, or recurrence of the abscess occurs, contact the rooms again.
Please remember, an abscess cannot be treated with antibiotics alone. It must be drained as well.
EXPOSURE / ATTACHMENT OF IMPACTED TEETH.
The exposure of a tooth is the procedure where an unerupted tooth (normally a canine tooth) is exposed, and an attachment (bracket) is glued on to the surface of the crown.
A chain or wire is attached to this attachment and with the help of an elastic band, the tooth is pulled down into the mouth orthodontically over a period of 3 – 6 months.
The procedure (etching on the tooth surface) is moisture sensitive and can become detached if not treated with care.
If this happens the procedure will have to be repeated. Unfortunately this practise cannot take any responsibility for any break-offs because every attachment is tested thoroughly intra-operatively.
- Swelling and pain which can last for up to 5 days.
Apply ice packs for 3 days followed by heat packs for 2 days.
- Slight discolouration which will subside within 5 days.
- Use your medicine as prescribed.
- Sutures are all self-dissolving and will dissolve within 10 – 14 days.
- Clean thoroughly around the chain/wire. Do not pull or eat on the chain/wire.
- See your orthodontist/dentist 14 days after the procedure for activation of the exposure.
- If any queries, contact the surgery at the above telephone numbers.
FRACTURES OF THE MANDIBLE AND THE MIDDLE FACE, INCLUDING THE ZYGOMA.
- THE MANDIBLE.
- The fractures of the mandible will be reduced under general anesthesia, with the possibility of staying in hospital for 2 – 3 days.
- In most cases the fractures are fixed with plates and screws. These plates compose a ridged form of reduction of your fractures and could mean that your jaws would not be wired after your operation. Although your jaws might not be wired, you will have to be on a special diet for 6 weeks.
- The diet will consist of a liquid diet for the first 2 weeks, followed by a soft diet for the rest of the period up to 6 weeks. In cases where the jaws are wired together, you will have to be on a liquid diet for the whole 6 weeks. A special diet will be prescribed to you.
- Most cases involving fractures of the condyles ( articulating part of the lower jaw – the joint ), will mean that your jaws will be wired for 6 weeks. If after removal of the wires, your bite (occlusion) is out, you will need an osteotomy of the lower jaw to correct your bite.
- Due to wires in your mouth, you will have to ensure extra care with your oral hygiene. This means that you will have to brush your teeth after every meal.
- Common signs of a mandible fracture is facial swelling and pain accompanied by a step in the occlusion with numbness of the lower lip. Bleeding from the mouth is also very common. An inability to open the mouth is also present.
- FRACTURES OF THE MIDDLE FACE AND ZYGOMA ( CHEEK BONE).
- Fractures of the middle face means that your upper jaw has broken loose from the rest of the skull. The maxilla is loose, and will be fixed with plates and screws under general anesthesia. The jaws may be wired together for 6 weeks. Again hospitalization will be for 2- 3 days.
- In the case of a zygoma fracture, the cheek bone is displaced, and is reduced under general anesthesia with the fixation of the segments with plates and screws.
- Approach to the fractures are from incisions done in the face, which will mean that there will be sutures placed, which must be removed in 7 days time.
- General signs of these fractures will show as facial swelling, nasal bleeding and pain, accompanied by redness of the eye, and bruising of the face. Numbness of the upper cheek and upper teeth are also associated with these fractures.
- In the case of a Zygoma fracture, double vision can also occur and is called a blow- out fracture of the orbit. In these cases you are advised not to blow your nose pre- and postoperative for 14 days, because air can be forced into the orbit, making a diagnosis of double vision impossible.
GENERAL POST- OPERATIVE INSTRUCTIONS.
- For swelling and pain, apply ice- packs and take your medicines, including your painkillers as prescribed. You will receive a mouth- wash which must be used after every meal after you have brushed your teeth.
- Sutures are normally self- dissolvable, especially those intra- orally.
- A special diet will be prescribed for mandible and maxillary fractures. It will consist of a liquid diet for 14 days, followed by a soft diet for the rest of the period up to 6 weeks. If your jaws are wired together, you will follow a liquid diet for 6 weeks.
- Your teeth must be brushed after every meal to ensure good oral hygiene.
- Follow- up appointments will made after 2, 4 and 6 weeks. X- rays will be done to ensure proper healing.
- Contact sports and activities involving bumping to the jaws are not allowed for at least 6 weeks.
POST OPERATIVE INSTRUCTIONS FOR OSTEOTOMIES:
- POST OPERATIVE PAIN:
Due to nerve involvement during your operation, you will experience less pain as anticipated. As a result your lower lip and chin area will be numb, and subsequently you will need fewer painkillers as anticipated. In the case of the upper jaw, your gums and palate will be numb. The numbness is usually temporary, but in certain cases it could be permanent in a small rea. Sensation loss can last for 6 weeks up to 6 months. Since it is the sensory nerve which is involved, the numbness is not visible, and very seldom a major problem.
- POST OPERATIVE SWELLING:
Swelling will start 12 hours after the operation and will last for up to 48 – 72 hours. This will depend on the operation you have received. Facial strapping and small drains ( in the case of the lower jaw), will be applied to reduce swelling. All will be removed before discharge from the hospital. To reduce swelling, ice packs are placed around the area of swelling, and physio- therapy is started in hospital. Ice packs should be applied for at least 4-5 days, after which heat backs are applied for another week to enhance jaw movement and reduce swelling ( bean bags).
