Jaw surgery recovery, week by week

Week by week

These are the recovery milestones and what studies say about each one. The exact timing of your diet, your check-ups and your return to routine is set in your plan.

1. HospitalSurgery is done under general anesthesia and from inside the mouth. When you wake up your face will be swollen, your nose stuffy and your lip numb: that's expected. Medication helps prevent nausea and swelling. How many days you stay in hospital is set in your plan; in published studies, the average stay after two-jaw surgery was 3.25 days.
2. 48–72 hSwelling peaks between 48 and 72 hours, then starts to go down. Sleep with your head raised, use cold packs as I tell you, take medication on time and drink plenty of fluids.
3. Weeks 1–2Your mouth won't open much: in one study, mouth opening was limited for the first two weeks. A liquid diet, then blended food. If you have guiding elastics, I'll show you how to manage them. Gentle hygiene and frequent check-ups with me.
4. Week 5In 378 patients after two-jaw surgery, the most common complaint at 5 weeks was nasal congestion (55.6%), followed by swelling (29.3%), pain (15.4%) and breathing difficulty (10.6%). If you still have some of that by then and it's improving, it's part of the process; if it gets worse, message me.
5. 3 monthsMouth opening keeps improving steadily over the first three months. Your diet moves toward soft foods you can chew and, once I clear you, back to normal.
6. 5 monthsIn a review of 22 studies (1,482 participants), quality of life five months after surgery had improved in all four dimensions of the OQLQ-22 questionnaire compared with before surgery.
7. 1 yearThis is when any remaining change in sensation is assessed. If the lower jaw was operated on, between 3.4% and 21% of people still have some change in the lip or chin, depending on the review; further down I explain why the range is so wide.

Swelling and your nose

Swelling rises over the first few days, peaks between 48 and 72 hours and then goes down little by little. It takes longer than people expect: at 5 weeks, 29.3% of patients in that study still reported it as a complaint. In a review of trials, corticosteroids given around surgery reduced facial swelling, although the evidence isn't strong; that's why their use is decided case by case.

• Sleep with your head raised for the first few nights.
• Use cold packs only as and when I tell you.
• Walk around the house from the first few days.
• If I operated on your upper jaw, don't blow your nose hard, and use only what I prescribe for congestion.
• Nasal congestion is expected, but I keep an eye on it: after upper-jaw surgery, sinusitis occurred in 3.3% of cases.

What to eat, stage by stage

Your diet moves at the pace of your mouth opening and bone healing, not the calendar. I confirm each change of stage at a check-up.

• Liquid: water, strained broths, fruit smoothies with milk or yogurt, and supplements if I recommend them. With a cup, spoon or syringe, as I show you.
• Blended or puréed: blended soups, mashed potato or squash, refried beans, yogurt, well-cooked oatmeal.
• Soft and barely chewed: scrambled eggs, soft fish, well-cooked rice, pasta, avocado.
• Normal: once I clear you. Hard or crunchy food and anything that makes you open wide comes last.
• At every stage: plenty of water, and protein at every meal. Eating and drinking too little leaves you without the energy to recover.

Lip and chin numbness

When the lower jaw is moved, the cuts pass close to the nerve that gives feeling to the lower lip and chin, and it's common for that area to stay numb for a while. In one recovery study, it was the most bothersome and longest-lasting symptom. Most people improve gradually over the months. At one year, between 3.4% and 21% still have some change in sensation, depending on the review: the figures vary so much because each study measures and defines it differently. In the largest review (47 studies), risk was higher with large lower-jaw advancements and when the nerve was manipulated during surgery; that's why I locate the nerve on the CT scan and plan the cuts away from it.

• With a numb lip you can't feel heat well: check the temperature before drinking anything hot.
• Check in the mirror that you're not biting your lip while you eat.
• Protect your lips from dryness and sun.
• If it hasn't changed after several weeks, we measure it at a check-up and look at options. According to a meta-analysis of 94 patients, low-level laser therapy may help lip sensation recover, with the effect visible after the first month.
• The tongue is rarely affected (between 0.1% and 0.7%), and, according to one meta-analysis, it usually resolves within the first year.

Back to school, work and sports

There's no number I can promise you: going back is gradual and depends on whether one or both jaws were operated on, how far the bone moved, the kind of work you do and how your check-ups go. We plan it before surgery so you can request the time off in advance.

• Classes or office work: once you're eating well, your pain is under control and you no longer need medication that makes you drowsy. Talking a lot is tiring at first, especially with elastics.
• Physical work or heavy lifting: later than desk work; I confirm it at a check-up.
• Driving: not while you're taking medication that makes you drowsy.
• Walking: from the first few days. Gym and intense exercise: once I clear you.
• Contact sports or anything with a risk of a blow to the face: not until I confirm the bone has healed.
• Flying: check with me before you buy the ticket.

Orthodontics after surgery

Surgery puts the bones in place; post-surgical orthodontics finishes settling the teeth on that new base. Your orthodontist resumes treatment once we agree healing allows it, and decides how long it lasts and when the braces come off. Studies indicate that quality of life tends to dip during pre-surgical orthodontics and improve once the full treatment is complete, although that evidence is limited and of low quality. Meanwhile we keep up the check-ups: I review the bite, the plates and that the bone stays where we planned it.

When to message me or go to the ER

• Shortness of breath that comes on suddenly or keeps getting worse, or loud, noisy breathing: go to the ER right away.
• Pain or swelling in one calf, or chest pain: go to the ER right away.
• Bleeding from the mouth or nose that pressure and rest don't control: call the office or go to the ER.
• Swelling that grows again after it had gone down, with fever, pus or a bad taste: message me that same day.
• Pain that gets worse instead of better, or that doesn't ease with what I prescribed.
• Vomiting that keeps you from holding down fluids, or signs of dehydration (very little urine, dizziness when you stand up). If you have elastics and are about to vomit, follow the instructions I gave you for removing them.
• A sudden change in your bite, new weakness on one side of the face, or thick, foul-smelling discharge from the nose.