MMF is maintained during the distraction phase to allow for the correction of the canted occlusion.
To reduce swelling, the application of ice-packs or cooling devices during the early post-operative phase is advice. Intravenous steroids should also be continued for a short period postoperatively for the same purpose.
The sterile dressing placed over the skin incisions is maintained for a minimum of 48 hours. Thereafter routine wound care should be instituted around the activation rod.
Antibiotic prophylaxis is continued for 1-5 days depending on the nature, complexity, and duration of the surgical procedure.
Airway control is of major importance. An individual decision has to be taken if the patient can be extubated or should remain intubated until it is clear that safe airway can be established.
Early post-operative x-rays are obtained to verify correct segment and distractor position. Additional postoperative imaging is performed as needed.
Remove sutures from skin after approximately 5 days if nonresorbable sutures have been used. Avoid sun exposure and tanning to skin incisions for several months.
Regular follow up examinations to monitor healing are required.
At each appointment, the surgeon must evaluate the patient's ability to perform adequate oral hygiene and wound care and should provide additional instructions if necessary.
Postoperatively, patients will have to follow three basic instructions:
A liquid diet should be used during the distraction phase while the patient is in MMF.
2. Oral hygiene
Patients with intraoral wounds must be instructed in appropriate oral hygiene procedures. The presence of orthodontic appliances, the splint, and elastics makes this a more difficult task. A small soft toothbrush with toothpaste should be used. Any elastics are usually removed for oral hygiene procedures. Additionally, antiseptic rinses can be used in the early postoperative period. An oral irrigator (eg, Waterpik) is a very useful tool. If a Waterpik is used, care should be taken not to direct the jet stream directly over intraoral incisions to prevent wound dehiscence in the early postoperative phase.
3. Functional training/physiotherapy
After the release of MMF, the patient is instructed in how to perform functional training (opening and excursive exercises) as soon as possible. The progress should be monitored by the surgeon. If available and needed, a physiotherapist can support the functional rehabilitation. An undisturbed mouth opening of minimum 35 mm interincisal jaw opening should be attained by 4 weeks after removal of MMF.
In case of undisturbed healing, the postoperative orthodontic treatment can usually start 2 to 6 weeks after consolidation depending on the case.