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Patient Information

Frequently Asked Questions

Find answers to common questions here.

If you need to print out some information, we recommend using the PDFs you can find further down the page.

Oral Surgery

Post-surgery instructions

On the day of surgery, you should avoid:

  • Mouth washing/Brushing the area
  • Spitting out
  • Hot drinks
  • Hot Food
  • Alcohol
  • Exercise or effort for the first 24 hours after surgery.
  • Smoking

From the day after surgery

Use hot salt water (teaspoon of table salt in a mug of hot water) or an antiseptic mouth rinse every 4 hours and after meals.

Continue with this until the area has healed.

Brushing

Be gentle when brushing teeth for the first few days in the extraction site, keep rest of teeth as clean as possible.

Bleeding

You may get a small amount of bleeding in the first few days. If the bleeding is persistent you should apply pressure to the area by biting hard on a clean rolled up handkerchief or cloth for 10 minutes. Make sure the handkerchief is placed directly on the bleeding area.

Avoid further mouth rinsing for 12 hours.

Pain

Discomfort can be expected after a tooth extraction or oral surgery and there may be some swelling. Simple pain-relieving tablets may be needed for the first few days. We recommend Paracetamol or any tablets you would normally take for headaches. Please follow the instructions on the packet.

Your local pharmacist can advise you on pain relief if necessary.

If you are worried or think an infection may be developing (increasing pain or swelling/dry socket) please contact the clinic where you were treated.

Contact details are on the Locations page.

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Having a biopsy

An oral biopsy is a procedure used to diagnose conditions that may affect the lining of the mouth. A biopsy is often the only way to diagnose oral lesions and diseases.

A small sample of the affected area is taken, which is then viewed by a Pathologist under a microscope, to provide a diagnosis. This is the best way to ensure the condition is accurately diagnosed and to make sure the correct treatment is offered.

There are different forms of mouth biopsies depending on the site on the mouth and the amount of lining removed.

Excisional

In this case, the aim is to remove the entire lesion. This is often done when a lesion is quite small and only affects one part of the mouth.

Labial Gland Biopsy

This is a very specific biopsy used to diagnose a condition that affects the salivary glands (small lobules in the lining of the mouth that produce saliva), in patients who suffer from dry mouth.

Seven tiny glands are removed from the lower lip, via a small incision and the area is closed with dissolvable stitches.

Incisional

This type of biopsy involves a representative sample of the lesion being taken; i.e. only some of the lesion taken.

This is done when a lesion affects multiple areas of the mouth or for slightly larger lesions, when removing the entire lesion may be inappropriate at this stage.

Please eat as normal before your biopsy and take your regular medication (if you take any).

Please bring an up to date list of your medication with you on the day.

The surgeon carrying out your biopsy will confirm the area of the mouth the biopsy is to be taken from and explain the procedure.

We must seek your consent for any procedure or treatment beforehand. Staff will explain the risks, benefits and alternatives where relevant before they ask for your consent.

If you are unsure about any aspect of the procedure or treatment proposed, please do not hesitate to ask for more information.

The area to be biopsied will be anaesthetised (made numb) using a injection. This is called a local anaesthetic.

It is the same type of anaesthetic when you go to the dentist (for fillings, teeth out etc).

The sample will be taken, and usually 2-3 dissolvable stitches will be placed to close the area. This helps to stop any bleeding and helps the area to heal.

Very occasionally, stitches are not needed and the area will be treated with a Silver Nitrate stick or bipolar electrocauterizing to stop the bleeding and then it will be left to heal.

Once the surgeon is happy that the area has stopped bleeding and you are feeling well, you will be allowed to leave.

The whole procedure usually takes approximately 20 minutes.

You will be given instructions by the surgeon (both verbal and written) on what to expect after the procedure and how to prevent problems.

You may wish to take simple analgesics (painkillers), such as Paracetamol, to control any discomfort. The surgeon can recommend specific painkillers based on your medical history and any medications you may be taking. Always follow the instructions and dosage.

You may find the area the sample has been taken from feels slightly swollen for a few days; this is normal.

It is important to keep the area clean to prevent infection. We recommend using a warm salty mouthwash several times per day (made by dissolving a teaspoon of salt in warm water). Begin using mouthwash the day after your biopsy and continue for 4 days.

The stitches will usually dissolve in 2-3 weeks, but may take longer depending on the type of suture used.

If a stitch comes out immediately after the procedure, it is best to return to have it replaced. However, if a few days have passed, there is no need to return.

Some mild oozing and blood-stained saliva is normal.

However, if you experience bleeding that does not stop with firm pressure after 5-20 minutes, you will need to seek help and advice from a dental/medical professional.

Details of this will be given on a post-operative information sheet after your treatment.

We recommend that you do not participate in any heavy exercise on the same day as your biopsy. You should not drink alcohol on the day of your biopsy. These things can increase the risk of bleeding.

You should avoid smoking for at least 48 hours after the biopsy.

It is likely you will be able to return to work immediately, depending on how strenuous your work is.

A review (follow-up) appointment will be made at the time of your biopsy, here you will be informed of your results.

If any treatment is required, this will be discussed and arranged as necessary.

At this review appointment, we will also confirm the biopsy site is healing properly and that any stitches have dissolved or been removed.

  • Pain
  • Swelling
  • Bleeding
  • Infection
  • Further surgery

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Removing a tooth

You need to have a tooth extracted because it may be broken beyond repair or is causing pain and infection.

It may also be part of another plan e.g.: ortho treatment for braces.

The dentist will check your medical history and any medications you are taking.

The dentist will then numb the tooth before removing it.

Please remember that some teeth sit close to the nerves, other teeth and other structures in the jaw. If this is the case, you will be warned about specific risks in advance of your own treatment.

Any possible difficulties or complications will be discussed with you before your treatment starts.

Frequently occurring problems

  • Bleeding
  • Swelling
  • Pain
  • Failure of local anaesthetic
  • Bruising
  • Infection (dry socket)
  • Breakage of the tooth or root
  • Limited opening or stiffness of the jaw

Other, less common, complications

  • A hole into the sinus that may need surgical repair
  • Displacement of the tooth into the sinus or fracture of the tuberosity (bone next to the top back tooth).
  • Nerve damage leading to altered sensation or numbness of your lip, teeth, tongue or gums. You may feel some numbness over your face or within your mouth due to a bruised nerve. This usually goes away on its own, but it can take a few months.
  • Retained root which, after discussion, may be best left in place.

The tooth will usually be removed using local anaesthetic, which is administered with an injection in the gum.

This will last up to a few hours, so care must be taken to avoid biting your lip whilst it is numb.

After a dental extraction, patients will normally get some pain and discomfort, so you will be advised of appropriate painkillers.

Some swelling and bruising may occur which is usually worse 48 hours after the procedure.

Infection can occur after any extraction, and if this occurs you may need some simple treatment with a dentist to relieve this.

Please note that smoking can affect the healing after an extraction and we would advise you that stopping smoking before and after an extraction can reduce the chances of infection.

If you require more information about stopping smoking please ask a member of staff before your procedure. Or help in giving up, call the NHS Stop Smoking Helpline on 0800 022 4332 or go on their website: www.nhs.uk/smokefree

Some teeth are more complicated than others and your dentist will advise you if you have any concerns about your extraction. This may be due to the unusual shape of the roots or the position in your mouth.

