Corrective jaw surgery, known as orthognathic surgery, is a procedure performed to correct irregularities of the jaw bones and realign the jaws and teeth to improve overall function and facial harmony. The recovery process often includes a period of limited jaw movement to allow the newly positioned bones to heal securely. A common concern for patients is the need for jaw immobilization, often referred to as being “wired shut.” This phase of recovery is a temporary and necessary step to ensure the long-term success of the surgical correction.
Defining Jaw Immobilization Techniques
The phrase “wired shut” is largely outdated, as modern surgical techniques prioritize stabilization while often allowing for controlled movement. Surgeons primarily secure the jawbones using internal fixation, which involves small titanium plates and screws placed directly onto the bone segments during the operation. This internal hardware provides the primary, long-term stabilization as the bone segments fuse together.
Temporary measures are also used to guide the bite into its final position and manage muscle memory. These typically involve small elastic bands, or elastics, placed on hooks attached to orthodontic braces or arch wires. The elastics limit the jaw’s range of motion and help coordinate the upper and lower jaws, but they do not completely lock the jaw in the way traditional wiring did. In some cases, a custom-made surgical splint may be secured to the upper jaw for several weeks to maintain the new alignment.
Standard Timelines for Stabilization
The period of maximum restriction, where elastics or wires are used to stabilize the jaw, typically lasts between four and eight weeks. A common timeframe for initial bone healing is around six weeks, but this varies significantly based on the surgical plan and the patient’s healing rate. The goal of this phase is to prevent movement at the surgical site, which is necessary for the cut bone segments to knit together firmly.
The extent of the surgery determines the required duration of stabilization. Procedures involving both the upper and lower jaws, known as double jaw surgery, may require a slightly longer period of restriction compared to a single-jaw procedure. Even after the restrictive elastics are removed, the jaw is not fully healed, and patients must adhere to a restricted, soft-food diet for several more weeks to protect the new bone formation. Full bone healing continues for several months, with the internal plates and screws maintaining the position until the process is complete.
Managing Nutrition and Hygiene During Recovery
During the stabilization period, the inability to chew necessitates a diet consisting entirely of liquids or pureed foods. Maintaining a high-calorie, high-protein intake is important to support the body’s accelerated healing process and prevent significant weight loss. Patients should consume six or more small, nutrient-dense meals daily, using a blender or food processor to achieve a smooth, thin consistency that can be consumed through a cup or syringe.
Oral hygiene is extremely important for preventing infection at the surgical sites, despite the limited access. Patients must diligently brush all accessible tooth surfaces with a soft, child-sized toothbrush after every meal. Rinsing the mouth frequently with warm salt water is recommended to keep the incision lines clean and reduce swelling. An antibacterial mouth rinse, such as one containing chlorhexidine, may also be prescribed to further reduce the bacterial load in the mouth during this period of limited access.
Relearning Movement After Immobilization
Once the initial stabilization period concludes and the restrictive elastics are removed, the focus shifts to restoring normal jaw function. The muscles and joints will be stiff and sore due to the limited movement, so the transition to a normal diet and full range of motion must be gradual. The initial phase involves simple, non-forceful opening and closing exercises, often starting around 10 to 14 days post-surgery.
Around four to six weeks post-surgery, patients begin specific physical therapy known as mandibular mobilization. These exercises are designed to stretch the jaw muscles and increase opening capacity, sometimes involving gentle finger pressure to assist the stretch. Applying moist heat to the face before these exercises helps relax the muscles and makes stretching more comfortable and effective. Patients are typically able to place two fingers between their front teeth comfortably by four to eight weeks, aiming for three fingers as flexibility and strength return.