- Reference Number: HEY-140/2020
- Departments: Maxillofacial Department
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This leaflet has been produced to give you general information about your condition. Most of your questions should have been answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.
What are fractures of the lower jaw?
Your lower jaw has been broken. The doctor who examined you has already established the number of fractures or breaks in your lower jaw, where they have occurred and whether or not they need treatment to help them heal. If surgical treatment is needed it usually requires a general anaesthetic i.e. you will be asleep during the operation. However, not all fractures need an operation, and some can be treated by sticking hooks on teeth, or by placing screws under a local anaesthetic.
Why do I need treatment?
It is important not to leave broken bones untreated as this may well result in difficulty with eating and drinking. Factures of any bones in the jaw will alter the way your mouth opens and closes, treatment will prevent risk of infections, dental decay and long term conditions such as arthritis.
Can there be any complications or risks?
Infection can occur but is uncommon if the mouth is kept clean and because of the antibiotics that are used.
Bleeding from the cuts inside your mouth is unlikely to be a problem but should the area bleed when you get home this can usually be stopped by applying pressure over the site for at least 10 minutes with a rolled up handkerchief or gauze swab.
There is a nerve that runs through the centre of the lower jaw that supplies feeling to your lower lip, chin and bottom teeth. This nerve may have been bruised at the time of the fracture and as a result you might already feel some tingling or numbness in your lip and/or chin. This may feel to have been made worse by surgery. In the majority of people the numbness gets better on its own although it can take several months to do so. For some patients it does not get better.
Occasionally the screws that are used may damage teeth adjacent to the fracture site.
If it has been necessary to put any plates or screws in your jaw under the gum to hold it in position these are not normally removed unless they get infected because they tend not to cause problems. The metal that is used is titanium which does not set off metal detectors in airports, etc.
How do I prepare for the operation?
Please read the information leaflet. Share the information it contains with your partner and family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this operation.
What does the operation involve?
If an operation is needed once you are asleep the fracture sites will be opened up. This may involve making a cut on the inside of your mouth through the gum, or on the outside through the skin. The broken bones are then put back together and held in place with small metal plates and screws. The gum is stitched back into place with dissolvable stitches that can take a fortnight or even longer to fall out. During the same operation it is often necessary to place wires or metal braces around your teeth so that elastic bands can be attached to them and guide your bite into the correct position after surgery. Screws inserted into the jawbone between the roots of the teeth are commonly used instead of these wires or metal braces. Any elastic bands, which may be used to guide your teeth together, are not usually attached until the day after your operation, i.e. your jaws will be able to move freely when you wake up from surgery.
Will anything else be done while I am asleep?
Occasionally it is necessary to remove damaged or decayed teeth at the site of the fracture. In very difficult fractures, including fractures around the jaw joint, it is sometimes necessary to make a cut on the outside of the mouth through the skin of your face. If this is thought likely to take place, the site and size of the cut will be discussed with you before you sign the consent form for your operation.
What will happen?
You will be given a letter detailing where you should attend, starving instructions and the time to report to the ward. Staff will greet you and show you around the ward. You will be seen by the doctor and possibly the anaesthetist. The type of anaesthetic you will be having is called a general anaesthetic. You will be prescribed pain relief to manage any pain you may suffer following the operation.
What happens afterwards?
It is likely to be sore and regular pain relief medication will be arranged for you. The discomfort is usually worse for the first few days although it may take a couple of weeks to completely disappear. It is also necessary to make sure that the fractures heal without any infection and so you will also be given antibiotics through a vein in your arm whilst you are in hospital. You will be sent home with pain relief medication and a course of antibiotics. Patients usually stay in hospital for one night following the surgery. The following day the position of your fractures is sometimes checked with X-rays before you are allowed home.
Although the plates and screws hold the fractures in place it still takes around six weeks for your lower jaw to heal completely. During this time you need to eat a relatively soft diet, the nature of which will be discussed with you by the doctors, nurses and dieticians. It is also important that you keep your mouth as clean as possible for the first few weeks after surgery to prevent infection. It may be difficult to clean your teeth around stitches because it is sore. It is best to keep the area free from food debris by gently rinsing your mouth with a mouthwash of hot salt water (dissolve a flat teaspoon of kitchen salt in a cup of hot water) commencing on the day after surgery.
You should also use any prescribed mouthwashes. As healing progresses you will be able to use a toothbrush as normal, or if your gums are tender put toothpaste on your little finger and use it as a toothbrush. If any wires, metal braces or screws are used to help guide your bite into the correct position they will be removed in the outpatient department when your doctors are satisfied that your fracture has healed.
Depending on the nature of your work it may be necessary to take a fortnight or so off, and to avoid strenuous exercise for this time. Some sports with a high risk of facial injury should not be performed for up to three months.
It is important to remember that you will not be able to drive or operate machinery for 48 hours after your general anaesthetic.
Some of information included in this leaflet has been provided by the https://www.baoms.org.uk/patients/procedures/
Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Maxillofacial Unit (01482) 463218
General Advice and Consent
Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.
Consent to treatment
Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.
The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:
- you must be able to give your consent
- you must be given enough information to enable you to make a decision
- you must be acting under your own free will and not under the strong influence of another person
Information about you
We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.
We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.
Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.
If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.