In most cases the procedure is completely successful, but on some occasions the process may be more complicated because the tooth breaks.

Sometimes teeth can break because they are fragile, quite thin, or they have large fillings in them. When this occurs, the gum may need to be cut and lifted so that we can see more clearly.

Sometimes drilling a small amount of bone away, and perhaps even cutting the tooth into small pieces, is necessary. This procedure may take a little bit longer than expected and there may be more swelling afterwards.

Usually you will have some stitches in your mouth that normally dissolve, but can take a few weeks to do so.

Not all teeth which are extracted need to be replaced. If you are already wearing dentures, then an addition to the existing denture may be possible.

Other options may include bridges or implants.

As every case is different, this discussion should take place with your own dentist.

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Removing a third molar (wisdom) tooth

This is variable. Some wisdom teeth may only take few minutes to remove.

More difficult wisdom teeth that need to be cut into pieces can to be removed can take around 30 minutes to extract.

It is likely that there will be some discomfort and swelling both on the inside and outside of your mouth after surgery. This is usually worse for the first 3 days, but it may take up to 2 weeks before all the soreness goes.

You may also find that your jaw is stiff and you may need to eat a soft diet for a week or so. It is likely to be sore after your surgery and your surgeon will advise you about pain relief medication.

It may also be necessary for you to have a course of antibiotics after the extraction.

There may be some bruising of the skin on your face which can take up to a fortnight to fade away.

The wisdom tooth (or 3rd molar) is usually the last tooth to erupt into the mouth, any time after 16 years of age.

Frequently there is not enough room to accommodate wisdom teeth and as such they do not come into the mouth normally. When this happens, the wisdom teeth are said to be ‘impacted’.

Wisdom teeth are usually either impacted forwards into the tooth in front, or backwards into the lower jaw bone.

An impacted wisdom tooth can cause a number of problems that mean the tooth is best removed. Most commonly these are:

  • Repeated attacks of infection in the gums surrounding the tooth. This leads to pain and swelling
  • Food packing which causes decay in either the wisdom tooth or the tooth in front.
  • Cysts can form around the wisdom tooth if it does not come into the mouth properly. A cyst occurs when fluid fills the sack that normally surrounds a developing wisdom tooth.
  • Removal to facilitate other forms of maxillofacial surgery.

Because the wisdom tooth has not fully erupted into the mouth, it is often necessary to make a cut in the gum over the mouth.

Sometimes it is also necessary to remove some bone surrounding the crown of the wisdom tooth. Rarely the tooth needs to be cut into 2 or 3 pieces to remove it.

Once the wisdom tooth has been removed, the gum is put back into place with stitches. In the majority of cases these stiches are dissolvable and take around two weeks to disappear.

A number of options are available and depend on how difficult the wisdom tooth is to remove.

  • Local anaesthetic – this is an injection into the gums surrounding the wisdom tooth, rather similar to that you may have had at your dentist for a filling. The injection takes a couple of minutes to numb the area and means that you feel no pain while the wisdom tooth is removed. This is the best option for wisdom teeth that are simple to remove.

  • Local anaesthetic and intravenous sedation – in addition to a local anaesthetic injection you can be given an injection in your arm. This makes you feel relaxed and less aware of the procedure.

  • General anaesthetic – it is usually possible to remove wisdom teeth under a ‘day case’ general anaesthetic, i.e. although you are put to sleep completely, you will be able to go home on the same day as surgery.

If you are having day surgery with sedation or under a general anaesthetic, you need to ensure that a responsible adult is with you for the first 24 hours after surgery and that they can escort you home as well.

You will need to make our own transport arrangements for your discharge unless arranged by the hospital in advance.

If arrangements are not in place your surgery will be cancelled.

It is important to keep the extraction sites as clean as possible for the first few weeks after surgery.

It may be difficult to clean your teeth around sites of the extraction because it is sore. If this is the case is it best to keep the area free from debris by gentle rinsing with a mouthwash or warm salt water (dissolve a flat teaspoon of kitchen salt in a cup of warm water), starting on the day after surgery.

Usually it will be necessary to take a few days off work and avoid strenuous exercise for this time. Depending on the type of anaesthetic used, you may not be able to drive (24 hours after intravenous sedation or after a general anaesthetic).

Immediately following a general anaesthetic, you may feel tired, dizzy or weak. You must have somebody to collect you and stay with you for the first 24 hours.

During the first 24 hours you must not drive or operate any motorised vehicles or electrical equipment, sign any legal documents, make any important decisions or drink any alcohol.

This is usually a very safe procedure, which is carried out by specially trained staff who are very experienced.

Complications with this type of surgery are, fortunately, rare and may not apply to you, but it is important that you are aware of them.

Bleeding

Although there may be a little bleeding at the time if extraction, this usually stops very quickly and is unlikely to be a problem if the wound is stitched.

Should the area bleed again when you get home this can usually be stopped by applying pressure over the area for at least 10 minutes with a rolled-up handkerchief or swab.

If the bleeding does not stop, please contact us for further help and advice or if out of hours then call 111.


Numbness

There are 2 nerves that lie very close to the roots of the lower wisdom teeth. One of these nerves supplies feeling to your lower lip, chin and lower teeth. The other supplies feeling to your tongue and helps with taste. Sometimes these nerves may be bruised when a wisdom tooth is taken out. This can cause tingling or numbness in your lower lip, chin or tongue, and (more rarely) altered taste.

About one in 10 people will have some tingling or numbness that can last for several weeks. Less than one in 100 people will have problems that last more than a year. These risks may be higher if your teeth are in a difficult position. Your surgeon will tell you if you are considered to be an increased risk. 

Infection

It is important to keep your mouth clean and to reduce or cut down your smoking following the removal of your wisdom teeth to prevent infection.

Antibiotics are not routinely prescribed after surgery, but your surgeon may prescribe antibiotics for particular cases.

Other risks

  • Pain
  • Swelling
  • Bleeding
  • Infection
  • Temporary/permanent risk of numbness
  • Risk of the roots retained or further surgery may be needed.

There may also be associated pain, swelling and stiffness of your jaw.

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Apicectomies

An apicectomy is a surgical procedure to remove the tip of the root of a tooth buried within your jawbone.

When a tooth is badly decayed, has a large filling, or receives a blow in an accident, the soft tissues within it (the pulp) may die. The dead tissue must be removed to prevent infection and this is usually undertaken by your dentist by a procedure called root canal treatment.

Sometimes this root canal treatment is unsuccessful, and infection persists at the tip of the root. This may sometimes cause pain, but more often the infection will spread and cause a small spot or gumboil nest to the tooth.

An apicectomy is an operation designed to remove this infected part of the root tip.

Usually a small filling is also placed in the end of the root to seal it.

Only the very tip of the root is removed: usually 3-4mm.

A cut is made in the gum above the tooth, followed by removal of bone to find the root tip.

The tip of the root is then removed, and a seal is put into place.

Once the apicectomy has been completed, the gum is put back into place with stitches.

In the majority of cases these stiches are dissolvable and take around two weeks to disappear.

A number of options are available and depend on how difficult the wisdom tooth is to remove.

Local anaesthetic

this is an injection into the gums surrounding the wisdom tooth, rather similar to that you may have had at your dentist for a filling. The injection takes a couple of minutes to numb the area and means that you feel no pain while the wisdom tooth is removed. This is the best option for wisdom teeth that are simple to remove.