FACIAL STRAPPING WITH DRAINS (LOWER JAW OSTEOTOMY)
- BLEEDING POST OPERATIVELY:
Minor bleeding can occur after surgery, but in case of the upper jaw, nasal bleeding is common and can in some cases be severe. Very seldom is bleeding a major problem. Nasal packs are sometimes placed to stop bleeding. In swallowing blood post operatively , can lead to vomiting due to the dead blood in the stomach. In some cases vomiting can occur as a result of the anaesthetic.
- NASAL STUFINESS AND NOSE BLOWING:
Only in case of upper jaw surgery will the patient experience nasal bleeding with nasal stuffiness. You will be encouraged not to blow your nose for 1 week. Nasal sprays can be administered to clear the stuffiness. Due to the sinus involvement in the upper jaw operation, nasal bleeding can occur for up to 2 weeks post operatively. In case of major bleeding, contact the rooms.
- MEDICATION AND HOSPITAL STAY:
Your medication post operatively will consist of Antibiotics, anti- inflammatory medication, painkillers and a mouthwash. All your medication will be in a liquidised form for easy swallowing. All this will be dispensed by the hospital prior to discharge. While you are in the hospital, an IV line will supply you of IV fluid and IV medication. Pain medication will be administered intra- muscular or via the IV line. Your hospital stay will be 1 night in case of the lower jaw operation, or 2- 3 nights in case of bi-maxillary procedures. The first night in case of the bi- maxillary procedure, will be in a high care facility.
- WIRING OF THE JAWS AND ELASIC THERAPY:
Very seldom are the jaws wired together. This is only applicable in case of a bad split of the jaw with multiple fractures. The jaws will then be wired only after 3- 4 days post operatively. In all cases, elastics are placed. ( Red packet elastics). You will be able to open your mouth slightly with your elastics in place, but you are not allowed to open wide with your elastics in place. This could lead to a non-union of your bone segments. Once you are at home, try to remove your elastics before eating, exercise your jaw by opening and side movements. Place heat packs on your TM joint area to enhance mouth opening. After eating, brush your teeth and replace your elastics. A new set of elastics should be placed after every 3 days. Replace your elastics exactly the way they were placed post operatively. Once you see your orthodontist after 10 days after your operation, your elastics will be removed and replaced.
Plates and screws are placed for fixation of your bone segments mostly intra- orally. In most cases these plates and screws will not need to be removed. In the placement of screws in the lower jaw, a trans buccal approach might be necessary, meaning that you could have a removable stitch on each cheek on the outside of your mouth. A Band Aid plaster will be placed, which needs to be replaced daily for 5 days. Clean the extra- oral area with surgical spirits every day. Intra- oral sutures are self dissolvable and need not be removed.
- YOUR DIET AND ORAL HYGIENE:
You are not allowed to eat anything for 6 weeks which needs to be chewed before swallowing. You will subsequently be on a liquidised diet for 10 days following by a soft diet for the remaining period up to 6 weeks. ( see diet ).
Your oral hygiene will consist of rinsing for the first couple of days with water and your mouthwash. Once you are able to brush your teeth, use your normal toothbrush and toothpaste to brush your teeth. This could be even over your elastics if you are unable to remove them whichever way, you will have to clean your mouth after every meal. Make sure that your fluid intake is sufficient (2-3 litres a day). Also enhance your general health by taking extra vitamins.
You could lose at least 3-4 kg of weight post operatively in your recovery phase. This is why you will be required to have at least 6 meals a day.
- PHYSIOTHERAPY AND EXERCISES:
The purpose of post operative physiotherapy and exercises are to:
- Reduce swelling and associated pain.
- Restore normal function.
- Minimise scar tissue formation.
- Accelerate your healing process.
- Enhance your eating ability
In hospital, you will receive physiotherapy treatments with further instructions from your physiotherapist.
At home your exercise will consist of opening and closing, left and right and forward movement of your lower jaw. This once you have removed your elastics, and once you have applied heat packs on your face and hot salt water in your mouth to heat the muscles. You should be able to get at least 2 fingers in your mouth after 4-6 weeks post operatively. If not, you will have to revisit the physiotherapist.
Most dento-facial deformities present with clicking / pain in the joints pre- operatively, the TM joints can become painful post operatively, which will be aggravated by the wearing of elastics.
- POSSIBLE RISKS AND COMPLICATIONS;
- Sensation loss in the lower lip and chin are in case of the lower jaw. Sensation loss on the gum and palate in case of the upper jaw.
- Infection, resulting in abscess formation leading to facial swelling after 3-4 weeks. This is usually a result of bad oral hygiene.
- Injuries to adjacent teeth in the upper jaw due to segmental surgery. The teeth can discolour.
- Fracture of orthodontic brackets.
- Post operative bleeding from the nose.
- Relapse of the operation. This is usually after brake down of the bone union due to eating solids too soon.
- TM joints pain and limited jaw movement. This can be as a result of prior joint problems pre operative or prolonged elastic therapy. Minor changes of position of the joint are present in all orthognatic procedures.
- FOLLOW- UP CARE:
- Visit the rooms after 10 days post operatively. Follow- up X- rays will be performed. A further follow-up appointment will be arranged for another 4 weeks.
- Visit your orthodontist after 10 days after your operation, once you have visited your surgeon.
- Take note of your oral hygiene, your diet, and your exercises.
- If any questions, please phone our rooms