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Nutrition

In its most basic sense, nutrition is the intake of nourishment- the fluids & fuels that we require surviving. Post any illness/surgical procedures, our nutrition needs are generally increased to facilitate healing. In the case of oral & maxillofacial surgery patients this particular need might be quite challenging for a number of reasons.

Since surgical incisions could be present in/around the mouth & there could be some postoperative swelling, chewing & swallowing normally can become difficult. In addition, the type of surgery that has been used might also necessitate a diet that is limited in consistency. In combination, all these factors, with the increased in nutrient needs post surgery, mean it might be difficult to ensure that the patient is well nourished in this stage.

Surgical Nutrition

Water is the single most vital nutrient. In general, an average adult should drink at least 6-8 glasses of fluids/day. Though this amount can be increased post an illness/ surgery/fever, etc, this is a good rule-of-thumb. The total calorie-needs can be estimated as 15calories/pound of body weight each day. In case of an average adult, this generally translates into around 2,000 calories a day. In addition, the protein requirements might increase post surgery, to promote healing.

Oral Surgery

When any kind of surgery is conducted in the mouth, such as dental implants, removal of teeth, biopsies & other similar procedures- these do not require any significant nutrient increase. Your oral & maxillofacial surgeon might suggest a liquid/soft diet for a very short time in order to make you more comfortable & to avoid inadvertent injury to the surgical site.

In most cases, post tooth removal, it is also suggested that the activities which may physically disrupt healing & clotting should be avoided. This includes consumption of carbonated beverages, and drinking with the use of a straw, vigorous tooth-brushing & mouth rinsing. You can always direct questions related to these, to your oral & maxillofacial surgeon.

Orthognathic Surgery, TMJ Surgery and Facial Fractures

In the past, when patients underwent jaw & fracture surgery, their jaws had to be immobilized in order to promote healing. Typically, this was accomplished by using elastic rubber-bands/ wiring to hold their teeth together. This particular technique might still be required in certain cases, such as jaw fractures. But today, small screws & fixation appliances are commonly used to ensure accurate & predictable healing.

These appliances are small enough and are barely perceptible to the patients. They need not be actually removed post healing. However, since they are small in size, it means they cannot resist the chewing-forces until these surgical sites have healed

The Challenge

There could be swelling immediately after surgery. This can make it difficult to consume solid foods. This phase can last several days, and the individual will have to consume all nutrition in liquid form. Given an adult person’s daily nutrition needs, this can be quite a challenge. Since fluids become the most important form of nutrient, special care should be taken to ensure that you consume at least 6-8 glasses of fluids each day. It can be quite challenging to meet caloric needs during this phase.

There are a number of proprietary liquid nutritional-supplements available. These are high in caloric density & more balanced in protein, calories & vitamins and help you meet your nutrition goals. Brands like Ensure®, Boost® & Sustacal® are available at all pharmacy and can be purchased over-the-counter. These can also be augmented with smoothies/shakes that contain protein powders, fruit/ other additives. It might be helpful to maintain a diet diary to record fluid volumes & calories. It ensures that your nutrient goals are all being met.

The Semi-Solid Diet

In most cases, post this brief dependence on various liquids, it will be recommended that you consume a semi-solid/"non-chewing" diet. This diet should generally be of a consistency which can be consumed without actually biting/chewing. A number of your normal dietary choices will be available to you, and you will be able to consume soft pancakes, soft scrambled eggs, flaky fish, well-cooked pasta, etc.

Remember, it is crucial that you avoid stressing these surgery sites until the healing has progressed. The non-chewing diet that you follow, should be maintained till your oral & maxillofacial surgeon approves a move onto a much more solid diet. This could be 3-6 weeks post surgery, though it could be longer, especially for patients who are undergoing reconstructive surgery/TMJ.

Intermaxillary Fixation

For patients whose teeth have been rubber-banded/ wired together post surgery (intermaxillary fixation), it will be necessary to consume a liquid diet until the wires/ rubber band have been removed. It’s good to start with the liquid diets that have just been discussed. Once the initial healing has taken place, you can consume a more varied diet. Cooked portions of a number of favorite foods can all be blended separately/ in combination to match your taste.

In order to ensure that these blended mixtures are of a proper consistency, water, juice, broth or milk can be used as a thinner. The blended mixture should also be strained to prevent any oral hygiene problems.  In addition, you can also consume the nutritional supplements that are mentioned above, to help you meet all your nutrient needs.

© 2005-2012 American Association of Oral and Maxillofacial Surgeons (AAOMS). All rights reserved.

Reprinted with permission from American Association of Oral and Maxillofacial Surgeons.