Local anaesthetic and intravenous sedation

In addition to a local anaesthetic injection you can be given an injection in your arm. This makes you feel relaxed and less aware of the procedure.

General anaesthetic

It is usually possible to remove wisdom teeth under a ‘day case’ general anaesthetic, i.e. although you are put to sleep completely, you will be able to go home on the same day as surgery.

If you are having day surgery with sedation or under a general anaesthetic, you need to ensure that a responsible adult is with you for the first 24 hours after surgery and that they can escort you home as well. You will need to make our own transport arrangements for your discharge unless arranged by the hospital in advance. If arrangements are not in place your surgery will be cancelled.

Teeth often feel slightly loose for 3-4 weeks after an apicectomy until new bone grows around the tooth root.

Then they usually become firm and more comfortable than before the operation, because the infection has been removed.

It is likely that there will be some discomfort and swelling both on the inside and outside of your mouth after surgery. This is usually worse for the first 3 days, but it may take up to 2 weeks before all the soreness goes.

You may also find that your jaw is stiff and you may need to eat a soft diet for a week or so. It is likely to be sore after your surgery and your surgeon will advise you about pain relief medication.

It may also be necessary for you to have a course of antibiotics after the apicectomy. There may be some bruising of the skin on your face which can take up to a fortnight to fade away.

It is important to keep the surgical site as clean as possible for the first few weeks after surgery.

It may be difficult to clean your teeth around sites of the extraction because it is sore. If this is the case is it best to keep the area free from debris by gentle rinsing with a mouthwash or warm salt water (dissolve a flat teaspoon of kitchen salt in a cup of warm water), starting on the day after surgery.

Usually it will be necessary to take a few days off work and avoid strenuous exercise for this time. Depending on the type of anaesthetic used, you may well be able not to drive (24 hours after intravenous sedation or after a general anaesthetic).

Immediately following a general anaesthetic, you may feel tired dizzy or weak. You must have somebody to collect you and stay with you for the first 24 hours.

During the first 24 hours you must not drive or operate any motorised vehicles or electrical equipment, sign any legal documents, make any important decisions, or drink any alcohol.

This is usually a very safe procedure, which is carried out by specially trained staff who are very experienced.

Complications with this type of surgery are, fortunately, rare and may not apply to you, but it is important that you are aware of them.

Bleeding

Although there may be a little bleeding at the time if extraction, this usually stops very quickly and is unlikely to be a problem if the wound is stitched. Should the area bleed again when you get home this can usually be stopped by applying pressure over the area for at least 10 minutes with a rolled-up handkerchief or swab.

If the bleeding does not stop, please contact us for further help and advice, or if out of hours then call 111.

Gum recession

The gum around the crown of your tooth can recede following your surgery.

Infection

It is important to keep your mouth clean and to reduce or cut down your smoking following the removal of your wisdom teeth to prevent infection.

Antibiotics are not routinely prescribed after surgery, but your surgeon may prescribe antibiotics for particular cases.

Failure of the operation

An apicectomy is not always successful but is often the last attempt to save your tooth. Your surgeon will explain your individual chance of success.

A post-apicectomy review is a meeting with your surgeon to determine whether healing is satisfactory, and if stitches need to be removed. Usually, an x-ray will also be taken.

This appointment is usually 7-10 days after your operation, and it is important that you attend this appointment.

The surgeon will usually wish to see you again 4-6 months later for a further x-ray to check that the bone has healed satisfactorily.

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Jaw Joint Problems

The temporomandibular joint (jaw joint) is located in front of the ear, where the skull and lower jaw meet. The joint allows the lower jaw (mandible) to move and function.

The joint itself is made up of two bones that are separated by a disc of cartilage. Ligaments and muscles surround the joint.

Problems with the jaw joint are very common, but typically only last a few months before getting better. In some instances, only the muscles are affected (myofacial pain dysfunction), whereas in others the cartilage and ligaments may also be at fault (internal derangement of the temporomandibular joint).

The most common symptoms are:

  • Joint noise, such as clicking, cracking, crunching, grating or
    popping
  • Pain, usually a dull ache in and around the ear. The pain may
    radiate, i.e. move forward along the cheekbone or downwards
    into the neck
  • Headache
  • Limited mouth opening

Most jaw joint problems are made worse by chewing and are aggravated at times of stress.

Pain is caused by the muscles in and around the jaw joint tightening up.

Joint noises occur if the disc of cartilage moves out of its normal position between the bones of the jaw joint. Most commonly, the cartilage slips forward and a noise is made when it returns to its normal position in between the bones of the jaw joint. The noises sound louder to some patients than others because the joint is just in front of the ear.

The ligaments and muscles surrounding the joint can, in turn, go into spasm, producing pain and limited mouth opening.

The cartilage in the jaw joint is thought to slip forward because of
overuse of the muscles surrounding the jaw. This overuse commonly produces tightening of the muscles and may occur as a result of chewing habits, such as grinding or clenching the teeth when under stress, or at night.

Nail biting or holding things between the teeth can also cause jaw joint problems.

Less commonly, missing back teeth, an uneven bite, or an injury to the jaw, can lead to the problem.

Often no obvious cause is found.

Treatment varies, depending on whether you are suffering from
myofacial pain dysfunction, internal derangement of the temporomandibular joint, or a combination of both.

On the whole, treatment is aimed at trying to reduce the workload of the muscles, to align the disc of cartilage to return to a normal position in the joint.

Some of these treatments are:

  • A soft diet that requires little chewing; this allows overworked
    muscles to rest.
  • Painkillers and anti-inflammatory medications (e.g. Nurofen) are good and can be either taken as tablets or applied as gel on the outside of the joint.
  • Heat, e.g. warm water in a hot water bottle (avoid boiling water) wrapped in a towel and applied to the side of the face.
  • Identifying and stopping any habits, such as chewing or grinding. Remember that these may be subconscious, i.e. you may not be aware of them.
  • Relaxation therapy and learning techniques to control tension and stress.
  • Jaw joint exercises. The exercises that are best for you, will have been discussed by the doctor seeing you. Please remember to carry them out as instructed.
  • Resting the joint as much as possible, e.g. avoiding yawning
    widely.
  • Providing a clear plastic splint that fits over the teeth and is worn mainly at night. This helps support the joint and the surrounding muscles.
  • Physiotherapy
  • Replacing missing teeth to balance the bite. If this is appropriate, it will have been discussed with you.

Surgery is carried out in only a very small number of cases. This can
involve manipulation or washing out of the joint space whilst you are asleep.

In extreme cases, it may be necessary to open the joint and operate on the bones, cartilages and ligaments.

It is important to realise that the jaw joint problems, although a
nuisance, are not sinister, and usually respond to relatively simple
measures over time. Patients themselves can manage most of these
treatments.

Occasionally, jaw joint problems may return after several weeks.

It is very rare for jaw joint problems to progress to arthritis.

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Orthognathic (Jaw) Surgery

Additional Information (orthognathic)

Additional information can be obtained from our YourJawSurgery.com website, which consists of an online resource consisting of a patient journey, patient stories, animations of surgery and other resources which may be of benefit.

Orthognathic (Jaw) Surgery

Orthognathic surgery is an operation to reposition the jaws within the face.

