Nutrition after oral surgery. Recommendations after surgical manipulations in the oral cavity. How to rinse your gums after an incision

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Before surgery, it is necessary to carry out professional oral hygiene.

If the operation is performed with an anesthesiologist, you must come with an accompanying person, or the operation will be cancelled.

After surgery, you may experience pain, which will go away as the tissue heals. Postoperative swelling or hematoma can also occur in areas adjacent to the surgical site, which is a natural consequence of surgery. There may be a slight increase in body temperature.

Before surgery

Prepare an ice pack at home.
On the day of surgery, eat a light meal 2-3 hours before your scheduled time.
The day before surgery, the consumption of alcoholic beverages is strictly prohibited.
Be sure to inform your dentist about all the individual characteristics of your body and any allergic reactions, in order to accurately select an anesthetic that is safe for you.
Visit the toilet before surgery.
It is better to come to the operation in loose clothes without a collar.

After operation

To avoid severe swelling and bleeding during the first 24 hours after surgery, it is necessary to apply an ice pack to the cheek on the side of the operation for 15-20 minutes with breaks of 30-40 minutes.

Rinsing your mouth when bleeding is unacceptable!

After sinus lift surgery, you should not drink through a straw, blow your nose vigorously, or puff out your cheeks.

To reduce the likelihood of nosebleeds (after maxillary surgery) and reduce post-operative swelling, you should sleep with your head elevated (add an extra pillow) for several days after surgery.

It is prohibited to drive a car on the day of surgery with premedication.

Oral hygiene

On the second day after surgery, it is recommended to carry out oral hygiene with a soft toothbrush, as well as rinsing with special solutions for the oral cavity (Tantum Verde, Eludril, etc.) after each meal.

Avoid heavy lifting, bending, playing sports, or taking hot baths for 5 to 7 days after surgery.

Within a few days, performance and the ability to drive may be reduced.

Remember to take medications prescribed by your dental surgeon after surgery.

We kindly ask you!

Appear for examination and removal of stitches 5-7 days after surgery, in agreement with your surgeon. You must immediately notify your surgeon or clinic administrator of any changes in your health.

The service life of the implant depends on:

The correctness of the surgical and prosthetic stages carried out in the dental clinic.
The patient's compliance with the recommendations given by the dentist immediately in the postoperative period and the period after implant prosthetics.
Careful hygienic care of the “implant-crown” structure.
Blood supply bone tissue and gums in the area of implantation. (Smoking cigars and cigarettes has a very, very negative effect on peripheral blood circulation, which can even interfere with implant implantation.!!!)

Oral hygiene

Regardless of the size or number of implants, they must be cared for as if they were regular teeth. Brush and floss your dental implants twice a day. Use special fluffy dental floss (for example, Oral-B superfloss or ultrafloss).

When brushing your teeth, pay attention Special attention on the back teeth and interdental spaces. Use a soft or medium-hard brush. In addition, use an irrigator for additional deep cleaning of the interdental spaces with water irrigation.

There are special brushes that can be used to clean interdental spaces - dental brushes. Ask your dentist about them - in some cases they are not recommended.

Visit your dental hygienist twice a year; they are the only ones who can clean your implants as thoroughly as necessary. Regular visits to the dentist are very important. Your dentist will check the condition of your gums, jaws and implants.

Smoking is bad for health and for dental implants, including. To have a good prognosis for the lifespan of your implants, it would be a good idea if you stopped smoking.

Eating

Avoid chewing hard candy, ice, or other hard foods (such as hard chocolate or dry fish) as they may loosen or break the abutment screw.

Avoid foods such as caramel or toffee, as they may stick to the crown and cause the abutment screw to loosen.

Do not open bottles or crack nuts with your teeth for the same reasons.

Wear protective sports mouth guards when participating in sports and avoid direct blows to the face.

Refrain from grinding your teeth. If creaking occurs unintentionally or during sleep (bruxism), notify your dentist and he will make you a thin night guard.

The length of their service depends on the quality and regularity of care for implants.

Before and after implantation

Before surgery:

Prepare several days off after the date of the planned operation.

If you are sick on the eve of the operation, please notify the implantologist.

Ask your implantologist about the medications you will need immediately after surgery.

Patients suffering from compensated diabetes mellitus must follow a strict diet 2 weeks before surgery and 2 weeks after it.

Get a good night's sleep the night before surgery.

