DISCHARGE INFORMATION: FACIAL FRACTURES
Patient who have sustained facial fractures undergo a variety of procedures to reconstruct the facial bones depending on the nature of the injury and the anatomical location.
The information below is a guide for patient to follow on discharge from hospital:
- HYGIENE/CARE OF WOUNDS
External incisions are closed with either non-resorbable or, occasionally, resorbable sutures and from time to time staples may also be used. The external wounds should be kept as dry as possible for 3-5 days. You will be supplied with an antibiotic ointment (Chloromycetin ointment) to be used as a thin smear (not blobs!) applied twice a day to the incision site for 3-5 days.
Where an intraoral wound is involved it is essential to maintain a very high standard of oral hygiene using a combination of Savacol mouthwash diluted 1 in 10 with warm water and regular toothbrushing. You should commence your mouthwashes and toothbrushing the day AFTER surgery and you should aim to use at least 4-5 mouthwashes per day. Where indicated, a Broxojet may be supplied to assist with oral hygiene.
Often you will have arch bars and ligature wires inside your mouth and these can become a site for accumulated debris. You will be shown how to use a Broxojet to keep your arch bars and wires clean but it is also necessary to use a soft tooth brush to remove food debris and plaque from the arch bars and the area of the intraoral wounds.
Patients undergoing a forehead flap will often have a series of staples across the top of their heads. The wound is to be kept as clean and dry as possible. Some spray from showering is acceptable but the wound should not become soaking wet and should be dabbed dry as soon as possible after showing. This applies to all other surgical incisions. Bathing or swimming involving immersion of the wound is not advisable.
Patients undergoing a forehead flap will frequently have at least two head dressings in the form of a “turban” applied to the head and there may be one or more drains protruding from beneath the dressings. The head dressings and any other facial dressings are removed after 24-48 hours (as are the drains) as they are primarily intended to apply pressure to the wound to avoid the formation of an haematoma (clot). Some patients may find the dressings a little tight and if necessary the outer dressing can be removed after 24 hours. The nursing staff can discuss this with Dr. Bowler.
- SWELLING AND BRUISING
Some swelling and bruising should be expected. Generally swelling takes up to 3 days to reach its maximum and then this will slowly subside over about 10 days. Bruising can be variable and may involve all of the surgical sites. Generally bruising will slowly discolour and dissipate over about 10-14 days.
You will be supplied with ice packs which should be kept on the face continuously for 48 hours, these can be re-frozen and re-used. Where surgery has been carried out around the orbit(s), icy wet gauze pads are used continuously for 48 hours and the nursing staff will show you how to do this.
When you recover from your surgery you may notice parts of your face/scalp are quite numb. You are given local anaesthetic injections at the time of your surgery and this is done deliberately as a pain control measure. The numbness generally takes 6-8 hours to wear off and during this time you should avoid contact with hot liquids etc. On occasions some of the sensory nerves in the jaw bones can be disturbed by the surgical procedures and this may cause some prolonged numbness lasting a few weeks, or in severe cases some months. On very rare occasions there may even be some permanently altered sensation in and around the jaws/face.
From time to time some oozing may occur from surgical sites. This can usually be controlled by the use of pressure packs. These should be placed over the wounds and pressure applied for at least 15 minutes. YOU SHOULD REST QUIETLY WITH YOUR HEAD ELEVATED. The hospital will supply you with spare pressure packs to take home and if the oozing or bleeding does not stop within 30 minutes please contact the hospital in which you were treated.
- NOSE BLOWING.
Patients with facial fractures involving the maxilla (top jaw) or the zygomaticomaxillary complex (cheek bone/eye socket) SHOULD NOT BLOW THEIR NOSES FOR AT LEAST TWO WEEKS following the injury and/or surgery. Forceful nose blowing could introduce air into the surrounding soft tissues (surgical emphysema), increasing the risk of an infection and post-traumatic pain.
It is quite normal for patients with maxillary and zygomaticomaxillary fractures to experience a little bleeding from the nose. This is due to the communication of the maxillary sinuses and nasal passages with the fractures. Patients are able to “sniff” a little and the bleeding can be removed with gentle “dabbing” with clean gauze but patients should not blow their noses for two weeks.