The operation aims to improve the gap between the lower and upper jaws, which will enable the teeth to bite together better. This also has the benefit of balancing your facial appearance.

Most patients are delighted with the results, and although there may be some difficult times during the treatment, once it is over the benefits are often significant.

The operation is carried out inside the mouth, so there are no external scars.

Occasionally, tiny incisions, less than 4 mm in length, are made on the face on the bridge of the nose or under the jaw line, but these are usually virtually invisible a few weeks after surgery.

Double jaw surgery (Bimaxillary osteotomy)

During this surgery the upper and lower jaws are cut precisely, to avoid damaging important structures like the teeth and the nerves which give feeling to the upper and lower lips, gums and roof of the mouth. The upper and lower jaws are then repositioned to correct the bite of the teeth.

Animation showing the proposed plan of a typical double jaw surgery procedure.
Animation showing the proposed plan of a typical double jaw surgery procedure.

The jaw bones are then fixed using plates and/or screws, which allow the bone to knit together and to heal in the correct position. These are very small titanium plates and screws, which normally stay in place indefinitely.

Braces are then used to settle the bite over a period of at least six months.

Surgery aims to produce a well balanced facial appearance and a good functioning bite.

 

Lower jaw surgery (Mandibular osteotomy)

During this surgery the lower jaw is cut precisely, to avoid damaging important structures like the teeth and the nerves which give feeling to the lower lip. The lower jaw can then be repositioned to correct the bite of the teeth, and to improve the position of the chin.

The jaw bone is fixed by plates and/or screws, which allow the bone to knit together and heal in the correct position. These are very small titanium plates and screws, which normally stay in place indefinitely.

Braces are then used to settle the bite over a period of at least six months.

The aim is to produce a well balanced facial appearance and a good, functioning bite.

 

Upper jaw surgery (Maxillary osteotomy)

During this surgery the upper jaw is cut precisely, dividing the top jaw and repositioning it in a new position, correcting the bite of the teeth.

The jaw bone is fixed by plates and/or screws, which allow the bone to knit together and heal in the correct position. These are very small titanium plates and screws, which normally stay in place indefinitely.

Braces are then used to settle the bite over a period of at least six months.

The aim of the operation is to produce a well balanced facial appearance and a good, functioning bite.

 

Chin surgery (Genioplasty)

During this surgery the chin is divided and repositioned in its new position.

The chin bone is fixed by small titanium plates, which allow the bone to knit together and heal in the correct position. These plates normally stay in place indefinitely.

The aim of this surgery is to produce a well balanced facial appearance.

 

Upper jaw widening surgery (SARPE)

During this surgery the roof of your mouth is surgically divided.

After a period of 3 – 5 days’ healing, you will be instructed to turn the screw in your upper brace appliance to gently widen the top jaw in very small amounts. You will carry on turning the screw, twice every day, for a number of days, until the desired widening is achieved.

This will produce a large gap between your upper central incisors, which will gradually start to close as your teeth drift towards each other over the next few months. New bone forms in the gap, and fixed braces are then used to straighten your teeth and further close the gap.

Your treatment is carried out within Sheffield Teaching Hospitals, and is led by a team made up of consultants: a maxillofacial surgeon and an orthodontist

Our consultant orthodontists are qualified orthodontists who have undergone specialist hospital training to enable them to treat your complex problems.

Our consultant maxillofacial surgeons have undergone a full surgical training coupled with dental expertise.

All surgeons are on the General Medical Council Specialist List for Oral and Maxillofacial Surgery.

Sometimes other health professionals may need to be involved in your care. This might include dietitians, speech and language therapists, clinical psychologists and psychiatrists.

We only perform jaw surgery if it is appropriate, if the patient wants it to be done and the patient is keen to undergo treatment.

It is not always possible to change your teeth and bite using only braces (orthodontics). This is because the bones of your face and jaws, in which the teeth sit, may be out of balance with one another.

Orthognathic surgery is able to improve large gaps between the jaws and balance the shape of your face.

If your jaws are to be moved into an improved position, it is important that your teeth are also moved so that they will meet better after the operation.

Fixed “train track” type braces are fitted about 18 months before surgery (but it may take longer). They are worn for up to six months after surgery, until the teeth are finely adjusted and stabilised.

Lastly, there will be a period where a removable retainer brace is worn at night that holds the teeth in their new position.

Yes. It will be important that you still have regular check-ups with your usual dentist throughout your treatment.

Your orthodontist will not be checking your teeth for decay.

In total, the treatment usually takes about two and a half to three years, with the surgery occurring between 18 months and two and a half years after the start of orthodontics.

Please note that missed appointments and any breakage of the braces lengthen the period of orthodontic treatment.

When you are ready for your operation, you will again be seen on a joint orthognathic surgery clinic for your team to discuss with you once more your expectations and proposed surgical movements.

Planning continues with the production of surgical plastic wafers that fit over and between the teeth guiding your surgeon at the time of surgery.

To make these wafers you will need some further moulds of your teeth, facial measurements and, in some cases, a 3D Cone Beam Computed Tomography (CBCT) scan is required.

A CBCT scan is a low-dose x-ray examination, which produces a very precise 3D image of your teeth and bony facial structures.

The main problems after surgery are numbness and swelling and often some bruising, rather than pain.

Everyone is different, but most patients find the swelling is at its worst at 36 – 72 hours after the surgery, and then gradually goes down over the next fortnight.

To help to reduce the swelling you will be given a Hilotherapy mask that fits closely over your face. The mask is connected to a Hilotherapy machine that pumps cold water around the mask, reducing pain, swelling and bruising.

Your final appearance will initially be masked by the swelling and may take several months to emerge as the shape of your face adjusts.

Pain and discomfort is worse during the first 24 hours, and will be controlled with regular pain killers. You may find it uncomfortable breathing through your nose, especially if you have upper jaw surgery and you may have a sore throat following your anaesthetic.

You may also feel uncomfortable and “sorry for yourself” for the first few days, but this normally settles over time. In our experience, older patients seem to find these symptoms worse and take longer to get over their operation than younger patients.

This is usually a very safe procedure, which is carried out regularly in this hospital by specialised and experienced clinical staff.

Complications with this type of surgery are, fortunately, rare and may not apply to you, but it is important that you are aware of them. Your surgeon and orthodontist will discuss your individual risk rates for your treatment.

The most commonly reported complications are:

Numbness

Your lips, chin and gums may all be numb immediately after your operation. The upper lip recovers relatively quickly, while the lower lip is much more variable and may take six to nine months to get normal feeling back.

In 30% of cases, there may be some permanent loss or alteration of sensation, but the lips look and move normally, and surveys suggest that this rarely bothers patients.

Infection

The small titanium plates and/or screws are usually left in place permanently. In less than 10% of cases, the plates may have to be removed if they should become infected. If this is the case, the plates can be removed during a short day case procedure.

Readjustment of the bite

Occasionally, patients may wake up from their relaxed state (caused by the anaesthetic) and the strong jaw muscles then alter the position of the jaw. Although the bite may be only a few millimetres out of place, a second operation to adjust the bite fixation may be necessary.