Make sure you are accompanied if you plan to undergo anesthesia, sedation or a complex operation, do not plan to be behind the wheel.

If you have herpetic rashes on the mucous membrane, the operation should be rescheduled.

After operation:

If you have had dental implants, you may experience some of the typical discomforts associated with any type of dental surgery. These may include:

Swelling of the gums and face.
Gum injury.
Mobility of adjacent teeth.
Pain at the implantation site.
Minor bleeding.
Bruises and bruises.

You may need painkillers and antibiotics. Follow the recommendations of the implantologist.

What must be observed after implantation:

Brush your teeth with a soft brush before removing sutures
Eat soft foods for 5-7 days. Do not eat hot, spicy or salty foods.
Starting from the third day after surgery until the sutures are removed, you should rinse your mouth with a chlorhexidine solution twice a day (after brushing your teeth).
Do not overheat in the sun or in a sauna.
Do not engage in active sports.
Stop smoking or reduce the number of cigarettes you smoke.
Do not fly on an airplane, do not swim, do not dive for 2 weeks (especially important after sinus lift surgery).
Do not blow your nose or sneeze with your mouth open (especially important after sinus lift surgery).
If swelling, discomfort or other symptoms increase within a few days after surgery, or the temperature rises, contact your implant surgeon.
After tooth extraction
If you have had a tooth removed, you must take care of your oral cavity. By following certain recommendations, you will feel better and healing time will speed up.

Stopping bleeding:

To control bleeding, it is necessary to bite down on a gauze pad placed by the dentist in the oral cavity. The pressure promotes the formation of a blood clot in the socket. If you have heavy bleeding that has not stopped within an hour of tooth extraction, you should bite into a regular tea bag. Tannin in tea helps in the formation of blood clots. Hold the tampon or tea bag until the bleeding stops.

Additionally, cool the extraction area, apply a cold compress to the face in the area of tooth extraction for 10-15 minutes. at one o'clock. A slight bleeding on the first day after removal is normal.

Fever, fever:

Sometimes a feverish state may occur, the temperature rising to 38-39 degrees on the day of removal. This condition can be explained by microbemia and/or toxemia - the entry of microbes and their toxins into the blood and their binding to the formed elements of the blood. In this case, carry out symptomatic therapy and take antipyretic medications. If your temperature persists the next day after removal, contact your doctor.

Pain relief:

To reduce pain, you must take analgesics and other medications prescribed by your doctor. Do not drive while taking any painkillers or other medications as you may feel drowsy. Ask your dentist what pain medications he or she recommends if needed.

Reducing swelling:

To reduce swelling, you need to put ice on your cheek in the area of the extracted tooth. You can make a cold compress by placing ice in a plastic bag and wrapping it in a thin towel. Apply ice to your cheek for 10-15 minutes per hour during the first day after tooth extraction. If you see a few bruises on your face, don't worry - this is normal, the bruises will disappear on their own within a few days.

Rest for the first 24 hours after removal. Rest during the day and get plenty of sleep. When you lie down, raise your head a little.

The diet should be composed of soft and healthy food. In addition, you need to drink plenty of fluids.

Brush your teeth with a soft brush. Avoid brushing teeth in the extraction area for the first 1-2 days. Rinsing toothpaste from your mouth may dislodge the blood clot, so be careful. Keep the removal site clean. After a day, you can gently rinse your mouth with salt water, diluting 1 teaspoon of salt with 1 glass of warm water.

Rinse your mouth very gently and carefully. IN otherwise the blood clot can be removed and bleeding can resume. Do not drink through a straw or spit; sucking through a straw can also dislodge a blood clot.

Do not drink hot liquids. Swelling may increase due to hot liquid intake.

Limit your alcohol intake. Excessive alcohol consumption in the first days after removal can slow healing and lead to rebleeding and disruption of the blood clot.

Do not smoke. Smoking can break down the blood clot, causing pain in the tooth socket.

You should contact your dentist if:

The bleeding doesn't stop.
The pain becomes more and more severe, and your condition becomes more and more severe the day after removal.
The temperature is significantly elevated and does not subside.
Swelling of the soft tissues on the side of removal increases.
Itching and rashes occurred after taking the drug.

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General information about rehabilitation

Currently, the rehabilitation of cancer patients is becoming increasingly important due to the increasing number of cured patients (Gerasimenko V.N., 1977).

It should be noted that the survival of patients with cancer is far from equivalent to a complete recovery.

