If MMF screws are used intraoperatively in conjunction with the patient’s
prostheses, they are usually removed at the conclusion of surgery if proper
anatomic fracture reduction and fixation have been achieved.
Postoperative x-rays are taken within the first days after surgery. In an
uneventful course, follow-up x-rays are taken after 4–6 weeks.
The patient is examined approximately 1 week postoperatively and
periodically thereafter to assess the stability of the fracture and to check
for infection of the surgical wound. During each visit, the surgeon must
evaluate the patients ability to perform adequate oral hygiene and wound care,
and provide additional instructions if necessary.
Follow-up appointments are at the discretion of the surgeon, and depend on
the stability of the mandible on the first visit. Weekly appointments are
recommended for the first 4 postoperative weeks.
Postoperatively, patients will have to follow three basic
instructions:
1. Diet
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.
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. A soft toothbrush (dipping in warm water makes it softer) should be
used to clean the oral cavity. 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.
3. Physiotherapy
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.
Long-term dental rehabilitation
An existing dental prosthesis (denture) must often be remade. Dental
implants may be placed in the anterior mandible after symphyseal screws have
been removed. Implant reconstruction is undertaken when bony union of the
mandible has been achieved.