Surgical Relapse

With most patients, significant relapse is not a problem. However, in those who are having complicated surgery (movement of 10 mm or more in one jaw, patients previously having had a cleft palate, or those with a particularly unusual bite), relapse can occur, where the muscles, skin, tongue and lips of the face pull the face and teeth towards their original position. If relapse does occur, it is exceptionally rare for this to be significant. However, there is also orthodontic relapse and long-term, age changes which the orthodontist will discuss with you.

Blood loss

Blood loss is usually minimal and a blood transfusion is rarely needed; less than 1% of our patients have needed a blood transfusion.

Limitations of mouth opening

There may be limitations of mouth opening, but this resolves as healing progresses. Symptoms of jaw pain and dysfunction can be made worse by jaw surgery.

Changes to the shape of the nose

An operation on the top jaw may alter the shape of your nose.

This type of treatment is not compulsory or life saving for any patient and, whilst there is a very small risk of not waking up after a general anaesthetic, this must be balanced with how much the tooth/jaw position is a concern to the patient and whether an operation can definitely improve jaw position.

Immediately following a general anaesthetic, you may feel tired, dizzy or weak. You must have someone to collect you and stay with you for the first 24 hours.

During the first 24 hours, you must not drive or operate any motorised vehicle or electrical equipment, sign any legal documents, make any important decisions, or drink any alcohol.

You may feel weak or dizzy at times during your first 7 – 10 days. If this happens, sit down until the feeling passes. You may also have the postoperative “blues”, though this should soon pass.

This depends on the individual, but most patients stay in hospital for one or two nights after surgery.

People vary in their speed of recovery, but you should consider taking between two and six weeks off from your usual commitments.

The mouth opens and closes normally, even on the day of surgery, but this opening is limited by the elastic bands, placed between upper and lower teeth, and swelling.

You will be encouraged to eat and drink from the first day, and gradually progress from soft, very mushy or liquid food, to a normal but soft diet over the next few weeks.

Our dietitians will give further advice, and there is a separate dietitian information sheet on managing your diet after jaw surgery, if required.

You will almost certainly look different to some degree; quite how different depends on the extent of your original problem and how much the jaw(s) have had to be moved.

Orthognathic surgery aims to balance the bony framework of the face, so that all the features are in proportion to one another, producing a pleasing facial appearance and teeth that chew better.

The vast majority of patients are delighted with the results, and although there may be some difficult times during the treatment, once it is completed the benefits will often last a lifetime!

On the day of surgery, you should avoid:

  • Mouth washing/Brushing the area
  • Spitting out
  • Hot drinks
  • Hot Food
  • Alcohol
  • Exercise or effort for the first 24 hours after surgery
  • Smoking

From the day after surgery

Use hot salt water (teaspoon of table slat in a mug of hot water) or an antiseptic mouth rinse every 4 hours and after meals. Continue with this until the area has healed.

Brushing

Be gentle when brushing teeth for the first few days in the extraction site, keep rest of teeth as clean as possible.

Bleeding

You may get a small amount of bleeding in the first few days. If the bleeding is persistent you should apply pressure to the area by biting hard on a clean rolled up handkerchief or cloth for 10 minutes. Make sure the handkerchief is placed directly on the bleeding area.

Avoid further mouth rinsing for 12 hours.

Pain

Discomfort can be expected after a tooth extraction or oral surgery and there may be some swelling. Simple pain-relieving tablets may be needed for the first few days. We recommend Paracetamol or any tablets you would normally take for headaches. Please follow the instructions on the packet.

Your local pharmacist can advise you on pain relief if necessary.

Several animated guides to jaw surgery for facial asymmetry can be watched here:

https://www.bos.org.uk/Public-Patients/Your-Jaw-Surgery/Your-Surgery-Explained/Other-types-of-Surgery

Additional information can be obtained from our YourJawSurgery.com website, which consists of an online resource consisting of a patient journey, patient stories, animations of surgery and other resources which may be of benefit.

Post-surgery instructions (Maxillofacial)

On the day of surgery, you should avoid:

  • Mouth washing/Brushing the area
  • Spitting out
  • Hot drinks
  • Hot Food
  • Alcohol
  • Exercise or effort for the first 24 hours after surgery
  • Smoking

From the day after surgery

Use hot salt water (teaspoon of table slat in a mug of hot water) or an antiseptic mouth rinse every 4 hours and after meals. Continue with this until the area has healed.

Brushing

Be gentle when brushing teeth for the first few days in the extraction site, keep rest of teeth as clean as possible.

Bleeding

You may get a small amount of bleeding in the first few days. If the bleeding is persistent you should apply pressure to the area by biting hard on a clean rolled up handkerchief or cloth for 10 minutes. Make sure the handkerchief is placed directly on the bleeding area.

Avoid further mouth rinsing for 12 hours.

Pain

Discomfort can be expected after a tooth extraction or oral surgery and there may be some swelling. Simple pain-relieving tablets may be needed for the first few days. We recommend Paracetamol or any tablets you would normally take for headaches. Please follow the instructions on the packet.

Your local pharmacist can advise you on pain relief if necessary.

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Facial Trauma & Injury

Cheekbone / eye socket fracture surgery

You have broken your cheekbone (Zygoma) and/or eye socket (Orbit). Your cheekbone is part of your eye socket. It protects your eyeball and supports it from below. It is also linked to the side of your nose and your upper jaw.

If your nose bleeds, simply wipe the blood away with a tissue. Do not blow your nose as this can cause swelling and an infection in and around your eye.

  • It relieves pain
  • You heal better and faster
  • It improves the shape of your cheekbone and the position of your eye
  • It may help correct any double vision and improve any restriction when you open your mouth
  • It reduces the risk of infection

Scarring

Any cuts made on your face will leave scars, but these should fade and be difficult to see after a few months.

Bruised nerve

The nerve that runs through your cheekbone supplies feeling to your cheek, side of your nose and upper lip. You might feel some tingling or numbness over your face if this nerve was bruised when you broke your cheekbone or during your operation. The numbness usually goes away on its own, but this can take a few months.

Bleeding from the cuts inside your mouth

This is not usually a problem, but if it happens you should be able to stop it by pressing against the wound with a rolled-up handkerchief or a swab for at least 10 minutes.

Drooping eyelid

If a cut is made in the skin of your lower eyelid, the outer corner of the lid may sometimes be pulled down slightly. This is called lower lid malposition or ectropion. This usually settles on its own but you may need further surgery.

Bleeding in and around your eye socket

This can affect your eyesight straight after surgery. We will monitor you closely for the first few hours to make sure that, if this happens, we pick it up quickly.

If your sight or pain gets worse when you get home, come back to the hospital immediately.

Infection

This is rare because we give you antibiotics. You also have a good blood supply to your face which makes infections less likely.

Straight after a general anaesthetic, you may feel tired, dizzy or weak. You must have someone to collect you and stay with you for the first 24 hours.

During the first 24 hours you must not:

  • Drive or operate any motorised vehicle or electrical equipment
  • Sign any legal documents or make important decisions
  • Drink alcohol

You may feel weak or dizzy at times during the first seven to ten days. If this happens, sit down until the feeling passes.

You may also have the “post-operative blues”, though this should soon pass.

If the fracture has not been dislocated or is only slightly dislocated, you may not need surgery.

You will come into the Maxillofacial Trauma Clinic at the Charles Clifford Dental Hospital for check-ups and we will ask you to contact us if your symptoms get worse.