Extensive surgical operations, intensive radiation, cytostatic and hormonal therapy used in oncological practice lead to serious disorders of various body functions.

A patient can consider himself healthy only if he retains the ability to live and work normally. The ultimate goal treatment is to provide assistance to the patient so that he can again take his previous position in the family and society. Rehabilitation of an oncological patient should be considered as a result achieved in the field of prevention, diagnosis and treatment of a malignant disease.

Behind last decade considerable experience has been accumulated in the treatment of patients with malignant tumors of the head and neck. Development of methods combination treatment led to prolongation of the life of patients for many years. As already noted, the main method of treatment for patients with locally advanced malignant tumors of the head and neck is combined, where extended surgical intervention occupies a leading position.

Extended and combined surgical interventions in head and neck cancer surgery are associated with certain difficulties, primarily due to the formation of postoperative defects, the possibility of closing which with local tissue is limited.

In addition, after extensive operations for locally advanced malignant tumors of the head and neck, disfiguring defects occur, leading to disruption of a number of important functions, in particular, the act of swallowing, chewing, speech, and breathing. Therefore, removal of locally advanced malignant tumors of the head and neck is only one of the stages in the treatment of patients.

Another, no less important and responsible task is the rehabilitation of these patients, returning them to a normal lifestyle and work, which is achieved in various ways. On the one hand, methods are being developed to eliminate postoperative defects using facial (ectoprosthesis) and dental prosthetics (V. M. Chuikov, 1976).

This, to a certain extent, makes it possible to reduce the degree of functional and cosmetic damage caused by the operation. On the other hand, there are attempts to eliminate defects through cosmetic and functional plastic surgeries (Matyakin G. G., 1977; Klim K. I., 1979).

Most authors, when removing malignant neoplasms, consider it advisable to perform plastic surgery, including the smallest number of stages. N. N. Blokhin (1956), N. M. Mikhelson (1962), P. V. Naumov (1966), A. T. Abbasov (1967), I. A. Sorochan (1971) speak in favor of the advantages of primary reconstructive operations ), B. M. Vtyurin, K. I. Klim (1976), N. N. Blokhin, B. E. Peterson (1979).

The search for the most effective methods primary plastic surgery of skin and mucous membrane defects after extended and combined operations in the head and neck area.

This is the key to surgical rehabilitation of patients after extensive operations. In this regard, we have been studying the possibility of rehabilitation of patients with head and neck tumors for several years.

Since extended and combined operations for locally advanced malignant tumors of the oral mucosa, larynx and thyroid gland lead not only to disfiguring defects, but also to dysfunction of swallowing, breathing, chewing and speech, we decided to highlight the issues medical rehabilitation patients with the specified tumor location.

Operations on the oral mucosa

After extended and combined operations for locally advanced malignant neoplasms of the oral mucosa, extensive defects arise, leading to disruption of the act of swallowing, chewing, and speech. Therefore, an important task for the surgeon after tumor removal is plastic modeling of a particular removed organ using skin flaps on a feeding pedicle, which help restore lost functions.

Primary plastic surgery of postoperative defects of the oral mucosa

We performed primary plastic surgery of postoperative defects in the oral mucosa using cervical and deltopectoral fasciocutaneous flaps on a feeding vascular pedicle. Primary plastic surgery with a cervical flap was used in 22 patients, and with a deltopectoral flap - in 7.

A pedicled cervical skin flap is cut out on the lateral surface of the neck in the projection of the sternocleidomastoid muscle with its base in the maxillary region. This arrangement of the flap allows it to include the largest arterial vessels of the skin of the neck, which ensures good blood supply, high viability of its tissues, and the close proximity to the expected defect allows you to restore the surface of the resulting defect in the most optimal conditions.

Unlike other authors, we also include the external jugular vein in the subcutaneous tissue of the flap. This significantly increases the viability of the cervical flap. The prepared skin flap has an elongated tongue-like shape with rounded edges at the end. The width of the flap leg is 5-7 cm, length - 10-14 cm (Fig. 64, a).

Rice. 64. Primary plastic surgery of postoperative defects of the oral mucosa: a - skin incision and cutting out a cervical flap: b - the stage of moving the cervical flap to the defect; c - final view of the postoperative frame. Formation of orostoma in the maxillary region

Upward tilting of the cut flap and wide mobilization of the skin provide good review surgical field, and also create optimal conditions for performing surgery on the lymphatic tract of the neck.

