If arch bars or MMF screws are used, they may be removed at the conclusion of surgery or may be maintained for several weeks at the discretion of the surgeon.
Postoperative x-rays are taken within the first days after surgery. In an uneventful course, follow-up x-rays are taken at the 4–6 week interval.
It will be necessary to see the patient after approximately 1 week to assess the stability of the occlusion. In an infected mandibular fracture, the aftercare has to include the observation of a number of factors including the special wound situation, the general health condition (nutritional status, diabetes, and particular medication), psychosocial status, economical situation and specific local regimens. The surgeon must also evaluate patient response to the current antibiotic regimens and check for systemic parameters (for example, CRP, white cell blood count, erythrocyte sedimentation rate). Patients will have to be re-examined periodically to rule out recurring signs of infection. At each visit, the surgeon must evaluate patient ability to perform adequate oral hygiene and wound care. It may be necessary to provide additional instruction to assure appropriate hygiene and wound care.
If a malocclusion is detected, the surgeon must ascertain the etiology of it (using the appropriate imaging technique). If the malocclusion is secondary to surgical edema or muscle splinting, training elastics may be beneficial. The lightest elastics possible are used for guidance, because active motion of the mandible is desirable. Patients should be shown how to place and remove the elastics using a hand mirror.
If the malocclusion is secondary to a bony problem due to inadequate reduction or hardware failure or displacement, elastic training will be of no benefit. The patient must return to the operating room for revision surgery.
Follow-up appointments are at the discretion of the surgeon, and will also depend on the stability of the occlusion noted on the first visit. If a malocclusion is noted and treatable by using training elastics, at weekly appointments to determine the progression are recommended.
Postoperatively, patients will have to follow three basic instructions:
Depending upon the stability of the internal fixation, the diet can vary between liquid and semi-liquid to “as tolerated”, at the discretion of the surgeon. Any elastics are removed during eating.
2. Oral hygiene
Patients having only extraoral approaches are not compromised in their routine oral hygiene measures and should continue with their daily schedule.
Patients with intraoral wounds must be instructed in appropriate oral hygiene procedures. The presence of the arch-bars and any elastics makes this a more difficult procedure than normal. A soft toothbrush (dipping in warm water makes it softer) should be used to clean the surfaces of the teeth and arch-bars. Any elastics are removed for oral hygiene procedures. Chlorhexidine oral rinses should be prescribed and used at least three times each day to help sanitize the mouth. For larger debris, a 1:1 mixture of hydrogen peroxide/chlorhexidine can be used. The bubbling action of the hydrogen peroxide helps remove debris. A Waterpik® is a very useful tool to help remove debris from the wires. If a Waterpik is used, care should be taken not to direct the jet stream directly over intraoral incisions as this may lead to wound dehiscence.
Physiotherapy can be prescribed at the first visit and opening and excursive exercises begun as soon as possible. Goals should be set, and, typically, 40 mm of maximum interincisal jaw opening should be attained by 4 weeks postoperatively. If the patient cannot fully open his mouth, additional passive physical therapy may be required such as Therabite or tongue-blade training.