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Nutrition, in its basic sense, refers to the intake of nourishment; specifically the fluids and fuels we need to survive. Following illness or surgical procedures, our nutrient needs are increased in order to facilitate healing. For oral and maxillofacial surgery patients this need may be particularly challenging for several reasons. The presence of surgical incisions in or around the mouth and postoperative swelling may make it more difficult to chew and swallow normally. Additionally, the type of surgical procedure may further necessitate a diet limited in consistency. These factors, in combination with the increased nutrient needs following surgery, mean it may be difficult to ensure that you are well nourished following your surgery.
The single most important nutrient is water. In general, the average adult should drink six to eight glasses of fluids per day. Our total calorie needs may be estimated as 15 calories per pound of body weight per day. Again, for the average adult, this translates into about 2,000 calories a day. Protein needs may further increase following surgery as well, to promote healing.
Surgery in the mouth, such as removal of teeth, placement of dental implants, biopsies and similar procedures, do not require a significant increase in nutrients. Your oral and maxillofacial surgeon may suggest a liquid or soft diet for a short time to make you more comfortable and to avoid inadvertently injuring your surgical site. Often, following tooth removal, it is suggested that activities that may physically disrupt clotting and healing should be avoided. This may include consumption of carbonated beverages, drinking through a straw, vigorous tooth brushing and mouth rinsing. Questions regarding when you may resume these activities should be directed to your oral and maxillofacial surgeon.
Orthognathic (Jaw) Surgery, TMJ Surgery and Facial Fractures
In the past, patients undergoing jaw and fracture surgery had their jaws immobilized to promote healing. This was accomplished by wiring or using elastic rubber bands to hold the teeth together. Although this technique may still be necessary in some cases, especially jaw fractures, more commonly small screws and fixation appliances are placed to ensure accurate and predictable healing. These fixation appliances are small enough to be barely perceptible to patients and need not be removed following healing. However, their small size also means they are unable to resist the forces of chewing until the surgical sites have had some time to heal.
Immediately following surgery, swelling may make it difficult to consume any solid foods. During this period of time, which may last several days, all nutrition will be consumed in liquid form; a challenge given an adult patient’s daily nutrition needs.
Since fluids remain the most important nutrient, particular care should be directed towards ensuring that you get your 6 to 8 glasses of fluids per day. Meeting the caloric needs may also be challenging during this phase. Many proprietary liquid nutritional supplements are available, which, because of their high caloric density and balance of protein, calories and vitamins, will help you meet your goals. Brands such as Ensure®, Sustacal® and Boost® are available at any pharmacy for over-the-counter purchase. They can be further augmented with shakes or smoothies containing fruit, protein powders or other additives. It may be helpful to keep a diet diary to record your fluid volumes and calories to ensure your nutrient goals are being met.
Following this brief dependence on liquids, it is likely that a semi-solid, “non-chewing” diet will be recommended. This diet should be of a consistency that can be consumed without biting or chewing. Many of your regular dietary choices are likely available to you, such as soft scrambled eggs, soft pancakes, well-cooked pasta, flaky fish, etc. Remember, it is most important to avoid stressing the surgery sites until healing has progressed. This non-chewing diet should be maintained until your oral and maxillofacial surgeon specifically approves a move to a more solid diet. This may be 3 to 6 weeks following surgery, although it may be longer, particularly for patients undergoing TMJ or reconstructive surgery.
For those patients whose teeth are wired or rubber-banded together following surgery (intermaxillary fixation), a liquid diet will be necessary until the teeth are released. The previous recommendations for liquid diets are a good starting point, however, following initial healing, a more varied diet will be desirable. Cooked portions of your favorite foods can be blended separately or in combination to suit your taste. To make blended mixtures of proper consistency, juice, milk, water or broth may be added as a thinner. To prevent oral hygiene problems, the blended mixture may be strained to remove particles and food fiber. Additionally, the previously mentioned nutritional supplements will help you meet your nutrient needs.