Along with this, tilting the flap and bending its feeding pedicles 180° while performing the main stage of the operation - removal of the primary tumor and neck tissue - makes it possible to assess the state of its blood supply. With adequate blood supply, we moved the flap and sutured it to the edges of the tissue defect (Fig. 64, b). A temporary orostoma was formed in the area of the base of the feeding pedicle (Fig. 64, c).

A study of the characteristics of wound healing after 22 similar operations (Table 35) shows that complete healing of the displaced flap was observed in 10 patients. Some tension of the graft, which was observed when closing the defect of the lateral floor of the mouth and tongue, when closing defects located in the area of the anterior floor of the mouth, led to circulatory disorders with subsequent marginal or more widespread necrosis of the flaps.

When wounds healed by primary intention with complete engraftment of the cervical flap, rehabilitation of swallowing and breathing functions occurred on average within 1.5 months. Otherwise, treatment was delayed for a longer time (on average 0.5 years).

Based on our own observations, we believe that indications for the use of a pedicled cervical flap are defects in the mucous membrane of the middle, posterior third and root of the tongue, floor of the mouth, cheeks and retromolar space, as well as large skin defects of the parotid-masticatory, buccal, submandibular areas and the carotid triangle of the neck.

Experience shows that this flap should not be used to replace tissue defects in the anterior floor of the mouth, lower lip and chin while maintaining the continuity of the lower jaw, since as a result of tissue tension and bending of the feeding pedicle, circulatory impairment occurs in the distal part of the flap.

It is not advisable to use a cervical flap for plastic surgery of defects if its feeding pedicle was in the irradiation zone before the operation. An example of successful neck flap reconstruction is the following clinical observation.

Clinical example

Patient P., 56 years old, was in the department of head and neck tumors of the Oncology Research Institute from November 5, 1977 to January 12, 1978 for cancer of the mucous membrane of the alveolar process of the lower jaw on the right, stage IIIa, T3N0M0. Biopsy No. 180097 - keratinizing squamous cell carcinoma.

From April 3 to May 25, 1977, she received a course of combined radiation therapy to the area of the alveolar process of the lower jaw: close-focus radiotherapy from one field at a dose of 5175 R, external irradiation on the Rokus gamma apparatus - 49.6 Gy. As a result, the tumor decreased by 50%.

On March 14, 1977, the patient underwent wide electrical excision of the tissues of the floor of the mouth, the lateral surface of the tongue, hempresis of the lower jaw on the right with disarticulation, and plastic surgery of the defect with a cervical flap. Tracheostomy.

The result of a histological examination of postoperative specimen No. 290740-40 is squamous cell keratinizing cancer of the mucous membrane of the alveolar process of the mandible with invasion into soft tissue and bone.

The postoperative course is smooth. Healing by first intention. On October 4, 1977, under local anesthesia with 20.0 ml of 0.25% novocaine solution, the orostoma was closed. Currently healthy. The observation period is 8 years.

Plastic surgery with delto-pectoral flap

Compensation of postoperative defects in the mucous membrane of the floor of the mouth and a significant part of the tongue can be successfully performed with a delto-pectoral skin flap on the medial pedicle.

After radical removal of the malignant tumor with resection of the anterior segment of the lower jaw, the distal section of the cut flap is introduced into the oral cavity through a tissue incision in the submandibular region and placed so that its skin surface fills the defect in the mucous membrane of the floor of the mouth and tongue (Fig. 66, a).

Rice. 66. Method of plastic surgery of soft tissue defects in the mucous membrane of the floor of the mouth and tongue with a delto-pectoral flap: a - wound surface and tissue defects after removal of a malignant tumor; b - replacement of a defect in the soft tissues of the mucous membrane of the floor of the mouth with skin - the distal portion of the deltopectoral flap on the medial base; c - final view of the postoperative wound. Formation of an orostoma in the submandibular triangle and stabling of the feeding pedicle of the flap

The subcutaneous tissue of the flap along the edges and its middle part is fixed with several knotted catgut sutures to the muscles of the tongue and fatty tissue of the skin of the submandibular region. Then knotted silk sutures are placed between the edges of the flap and the defect of the oral mucosa, forming the stump of the tongue, the floor of the mouth and the chin area (Fig. 66, b).