We will give you an appointment to see a Consultant in the Maxillofacial Trauma Clinic. This appointment is usually five to seven days after you injured yourself.

They will decide if you need an operation to mend the break and agree a date with you for surgery. This will be about two weeks after the injury, to give the swelling in your face time to go down.

All cheekbone breaks also lead to a break in the floor of your eye socket and we sometimes need to treat this as well.

You will have a general anaesthetic for your surgery so you will be completely asleep.

We will ask you to come to the pre-assessment clinic for some screening tests. These include MRSA screening, taking a blood sample and checking your blood pressure, height and weight.

We may also ask you to come to an appointment in the orthoptics department. This is so we can check and note your eye movements and sight before any surgery.

The Admissions Officer will ask you to come to a named ward at a set time, usually at 7.30am on the morning of your operation.

Please arrive on time. If you do not arrive on the ward on time, we may cancel your operation.

We will give you a general anaesthetic. Once you are asleep, we will put your cheekbone back in the right place and fix it using plates and screws.

The surgeon will make a cut (incision) on the inside of your mouth through the gum above your back teeth.

They may also make one or more other cuts:

  • Close to the outside end of your eyebrow or upper eyelid
  • On the skin crease just below your lower eyelashes or on the inside of your lower eyelid, or
  • On the side of your scalp

These cuts are closed with stitches at the end of the operation.

If the floor of your eye socket is broken, the surgeon will make a cut on the inside or outside of your lower eyelid, as described above.

Sometimes, the bones in the floor of your eye socket are shattered and do not support your eyeball properly, even if they are put back in the right place. If this has happened, we may need to rebuild the floor of your eye socket to support your eyeball. This involves using a graft, usually a piece of mesh made of titanium or dissolvable plastic, or a specifically made implant. We will discuss this with you before you sign the consent form.

The nurses may check your eyes and sight frequently after your operation.Before you go home you may have an x-ray to check the
position of your repaired cheekbone.

The area we operated on is likely to be sore so we will give you painkillers to ease the pain. The discomfort is usually worse for the first few days and it may take a couple of weeks to go away completely.

Although cheekbone fractures usually heal without infection, we may need to give you antibiotics, particularly if we have used a mesh or implant.

At first we may need to give you antibiotics through a vein in your arm (intravenously) while you are in hospital. We will also give you painkillers and a course of antibiotics to take at home.

You will have some swelling and bruising around your eyelids.

Sometimes the whites of your eyes will become bruised and look red. You will see these changes most in the first 24 hours after surgery and they will have gone down a lot by the end of the second week.

You can help to reduce the swelling and bruising by using a cold compress, such as an ice pack wrapped in a cloth or a towel, and sleeping propped upright for the first few nights after surgery.

It takes about six weeks for your cheekbone to heal completely. During this time you must be careful not to injure this side of your face because it may push the bones out of place again.

You should also avoid blowing your nose on the side of the fracture for a month after surgery because this can cause swelling in and around your eye.

It is important to keep any stitches or dressings dry until they are removed.

You will stay in hospital for one night after surgery.

You may find it more comfortable to eat a soft diet for the first few days after surgery, as chewing hard foods may feel a bit sore.

It is important that you keep your mouth as clean as possible for the first few weeks after surgery, to prevent infection. It will be sore and you may find it difficult to clean your teeth around the stitches. Try using a soft small-headed toothbrush, such as a child’s.

Starting the day after your surgery, gently rinse your mouth with
mouthwash or warm salt water (dissolve a flat teaspoon of table salt in a cup of warm water) three times a day for five to seven days, to keep it free from food remains. We will give you mouthwash to start using in hospital and to take home with you. Please note that mouthwash does not replace brushing your teeth.

It is important that you do not smoke because it makes you more likely to develop an infection. If you would like advice on how to stop smoking please speak to a nurse.

It depends on what type of job you do. You may need to take about
two weeks off work and avoid hard exercise.

Do not play contact sports for three months after surgery.

You can start gentle exercise after two weeks.

Before you leave hospital we will make a review appointment for you. We will keep a close eye on you for a few months after treatment to make sure that your cheekbone heals properly.

When we put plates and screws in your cheekbone to hold it in position, we do not usually take these out unless they cause problems. They are made of titanium, a type of metal that does not set off metal detectors in airports. You can still have MRI scans.

If you had stitches in your face, you need to go to your GP surgery a
week after surgery to have them taken out.

If you had any stitches inside your mouth, they usually dissolve and do not need taking out. They can take up to two weeks or longer to dissolve.

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Lower jaw (mandible) fracture surgery

You have broken your lower jaw.

A doctor has examined you and advised that you need surgery to help it heal. They have based their decision on the number of breaks (fractures), where they are and whether they need treatment to help them heal.

You will have a general anaesthetic for your surgery so you will be completely asleep.

  • It relieves pain
  • You heal better and faster
  • It supports your jaw shape and keeps your teeth in line, which allows you to bite normally again
  • It reduces the risk of infection

Infection

This is rare because we give you antibiotics. You also have a good blood supply to your face which makes infection less likely.

Bruised nerve

The nerve that runs through the centre of your lower jaw supplies
feeling to your lower lip, chin and bottom teeth. You might feel
some tingling or numbness in your lip and/or chin if this nerve was
bruised when you broke your jaw or during your operation. This
tingling may be caused by or made worse by surgery. The numbness usually disappears on its own, but this can take several months, or may be permanent.

Damaged teeth

Sometimes the teeth next to the break can be damaged by the screws we use to fix it or by the fracture. You may need to have
these teeth removed.

Bleeding

Bleeding from the cuts inside your mouth. You should be able to
stop this if you press against the wound with a rolled up handkerchief or swab for at least 10 minutes.

Straight after a general anaesthetic you may feel tired, dizzy or
weak. You must have someone to collect you and stay with you for the first 24 hours.

During the first 24 hours you must not:

  • Drive or operate any motorised vehicle or electrical equipment
  • Sign any legal documents or make important decisions
  • Drink alcohol

You may feel weak or dizzy at times during the first seven to ten days. If this happens, sit down until the feeling passes. You may also have the “post-operative blues”, though this should soon pass.

Consent

If you have not done so already we will ask you to sign a consent form. As with any treatment or procedure we must seek your consent beforehand. Staff will explain the risks, benefits and alternatives where relevant before they ask for your consent.

If you are unsure about any aspect of the procedure or treatment proposed, please do not hesitate to ask for more information.

You may not need surgery if the fracture is not displaced or is only slightly displaced, you are comfortable and you can bite together normally.

Sometimes special screws or wires are placed around your teeth and elastics used to keep your teeth aligned. This is called intermaxillary fixation. This is removed after 6 weeks once the fracture has healed.

You will need to eat only soft foods for six weeks and we will ask you to come to the Maxillofacial Surgery Trauma Clinic at the Charles Clifford Dental Hospital for regular check-ups.

We will give you a general anaesthetic. Once you are completely asleep,
we make a cut on the inside of your mouth through your gum, to open
up the fracture.

We put your broken bones back together using small metal plates and
screws to hold them in place. This restores your bite.

We use dissolvable stitches to stitch your gum back into place. These
take up to two weeks or more to disappear.

Sometimes we also make a small cut on the outside of your mouth
through your skin, by the angle of your jaw. If we plan to do this we will advise you before you sign the consent form. We use one or two stitches to close this cut. These need to be removed by a nurse five days after surgery.