Depending on the nature of your facial fracture the diet will vary. Patients who have undergone any form of intraoral approach to their facial fractures will need to be on a “clear fluid” diet for 48 hours and then can commence a totally blended diet for approximately 6 weeks. IT IS NOT POSSIBLE FOR SUCH PATIENTS TO CHEW FOODS UNTIL THEY REACH AT LEAST 6 WEEKS POST-OP. The hospital dietitian will provide you with advice in this regard and you can consult him or her as an outpatient. Patients who have undergone surgery for “higher level” facial fractures where the dental occlusion is NOT disrupted are able to commence a soft diet after 48 hours and can gradually build this up over 10 days.
It is highly desirable that you DO NOT SMOKE FOR AT LEAST 2-3 WEEKS following the surgery and if bone grafting has been carried out you should not smoke AT ALL until advised by Dr. Bowler. Please be aware that smoking has a systemic effect and a history of smoking can jeopardize the overall success of your surgery.
- SPECIAL ASPECTS
It is unusual to wire the jaws together after the treatment of a facial fracture these days but occasionally patients require immobilisation with intermaxillary elastics. Generally patients with fractures of this nature will return to the ward with arch bars and ligature wires on their teeth. These are to be kept as clean as possible with a combination of toothbrushing, mouth washing and the use of a Broxojet to remove gross debris and plaque.
Patients who are treated with intermaxillary elastics or wires will be provided with a separate sheet of instructions describing the special precautions that need to be taken into consideration if the jaws are immobilised.
Most patients who have sustained a fracture of the maxilla (top jaw) will be asked to AVOID NOSE BLOWING FOR AT LEAST 10-14 DAYS following their injury/surgery. There is a risk that during forcible nose-blowing air can be driven through the nose and sinuses into the soft tissues surrounding the recent fracture causing surgical emphysema (air in the tissues) and there is a risk of an infection. Occasional sneezing should not be a problem.
- POST-OPERATIVE MEDICATIONS AND SUPPLIES ETC.
You will be provided with the following on discharge:
A course of antibiotics.
You will have been given intravenous antibiotics in the operating theatre and sometimes on the ward post-operatively. A prescription for your oral antibiotics will be available for you to take home or alternatively the ward may have the prescription filled for you before discharge. IT IS ESSENTIAL YOU COMPLETE ALL OF THE ANTIBIOTICS as indicated on the label.
Patients with skin incisions will also be provided with a tube of antibiotic ointment (Chloromycetin ointment – small tube) to use as a thin smear (not blobs!) twice daily on all skin incisions and along the lower eyelid if orbital surgery has been performed. The nursing staff on the ward will show you how to do this.
These are also prescribed and the prescription will be available for you to take home or, as with the antibiotics, the ward may have the prescription filled for you before discharge. Generally “middle of the range” analgesics are satisfactory for pain control following the treatment of a facial fracture.
A bottle of Savacol mouthwash will be supplied for you to take home. Please use this diluted 1 capful in a glass of warm to hot water (i.e. 1 in 10) and the mouthwash should be used 5-6 times per day, particularly at night before bed. You should start your mouthwash the day AFTER surgery. You may need to purchase another bottle of mouthwash, depending on the progress of your wounds.
Steroid ointment (Sigmacort – large tube).
A tube of steroid ointment will be provided for you to take home. A THIN SMEAR of ointment should be placed on the lips once or twice a day, particularly in the corners of the lips where these may have been stretched, and this can be continued for approximately a week post-operatively. The steroid ointment will assist with healing of the lips.
You will be supplied with ice packs to keep on your face constantly for 24-48 hours post-operatively to help reduce your swelling. The ice packs can be re-frozen and re-used and should make your face feel more comfortable. Patients who have had orbital surgery may find the continued use of icy wet gauze packs will provide increased comfort for 5-7 days.
Spare mouth packs/gauze are usually supplied by the hospital to assist with the control of oozing and bleeding from surgical sites in the mouth.
- FOLLOW-UP CARE.
It is important that all patients are seen for follow-up and generally an appointment will have been made for you to attend Dr. Bowler’s rooms either the day you are discharged or shortly thereafter. Sutures are frequently a combination of resorbable (dissolvable) and non-resorbable (removable) and Dr. Bowler will advise you when these need to be removed. Suture removal intraorally is usually very simple as the sutures stay wet and therefore become easy to remove. If you do not have an appointment please telephone the practice on 4942 1211 to make a post-operative appointment.
If you have any concerns following your surgery please do not hesitate to contact the hospital in which you were treated. Dr. Bowler can be reached throughthe hospital and is available most times. If for some reason this is not possible, there is a 24 hour service available throughLake Macquarie Private HospitalEmergency Department Tel 02 4947 5700