In the submandibular triangle, at the site of insertion of the deltopectoral flap into the oral cavity, an orostoma is formed by folding the flap into a tube shape with the epidermis inward. At the base, the flap is given the appearance of a round skin stalk (Fig. 66, c).

Our observations suggest that in order to create the contour of the floor of the mouth, forming tampons made of quick-hardening plastic, covered with iodoform gauze, should be used. They cover an area of skin flap that fills the tissue defect between the mucous membrane of the lower lip and the lower surface of the tongue stump.

The tampon is fixed with ligatures. The orostoma is closed with turunda with xeroform for the next 2-3 weeks, until the skin graft is completely engrafted. After the flap has been implanted in the oral cavity, the feeding pedicle is cut off under local anesthesia.

It should be noted that, despite favorable location vessels in the flap, the length of the stemmed feeding pedicle should be reduced to a minimum in order to prevent kinks that negatively affect the blood supply to the graft. Tension on the leg is also unacceptable. These mistakes can be avoided by carefully planning your plastic surgery.

We used the described method of plastic surgery of postoperative soft tissue defects in the anterior part of the mucous membrane of the floor of the mouth and tongue in 7 patients (Table 36) and in 2 with cheek defects. Complete engraftment of the flap occurred in four cases (Fig. 67, a-c). Circulatory disorders in the form of marginal necrosis were noted in three patients.

Table 36. Immediate results of plastic surgery with a delto-pectoral flap on a medial basis

Rice. 67. Patient L. with a malignant tumor of the floor of the mouth. Block of removed tissue. A crater-shaped tumor ulcer covers the tissues of the floor of the mouth. tongue, frontal and horizontal branches of the mandible

In two cases, there was partial necrosis of the flap due to the addition of a banal infection in the subflap space. Excision of necrotic areas of the flap was performed on days 8-10. By this time, the viable area of the flap has fused with the underlying tissues, thereby reducing the possibility of saliva and infection getting under the flap and its further rejection.

It should be noted that of the two patients in whom the defect of the buccal mucosa was repaired with a deltopectoral flap, in both cases there was a circulatory disorder in the form of marginal and partial necrosis of the flap. Therefore, we believe that the deltopectoral flap can be successfully used only for primary plastic surgery of defects in the anterior mucosa of the floor of the mouth and tongue.

Thus, our observations have shown that the use of a deltopectoral flap expands the indications for surgical treatment and contributes to the rehabilitation of lost functions of breathing, swallowing and speech on average within 1.5-2 months in patients with locally advanced tumors of the mucous membrane of the floor of the mouth.

Of the 30 patients who underwent extended and combined operations for locally advanced cancer of the oral mucosa, who lived for 3 years or more, 13 were engaged in mental labor, 5 in physical labor. The remaining 12 patients were in disability group II.

Topographic-anatomical data

The oral cavity consists of the vestibule and the oral cavity itself. The entrance to the vestibule of the mouth is the oral fissure (rima oris), which varies in size, and is limited by the lips.

Vestibule of the mouth (vestibulum oris)- a narrow, horseshoe-shaped space that follows the shape of the alveolar arches.

It is limited in front and sides by the inner surface of the lips and cheeks, and behind - outer surface teeth and alveolar processes of the jaws. Above and below, the vestibule of the mouth has arches, limited by the mucous membrane, which passes from the cheeks and lips to the gums and is called the transitional fold.

With the jaws closed, the vestibule on one and the other side communicates with the oral cavity proper through slit-like spaces located behind the last molars. With the mouth open, the vestibule communicates with the oral cavity itself.

The oral cavity itself (cavum oris proprium) with the jaws closed has the following boundaries: in front and on the sides, the inner surface of the teeth and alveolar processes of the jaws; below - the bottom of the oral cavity. consisting of muscles, among which the main one is the mylohyoid (m. mylohyoideus s. diaphragma oris); above is the palate, which is divided into hard (palatinum durum) and soft (palatinum molle), which is a continuation of the first.

The oral cavity in a closed state is almost entirely filled with the tongue. The tongue is a very mobile organ. It has a tip, a body, a root. The tongue is divided into upper, lower and lateral surfaces.

"Clinical operational
maxillofacial surgery”, N.M. Alexandrov

When closing large wound surfaces in the area of the vestibule of the mouth, when the stens insert and skin graft are large (more than 5 cm in length), the above method of fastening is insufficient. During such operations, we fix the liner together with the skin graft with additional 2 - 3 mattress sutures using polyamide thread (diameter 0.5 - 0.7 mm), which are applied over...