During the operation, we sometimes place temporary wires or metal braces around you teeth or put screws between your teeth to fix elastic bands to. The elastic bands help us to guide your bite into the correct position.

We usually attach the elastic bands properly a few hours after your operation. This means that when you wake up from surgery you will be able to move your jaw freely.

If you have any wires, metal braces or screws put in to hold the elastic bands, we will take them out at an outpatient clinic appointment when your doctors are happy that the fracture has healed. This usually happens about four to six weeks after your operation.

If we put plates and screws in your jaw to hold it in position, we do not normally take them out unless they cause problems. They are made of titanium, a type of material that does not set off metal detectors in airports. You can still have MRI scans.

Sometimes we take out damaged or decayed teeth near your break.

Your jaw is likely to be sore, so we will give you painkillers regularly to ease the pain. The discomfort is usually worse for the first few days and may take a couple of weeks to go away completely.

We will give you antibiotics through a vein in your arm (intravenously) to reduce the risk of infection of the fractures.

Before you go home you will have an x-ray to check the position of your fractures. We will also give you painkillers and might give you a course of antibiotics to take home.

This depends on what time you have your surgery and how well you recover.

You can sometimes go home on the same day or more commonly you may need to stay one night in hospital.

Your lower jaw will take about six weeks to heal completely. During this time you will need to eat a soft diet, such as mashed potato, soup, smoothies, well-cooked pasta, scrambled egg, jelly and ice cream.

Chewing harder foods may make the plates bend or break.

If you eat the right foods, you can prevent complications and you are more likely to heal quickly.

It is important that you keep your mouth as clean as possible for the first few weeks after surgery to prevent infection. It will be sore and you may find it difficult to clean your teeth around the stitches. Try using a soft, small-headed toothbrush, such as a child’s brush.

Starting the day after your surgery, gently rinse your mouth with mouthwash or warm salt water (dissolve a flat teaspoon of table salt in a cup of warm water) three times a day for five to seven days, to keep it free from food remains. We will give you mouthwash to start using in hospital and to take home with you. Please note that mouthwash does not replace brushing your teeth.

Smoking can affect healing after surgery and makes you more likely to develop an infection. We would advise you to stop smoking before and after your surgery.

If you would like more information about stopping smoking please visit www.nhs.uk/smokefree, call the Smokefree National Helpline on 0300 123 1044 or speak to a member of staff for more information.

It depends on what type of job you do. You may need to take about two
weeks off work and avoid hard exercise.

Do not play contact sports for three months after surgery. You can start gentle exercise after two weeks.

Before you leave hospital, we will make a review appointment for you. We will keep a close eye on you for six weeks after treatment, to make sure that your jaw heals properly.

If you have any wires, metal braces or screws put in to hold elastic bands, we will take them out at an outpatient clinic appointment when your doctors are happy that your fracture has healed. This usually happens about four to six weeks after your operation.

If you had a cut made on the outside of your jaw during surgery, you will need to make an appointment with your GP to have the stitches taken out five days after surgery.

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Facial Implants

Facial Implants

Facial implants are custom made implants used to reconstruct the face and usually made from Medpor, PEEK (Polyethetherketone) or titanium. All materials have been commonly and successfully used in surgery for many years.

Custom made implants are made following a CT scan of the bony structures of your face and are bespoke and personal to you.

Your treatment is carried out within Sheffield Teaching Hospitals and is led by a team of Consultants which might include a Maxillofacial Surgeon and an Ophthalmic Surgeon.

Our Consultant Oral & Maxillofacial Surgeons have undergone a full surgical training coupled with dental expertise. All surgeons are under the General Medical Council Specialist for Oral & Maxillofacial Surgery.

Sometimes other health professionals may need to be involved in your care. This might include dietitians, clinical psychologists and psychiatrists.

We only perform this type of surgery if the implant is appropriate for you and you would like to undergo treatment.

Facial implants have been used for people who have an under-development of the mid part of the face with an overall flatter appearance. They can also be used for facial rejuvenation.

As we get older the tissues of the midface tend to lose the youthful experience that we once had and a small cheek zygoma implant can restore the fullness of the cheek bone that we had when we were younger.

If you have sustained previous trauma to your cheekbone (zygoma), then a facial implant can be helpful in reconstructing the face reducing flatness and improving your overall symmetry.

If you have a congenital asymmetry of the face, implants of the cheek (zygoma) and mandible can also be used to help restore and improve the symmetry.

When you are ready for your operation, you will be seen on a planning clinic with your team to discuss with you your expectations and proposed desires.

Planning continues with the production of your facial implant which we fit onto the bones of your face.

To make these facial implants, we require a CBCT scan. A CBCT scan is a low dose x-ray examination which produces a very precise 3D image of the bones of your face.

The operation is usually carried out inside the mouth so that there are no external scars.

The placement of the facial implants are generally placed under general anaesthetic, sometimes they can be performed under local anaesthesia with or without sedation.

Lower Jaw Implants (mandibular patient specific implants)

During this surgery a small incision is made in the mouth adjacent to the lower back teeth and the implants are placed directly onto the jaw, and secured with two to three small titanium screws to prevent any movement of the implants following placement. The wounds are then closed with dissolving stitches.

Chin Implant

Chin implants are placed by an incision made from inside the mouth or from an incision made directly under the chin.

The chin implant is usually placed adjacent to the chin point before being fixed in position with very small titanium screws and then the wound is closed using sutures in the mouth and/or under the chin.

A 3D skull showing implants reconstructing the lower jaw.
A 3D skull showing implants reconstructing the lower jaw.

Cheek Bone Implants (zygoma patient specific implants)

A small incision is made in the mouth above the upper teeth and these implants are placed directly onto the cheek bone and screwed into the bone with small titanium screws to prevent any movement of the implants following placement. The wound in the mouth is closed with dissolving stitches.

A 3D skull showing implant reconstruction of the right cheek (zygoma).
A 3D skull showing implant reconstruction of the right cheek (zygoma).

This is usually a very safe procedure which is carried out regularly in this hospital by specialised and experienced clinical staff. Complications with this type of surgery are fortunately rare and may not apply to you, but it is important that you are aware of them.

The most commonly reported ones are numbness and altered sensation of the upper teeth, upper lip and cheek. If a mandibular (lower jaw and chin) implant is placed there is the risk of numbness to the lower lip and chin. If a mandibular or chin implant is placed, we would hope that any altered sensation would be temporary, but there is a risk that it could be permanent.

Initially following the surgery, you will expect to have some soreness, swelling and tightness, but this will settle with time.

Other complications include bleeding, infection, facial asymmetry and numbness which is usually temporary and can take a few weeks to settle.

Implant infection may mean that the implant needs removal and if this occurs, then we would need to wait until the tissues have totally healed before another implant could be considered.

It may also be possible to feel the edges of the implant under the skin if you have thin skin.

With all facial implants, there is also the risk of dissatisfaction with the appearance after the surgery.

Your surgeon will discuss your individual risks.

This type of treatment is not compulsory or life-saving for any patient, and whilst there is a very small risk of not waking up after a general anaesthetic, this must be balanced with how much your face is a concern to you and whether an operation can improve your overall facial balance.

Straight after a general anaesthetic, you may feel tired, dizzy or weak. You must have someone to collect you and stay with you for the first 24 hours.

