As a result of an accident or surgery, you have had your jaws wired together. This was done by the Oral and Maxillofacial Surgeons for a special reason. The function of the arch bars and wires is like that of a cast one might have for a broken leg or arm. These appliances keep the jaws from moving to allow the bones to heal in the correct position. Your jaws will be wired together approximately six to eight weeks. This is the time it takes for the bones to heal in a good, strong union. During the time your jaws are wired together, you will find eating, talking and other daily activities somewhat difficult. Hopefully, this manual will provide some solutions to the problems you may encounter, and make this a more comfortable time for you.
Since you will not be able to actually chew any food for an extended period of time, your intake at home will be different from what you have been accustomed. If you have a blender or food processor, you can blend ordinary table foods used by the rest of the family. The foods are blended to the consistency you can suck through a straw and through your teeth. Mixed dishes, such as stews and spaghetti with meat sauce, can be blended with a small amount of bouillon or thin gravy to the consistency you will need. You can also use tomato juice or sauce, milk, water, or V-8 juice as thinners. Foods may be blended for 30 seconds on the chop setting on your blender and then 30 seconds on high so the food is the consistency of a milk shake. Do not be afraid to experiment with new foods and flavors.
There are some foods which do not blend thoroughly: vegetables with tough skins, such as corn, dried peas and beans, are some examples of vegetables you should avoid blending. They will get stuck in your teeth and wiring. Some fruits, such as strawberries and blackberries, have tiny seeds that would have a tendency to become caught in your teeth, so stay away from these. Strain all meats to insure all fibers and skins are removed so eating will be easier.
Remember, although your ability to chew has changed, your body still wants and needs the same foods you needed before, especially now for wound and bone healing. You will need to carefully plan your meals to insure that all your nutritional and healing needs are being met.
Each day you should include the following in your diet:
Eat small, frequent meals each day. Plan midmorning, midafternoon, and evening snacks. This will insure a balanced diet during your recovery and in case of nausea there will be less food in your stomach. High caloric drinks may be used to supplement your diet. These are available at most drug stores. For recipe’s and meal suggestions, see Appendix.
Mouth care is extremely important for everyone. Now that your jaws have been wired together you must be especially concerned about good oral hygiene. You must keep your mouth clean to avoid infection and tooth decay, food caught in the wires is not only unsightly, but it can produce a most unpleasant odor. You should brush your teeth after every meal and before bedtime. A small, soft, child size toothbrush is easier to use while your jaws are wired together. Brush your teeth by taking your finger and pulling out the cheek on the side that you plan to brush. Take your toothbrush and brush in and out. This helps to prevent the chance of pulling the sutures that you might have in your mouth. You should also rinse your mouth with warm salt water (one half teaspoon of salt to a large glass of warm water), then brush again until all debris has been cleared from the wires. If you have an incision in your mouth, avoid this area for the first week. If you have a waterpik available, it may be used to rinse the food out between your arch bars. Place warm water in the waterpik, set it on the lowest setting and slowly go over your arch bars, until food particles are gone. Do not forget to apply vaseline to your lips continually to prevent drying and cracking.
Swelling is natural following surgery or injury. This usually disappears in a week or two. When you return home, moist heat may be applied until the swelling subsides. Heat helps to dilate the blood vessels carrying more blood to the injured area, this reduces swelling and aids in muscle relaxation. Moist heat is less likely to burn and dry out the skin. You can accomplish this by applying a moist washcloth to the skin and placing a water proof plastic wrap around the top of the washcloth, then cover this with a dry towel.
Take all medications as directed by your doctor. If you are to take an antibiotic, be sure to take all of the medicine until it is gone. The antibiotic will not prevent an infection if you do not take all of it. Take pain medication only as needed for discomfort.
In case of vomiting, bend your head over to allow the vomitus to flow out of your mouth and nose. Cough frequently after the episode to make sure you do not inhale any food particles. Remember, everything you have had to eat since your jaws were wired together has been liquid, so there is really no need to cut the wires that hold your jaws in place unless you have severe difficulty with breathing.
You may have some mild discomfort in your jaws and ears from muscle spasms while the facial muscles adjust to the immobilization. Moist heat placed over the cheeks will soothe the pain.
During the period of time your jaws are wired together, you may find you have a change in bowel habits. Stools are usually softer, and you may have to urinate more frequently. You could also experience constipation because of the lack of bulk in your diet.
You may find it difficult to talk and be understood the first week or so after fixation. Be patient and try not to be frustrated if people cannot understand you. Talk as slowly and as distinctly as you can. Carry a pen and pad for especially difficult times, but do not become too dependent on them.
If you have an incision with sutures on the outside of your jaw or face, you must keep it clean, dry, covered with an antibiotic ointment and without a bandage. You may wash your hair if you cover your incision with a gauze dressing and keep it dry. If your sutures have been removed , apply an antibiotic ointment for one week and keep the incision line clean. Do not shave the area around the incision for at least four to five days after the sutures have been removed. You may wash your hair as you normally would.
If your wires irritate your cheeks and lips, ask your doctor for some wax or use paraffin to put over the wires in these irritated areas.
In case of an emergency, abnormal bleeding, or increased temperature (above 100 F or 38 C), call the Oral and Maxillofacial Surgery Clinic 405-271-4955 during the weekday or 405-271-5656 during the weekend or evenings, and ask for the Oral Surgery Resident on call.
If both of your jaws have been operated on, you must be careful not to blow your nose until instructed by the doctor, you may use nose spray to decrease the drainage. If it continues, allow your nose to drain and use a tissue to wipe it away.
During your hospitalization it is very important for your rapid recovery to walk around soon after surgery. Once you return home, you can resume the majority of your daily activities. For the sports enthusiast, you should avoid any contact sports until further instructed by your doctor.
Adapted from the works of Joan C. McIntrye, R.N., B.S.N. and Kimiko C. Carey, R.N. ,B.S.N.