The operation of eliminating cicatricial constrictions of the buccal mucosa is fundamentally similar to the operation of deepening the arch of the vestibule of the mouth. Here, the issue of fixing the stent insert is resolved differently. In these cases, the patient must have some kind of fixation device made before surgery. At the Clinic of Maxillofacial Surgery and Dentistry of the V.Med. S. M. Kirov for this they usually use a protective palatal plate with a pelot...

During this operation, the same steps are carried out as when deepening the arch of the vestibule of the mouth. The operation is performed under infiltration anesthesia. The operation scheme is as follows. The assistant, using a silk ligature or tongue holder, pulls the tip of the tongue upward as much as possible. In one layer, the scars between the lower surface of the tongue and the tissues of the floor of the mouth are dissected until the moving part is completely freed...

When scars are located in the posterior sections of the cheek, in particular in the retromolar space, extra-articular scar contracture of the mandible often occurs. Surgical treatment extra-articular scar contractures of the lower jaw in such cases consists of dissection and, if possible, excision of scars with maximum abduction of the jaw downwards. If the wound cannot be closed by mobilizing and moving the mucous membrane from...

Dermoid and epidermoid cysts are among the benign tumors that develop due to dystonia of the elements of ectodermal tissue during embryonic development. Dermoid cysts have a wall in the form of developed skin with sweat and sebaceous glands, and their contents are a mushy, greasy mass, including detritus, desquamated epidermis, cholesterol, and sometimes hair. Unlike dermoid cysts, connective tissue…

Anesthesia is carried out by bilateral conduction anesthesia of the lingual nerves with a 2% novocaine solution in combination with infiltration anesthesia with a 0.5% novocaine solution. During the operation, the assistant, using external pressure on the tissue of the oral cavity, protrudes the tumor towards the tongue and thereby helps the surgeon navigate the location of the tumor and its removal. A section of the mucous membrane in the form of an arcuate line parallel...

Stones localized in any duct salivary gland, removed through intraoral incisions of the mucous membrane. Most often, stones occur in the duct of the submandibular salivary gland. During the operation of removing a stone from this duct, conduction anesthesia of the lingual nerve is performed (mandibular type); in addition, the mucous membrane of the floor of the mouth is lubricated on the corresponding side with a 5% solution of cocaine. Infiltration anesthesia should...

To lengthen the frenulum of the tongue, the following two main operations are used: plastic surgery with triangular flaps according to A. A. Limberg and plastic surgery with transverse dissection. Plastic surgery by counter-exchange of triangular flaps is carried out in the same way as when lengthening the labial frenulum. In this case, a median incision is made along the frenulum from the lower surface of the tongue to the excretory ducts of the salivary glands, which cannot be injured during the operation. Plastic…

The elimination of such cords and folds is most often used when preparing the oral cavity for prosthetics, especially with toothless jaws and defects of the alveolar process, when they worsen or completely eliminate the wearing of dentures. During the operation, the assistant pulls back the lip or cheek with blunt hooks, clearly exposing the arch of the vestibule of the mouth. In this case, a scar cord or fold of the mucous membrane is clearly indicated...

Scar cords should be understood as the presence of rough, flat scar cords formed at the site of damage to the mucous membrane as a result of gunshot wounds and mechanical injuries, chemical burns, noma and other pathological processes. Scar cords cause a number of functional disorders (difficulty in eating and chewing food, limited mouth opening, etc.). Flat cords that arise in the area of the arches of the vestibule of the mouth...

After oral surgery, such as complex tooth extraction, cystectomy (cyst removal), flap surgery, and others, the following recommendations must be followed.

1. Bleeding.

During the first few days after surgery, there is slight bleeding in the mouth and the saliva turns pinkish. If the bleeding is severe enough, you should contact
physician to avoid infection in the wound.
Bleeding may last longer than a week if you are taking medications that affect blood clotting or took medications in the week before surgery.
aspirin.

For the first time after surgery, you should not chew food on the operated teeth, spit, or drink through a straw. You also can’t smoke during the first week, and it won’t be superfluous
quit smoking. You should rinse your mouth carefully and do not brush your operated teeth for the first days. You can then brush your teeth with a soft toothbrush, being careful not to touch the operated areas.