During the first 24 hours, you must not drive or operate any motorised vehicle and electrical equipment, sign any legal documents or make any important decisions, or drink any alcohol.

You may feel weak or dizzy at times during your first 7 – 10 days. If this happens, sit down until the feeling passes.

You may also have the postoperative “blues”, though this should soon pass.

This depends on the individual, but most patients stay in. Some implants can be placed as a day stay procedure, but most patients stay in hospital for one night after surgery.

People vary in their speed of recovery, but you should expect 7-10 days off work following the surgery and you should avoid any strenuous sports for four to six months.

Gentle exercise can be resumed at three to four weeks after surgery and we would aim to see you back on our clinic for a follow up appointment one week, three months and then six months after your surgery.

There will be some gentle settling of the soft tissues before the final results of the surgery become apparent.

For the first few days you will be asked to keep to a soft diet to aid healing after surgery.

Chewing can also be more painful and sore if chewing hard foods.

It is important that you keep your mouth as clean as possible for the first few weeks after surgery to prevent infection. It will be sore and you may find it difficult to clean your teeth around the stitches. Try using a soft small headed toothbrush, such as a child’s toothbrush.

Starting the day after your surgery, gently rinse your mouth out with a mouthwash of warm salty water (dissolve a flat teaspoon of table salt in a cup of warm water) three times a day for 5-7 days to keep it free from any food remains.

We will give you a mouthwash to start using in hospital and to take home with you. Please note that mouth washing does not replace brushing your teeth.

You will also be given a short course of oral antibiotics to be taken following the surgery and the course should be completed.

It is important that you do not smoke as this will make it more likely that you develop an infection. If you would like advice on how to stop smoking, please speak to a nurse or your GP. If you require more information about stopping smoking, please ask a member of staff before your procedure. To help with giving up smoking, call the NHS Stop Smoking Helpline on 0800 0224332 or go to www.smokefree.nhs.uk.

You will be swollen where you have had your surgery.

Pain and discomfort should be controlled with regular analgesia.

Some temporary numbness of your face is common.

Please contact your team urgently if the implant is visible in the mouth or any signs of infection (high temperature, redness and discharge)

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Salivary Gland Surgery

Sublingual gland surgery

The sublingual gland is a salivary gland about the size of an almond that lies underneath the tongue in the floor of your mouth.

Saliva drains from it through a number of small tubes that open on the inside of the mouth underneath the tongue.

The most common reason for removing a sublingual gland is as a result of a blockage to these drainage tubes. This can lead to a swelling (ranula).

The sublingual gland is removed under a general anaesthetic, i.e.: you are put to sleep completely.

The operation involves making a cut around 2cm long (1½”) underneath the tongue on the inside of the lower teeth.

Once the gland has been removed the incision is held together again with stitches. These are usually dissolvable but may take several weeks to disappear.

The length of time partly depends upon the degree of difficulty.

In an uncomplicated procedure it will take approximately 30 minutes to remove the sublingual gland.

You usually require a night in hospital following the surgery. It is unlikely to be very sore but regular painkillers will be arranged for you.

There is relatively little swelling following sublingual gland removal.

It is usually advisable to take a week off work to recover from the surgery. During this time, you should avoid strenuous activity.

It is important to remember that you will not be able to drive or operate machinery for 48 hours after your general anaesthetic.

Bleeding from the wound is unlikely to be a problem. If it occurs, it usually does so within the first 12 hours of surgery which is why you need to stay in hospital overnight.

Infection is uncommon but if your surgeon thinks it may happen to you a short course of antibiotics will be arranged.

There are potential complications with any operation. With this type of surgery complications are rare and may not happen to you. However, it is important that you are aware of them and have the opportunity to discuss them with your surgeon.

Numbness of the tongue

The lingual nerve which supplies feeling to the side of the tongue can become bruised as a result of surgery. If this occurs you will experience a tingly or numb feeling in the tongue, similar to the sensation after having an injection at the dentist.

This numbness may take several months to disappear and in a minority of patients may last for ever.

Damage to the submandibular duct

The submandibular duct is the name of the tube which carries saliva from the submandibular gland into the mouth. The submandibular gland is a salivary gland about the size of a plum that lies immediately below the lower jaw at the top of the neck. The duct runs close to the sublingual gland before opening on the inside of the mouth under the tongue immediately behind the lower front teeth.

If this duct is damaged saliva may not drain properly from the submandibular gland and the gland may therefore swell in the upper part of the neck. The majority of these swellings settle down on their own.

The removal of one sublingual gland will not have an impact on the amount of saliva that you produce.

There are many other saliva glands left in and around your mouth that will still keep it moist.

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Submandibular gland surgery

The submandibular gland is a salivary gland about the size of a plum that lies immediately below the lower jaw. Saliva drains from it through a tube that opens on the inside of the mouth under the tongue immediately behind the lower front teeth.

The most common reason for removing a submandibular gland is as a result of infection that occurs if the tubes that drain saliva become blocked. Blockages usually arise as a result of stones.

The submandibular gland is removed under a general anaesthetic, i.e. you are put to sleep completely.

The operation involves a cut around two inches long (5cm) in the upper part of the neck just below the jaw line.

Once the gland has been removed the incision is held together again with stitches. These usually need to be removed around a week after surgery.

At the end of the operation a small tube is also placed through the skin into the underlying wound to drain any blood which may collect. This is usually removed on the morning following surgery.

The length of time partly depends upon the degree of difficulty.

In an uncomplicated procedure it will take approximately 45 minutes to remove the submandibular gland.

You usually require a night in hospital following the surgery. It is unlikely to be very sore but regular painkillers will be arranged for you.

There is relatively little swelling following submandibular gland removal.

It is usually advisable to take a week off from work to recover from the surgery. During this time, you should avoid strenuous activity.

All cuts made through the skin leave a scar, but the majority of these fade with time and are difficult to see when they are fully healed.

It may take several months for your scar to fade but eventually it should blend into the natural folds and contours of your face.

Bleeding from the wound is unlikely to be a problem. If it occurs, it usually does so within the first 12 hours of surgery which is why you need to stay in hospital overnight.

Infection is uncommon but if your surgeon thinks it may happen to you a short course of antibiotics will be arranged.

There are three nerves that lie close to the submandibular gland that can be damaged during its removal. Most nerve damage occurs as a result of bruising of the nerves since they are held out of the way and protected during surgery. If nerve damage occurs, it is usually temporary but can be permanent.

There are three nerves that can be damaged all with varying results:

Weakness of the lower lip

A lower branch of the facial nerve is the nerve most likely to be bruised in the removal of a submandibular gland. If bruising occurs it affects the movement of your lower lip, leading to a slightly crooked smile.

Numbness of the tongue

The lingual nerve is rarely bruised. Since it is the nerve that supplies feeling to the side of the tongue, bruising results in a tingly or numb feeling in the tongue similar to the sensation after having an injection at the dentist.

Restricted tongue movement

The hypoglossal nerve is only very rarely bruised. It is a nerve that makes the tongue move, and damage can therefore result in decrease of tongue movement.

The removal of one submandibular gland will not have an impact on the amount of saliva that you produce.

There are many other salivary glands left in and around the mouth that will still keep it moist.

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Nicholas Lee: Oral & Maxillofacial Surgeon, Sheffield UK