Jaw surgery, also known as orthognathic surgery, is a set of procedures used to correct significant jaw and facial imbalances that affect bite, function, and aesthetics. These operations involve physically cutting and repositioning the jawbone, whether for trauma repair or corrective alignment of the upper (maxilla) or lower (mandible) jaws. While modern sterile techniques keep the incidence relatively low, infection is a known and potentially serious post-operative complication requiring prompt identification and medical intervention. Understanding the difference between expected healing and a developing infection is crucial for a successful recovery.
Recognizing the Warning Signs
Normal post-operative recovery always includes some degree of swelling, bruising, and discomfort, which typically peaks around 48 to 72 hours following the procedure. A developing infection is often signaled by symptoms that worsen instead of improving after this initial peak period, or symptoms that appear several days later. Persistent or increasing pain that is not managed by the prescribed pain medication is a significant indicator. This pain is often described as a throbbing sensation that can interfere with sleep or become sharper over time.
Another definitive sign of infection is the presence of purulent discharge, commonly known as pus, oozing from the surgical site. This discharge may appear yellow or green and is often accompanied by a foul taste or persistent bad breath that cannot be resolved with oral rinsing. A fever is a systemic response to infection; a temperature above 100.4°F (38°C) that persists or increases should be reported to the surgeon immediately.
Localized signs include increased warmth and redness (erythema) at the incision site that begins to spread into the surrounding tissue. Swelling that continues to increase after the third day, or swelling that becomes particularly firm and tender, can indicate the formation of an abscess. Patients may also experience trismus, which is difficulty opening the mouth or swallowing, resulting from swelling that restricts the movement of the jaw muscles.
Factors Increasing Infection Risk
Certain patient health conditions and procedural details can predispose an individual to developing a post-surgical infection. Patients with systemic conditions like diabetes mellitus are at an elevated risk because high serum glucose levels can compromise the body’s immune response and delay wound healing. Immunosuppression from other medical conditions or medications also reduces the body’s ability to fight off bacterial colonization at the surgical site.
Smoking and the use of tobacco products represent a significant risk factor for post-operative infections following orthognathic surgery. Tobacco constricts blood vessels, leading to reduced blood flow (perfusion) to the healing tissues, which slows recovery and limits the delivery of infection-fighting cells. Longer operations involving extensive bone manipulation or the use of bone grafts have an increased rate of infection. The placement of foreign materials, such as titanium plates, screws, or wires used for rigid fixation of the repositioned bone segments, also introduces a surface upon which bacteria can adhere and form a biofilm.
Prevention and Post-Operative Care
Adherence to the prescribed medication regimen is the most direct way a patient can mitigate the risk of infection. If antibiotics are prescribed, the patient must take the entire course of medication exactly as directed, even if they feel recovered before the prescription is finished. Stopping antibiotics prematurely can allow resistant bacteria to survive and multiply, leading to a recurrent or more severe infection.
Oral hygiene protocols require specific attention to maintain a clean surgical field without causing trauma to the healing incisions. Patients are typically instructed to begin gentle rinsing with a warm salt water solution or a prescribed chlorhexidine mouth rinse starting the day after surgery. These rinses should be performed multiple times a day, especially after meals, to flush out food debris and reduce the bacterial load. Brushing should resume the day after surgery, but must be done gently, avoiding the immediate surgical sites to prevent damage to the sutures or blood clots.
Dietary modifications are also a necessary part of post-operative care, as a soft or liquid diet is required for several weeks to prevent mechanical irritation of the jaw. Patients must avoid strenuous physical activity for at least one week, as exertion can increase blood pressure and potentially disrupt the healing site. Attending all follow-up appointments allows the surgical team to monitor the healing progress, assess the stability of the fixation hardware, and catch early signs of complication before they escalate.
Medical Management and Treatment
Once an infection is suspected, the clinician initiates a diagnostic workup to determine the extent of the bacterial involvement. Imaging, frequently a computed tomography (CT) scan, is used to differentiate a soft tissue abscess from bone involvement, which may indicate a more serious condition like osteomyelitis. The CT scan provides high resolution images that clearly show the extent of the infection and any potential spread to nearby tissue spaces.
Treatment usually begins with adjusting the antibiotic regimen, often transitioning to a different class of antibiotics based on the suspected or cultured pathogen. For severe infections that have developed into an abscess, surgical intervention is required to drain the collected pus, a procedure known as incision and drainage (I&D). During an I&D, the surgeon makes a small opening to release the pressure and wash out the infection, sometimes leaving a small drain in place for 24 to 48 hours.
If the infection involves the fixation hardware (plates and screws) or has resulted in necrotic bone, the management becomes more complex. Infected hardware is a common cause of removal, as the metal can harbor bacterial colonies that prevent the infection from clearing. In cases where the infection is resistant to initial treatment, the surgeon may need to remove the hardware entirely and perform a debridement, which involves surgically removing all infected or non-viable tissue to allow healthy bone to heal.