If bleeding starts, you need to press a previously washed finger to the bleeding site and hold it for up to 20 minutes. If bleeding continues, hold very cold water in your mouth for 5 minutes or press a damp tea bag over the bleeding area. It is recommended to sleep on several pillows so that the head is elevated, and in case of bleeding, place a towel nearby, but try not to sleep on the side of the operation .

2. Pain and swelling.

To reduce pain and swelling, you should take painkillers, but only as directed by your doctor. If the medications do not help or the pain intensifies, do not tolerate it, as this may cause complications and seek help from your doctor. Moreover, painkillers can cause drowsiness, so it is not recommended to drive a car or drink alcohol while taking medications.

On the third postoperative day, tissue swelling develops (increases) and is most pronounced. You cannot heat the operated area; on the contrary, use an ice pack, which should be applied wrapped in a towel for 20 minutes, then removed for 20 minutes, and so on for the first 6 hours after surgery (the doctor can increase the time of exposure to cold to 3 days). If the swelling does not decrease or increases even more after 3 days, you should consult a doctor!

3. Temperature.

In the first days after surgery, body temperature may rise to 38 C, as a natural response of the body to surgery, but there is no need to lower the temperature medicines. If the temperature rises above 38 C, or persists without decreasing for more than 3 days, consult a doctor!

4. Rinse the mouth.

Given the impossibility of compliance personal hygiene in the postoperative area in full, it is recommended to rinse oral cavity antiseptic and antimicrobial solutions. Moreover, you can start rinsing only on the second day after the operation. If there are no special medical prescriptions, take a solution of chlorhexedine into your mouth and keep it at the surgical site for 1-3 minutes.

For the first 3-5 days, it is advisable to use Metrogil-dent gel to treat the gums (sutures) in the area of intervention. Use a cotton swab (ear cotton swab) to blot the saliva from the gums at the operation site, apply a thick layer of gel, and then do not eat for 30 minutes.

5. Nutrition.

On the first day, it is better to eat cool food to avoid burns or bleeding. You should not chew on operated teeth until the sutures are removed, or for two weeks. At the same time, nutrition must be complete so that the body receives all the nutrients it needs.

6. Possible consequences operations.

Bruises may appear at the surgery site, which will go away within a week.
The corners of the mouth may become dry and cracked, so they need to be moistened with ointments.
possible exacerbation of herpes
There may be a temporary sore throat or aching pain in the jaws, ears, head or neck
It may be difficult to open your mouth wide for three days after surgery

Typically, teeth are mobile for 2-3 weeks after surgery, then they become stronger.
Teeth may react to cold and sweet foods from 2 weeks to 2 months after surgery. This sensitivity can be reduced by using desensitizing toothpaste. The results of treatment can only be assessed during a visit to the doctor. Do not be guided only by your feelings, do not self-medicate, if you doubt anything, consult a doctor.

Surgical interventions in maxillofacial area differ from surgical interventions performed in other parts of the human body and have a number of features. They are due to the complexity of the anatomical structure of this area, the variety of physiological functions (vision, hearing, smell, breathing, etc.), abundant blood supply and innervation. Ignorance of these features can lead to the development of local complications, ultimately leading to unsatisfactory treatment results.

The face reflects individual feature person, his personality. In this regard, high demands are placed on the technique of performing surgical interventions on the face.

The maxillofacial region has an extensive network of blood vessels, so surgical procedures are often accompanied by significant bleeding. Heavy bleeding can also occur during minor surgical interventions in patients suffering from hypertension, diabetes mellitus, and diseases of the blood coagulation system and liver. In connection with the above, during operations accompanied by heavy bleeding, blood should be transfused or, if indicated, the volume of circulating blood should be replenished by administering blood substitutes.

Operations in the maxillofacial area also differ in the conditions for their implementation. They can be performed on the face and neck under aseptic conditions, but it is impossible to create aseptic conditions in the oral cavity.

The skin and mucous membrane of the oral cavity are in contact with the external environment, oral fluid, i.e. a large number of pathogenic and conditionally pathogenic microflora. In this regard, if their integrity is violated, the possibility of developing inflammatory processes arises.

Positive feature the skin of the maxillofacial area and the oral mucosa is high regenerative capacity.

The increased regenerative ability of facial tissues and their resistance to microbial contamination are mainly due to the rich blood supply and innervation. It is also important that in the perioral area there is a significant amount of connective tissue with poorly differentiated cellular elements, which are “tissue regeneration potential.”

The high regenerative ability of the skin of the maxillofacial area and the oral mucosa is also due to the presence of the lymphatic system, which is involved in the formation of cellular and humoral immunity. There are eight groups in the maxillofacial region lymph nodes(more than in any other area). Oral tissues are protected not only by general immunity, but also have their own local immunity, which plays a major role in protection against infections. Local immunity of the oral cavity depends on many factors: the integrity of the mucous membrane; content of protective substances (immunoglobulins A, M and G); composition of saliva (content of lysozyme, lactoferrin, neutrophils, secretory IgA); state of lymphoid tissue.

The lymphadenoid ring (Pirogov’s ring), which is part of a single immune system body and is its barrier. Lymphoid pharyngeal tissue plays an important role in the formation of both regional and general protective reactions of the body. Of great clinical importance is the anatomical feature of the oropharynx, such as the presence in the immediate vicinity of spaces filled with loose connective tissue. With various injuries and inflammatory diseases of the oropharynx, they may become infected, and in the future the development of such serious complications as mediastinitis, sepsis, erosive bleeding from large vessels that threaten the patient’s life.

The maxillofacial region has a rich innervation, which must be taken into account during surgical interventions on the face. First of all, it requires good pain relief, and then - execution cuts taking into account the course of the branches of the nerves (especially the facial nerve). Therefore, incisions on the face are made parallel to the course of the branches of the facial nerve.

The cosmetic result also depends on the choice of location and direction of the incision in the maxillofacial area. To obtain a good cosmetic result, it is also possible to complicate the surgical approach. For this reason, most facial incisions are made perpendicular direction power lines facial muscles, parallel to the natural folds of the skin. In the oral cavity, the intended incision lines should not cross the excretory ducts of the salivary glands, and the postoperative scar should not interfere with the function of the tongue. Also, to achieve a positive cosmetic effect, it is necessary to take into account the thickness skin, which varies significantly in different areas of the face.

To obtain good cosmetic results, facial surgery plays an important role. wound edge ratio, suturing technique and suture material.

In case of a deep wound, to prevent the development of hematomas, it is necessary to first bring the edges of the wound closer together in depth and then suturing the wound layer by layer. Bringing the edges of the wound closer together and suturing the skin is carried out only after applying a suture to the most superficial layer of fatty tissue. In order for the postoperative scar to be less noticeable, sutures are placed on the facial skin at a distance of 1-5 mm from the edge of the wound, piercing only the dermis, to the fatty tissue, or to the most superficial layer of the latter. The injection and puncture of the needle must be strictly at the same distance (from the edge of the wound). The edges of the wound must be aligned very evenly so that when tying the sutures, one edge does not protrude or turn under. Frequency of suturing per different types fabrics are different. The muscles are sutured at a frequency of 8-15 mm, the skin of the maxillofacial area is sutured at 8-10 mm, and the oral mucosa can be sutured at a frequency of 4-5 mm. You should not tie the knots too tightly, otherwise the seams will cut in and leave scars. When suturing the skin, very thin triangular, steeply curved cutting or atraumatic needles are used. When comparing the edges of the wound, you should not firmly grasp the edge of the skin with tweezers, as this can lead to impaired blood circulation in it, and subsequently to necrosis that is insignificant in extent. Vessels in the wound should be tied using a tool.

In the maxillofacial region, along with interrupted sutures, a continuous suture under the epidermis (cosmetic suture) is used, passing the thread alternately through both internal surfaces of the wound. After such a suture, the postoperative scar remains linear, very thin and almost invisible.

A variety of suture materials are used in maxillofacial surgery. Thus, thick silk (No. 3-5) is used for ligation of the carotid arteries, and thin polyamide thread (0.2-0.3 mm), horsehair or nylon is used for suturing the skin and mucous membrane.

Drainage wounds are a mandatory element of any surgical intervention in the maxillofacial area. There are two ways to drain a wound: active and passive. Passive drainage is a tape or tubular drainage inserted into a wound to evacuate its contents. For active drainage of wounds, in order to improve outflow from the wound, vacuum sources are used: electric suction, vacuum pump, microcompressor, etc. Passive drainages are installed in all wounds of the maxillofacial area for at least 24 hours.

In case of through wounds of the maxillofacial area communicating with the oral or nasal cavity, suturing the edges of the wound begins from the side of the mucous membrane and ends with the skin. The mucous membrane is sutured tightly, and drainage is introduced only from the side of the wound on the skin.