• Reference Number: HEY-143/2020
• Departments: Oral Surgery, Dentistry and Max Fax
• Last Updated: 16 July 2020

Introduction

This leaflet has been produced to give you general information about your treatment.  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 is a fracture of the upper jaw?

Your upper jaw has been broken. This is usually detected by you describing your symptoms and the doctor examining you and any X-rays or scans you have had. This will established the number of fractures, where they have occurred, and whether they need treatment to help them heal.

Why do I need treatment?

Sometimes when the upper jaw is broken it needs to be repaired otherwise the teeth do not meet together properly.

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 15 minutes with a rolled up handkerchief or gauze swab. If the bleeding does not stop please contact the department.

Occasionally the screws that are used may damage teeth adjacent to the fracture site.

If plates or screws have been used to hold your jaw in position these are not routinely removed. The metal that is used is titanium which does not set off metal detectors in airports, etc. Occasionally the screws or plates do need removed at a later date if they become infected or protrude through the gum.

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.

Depending on what injuries you have, some people may be admitted to hospital straight away, others may be asked to attend at a date in the near future for treatment.  You will usually be invited to a pre-assessment, where the nurse will check that you are fit for surgery and explain the operation. They will also answer any questions that you may have.

You will be given a letter detailing where you should attend, what time and starving instructions. You will be seen by the surgeon and the anaesthetist. The type of anaesthetic you will have is called a general anaesthetic, so you will be asleep for the treatment.

What will happen?

The operation involves opening up the fracture sites which by making a cut inside the mouth through the gum above your upper teeth. The broken bones are then put back together and held in place with small metal screw and plates. The gum is stitched back into place with dissolvable stitches that can take a fortnight or so to fall out. During the operation it is often necessary to place wires or metal braces around your teeth. Screws inserted into the jawbone above the teeth are occasionally used instead of wires. These may be left on for a few weeks after your operation. Elastic bands can be attached to them to guide your teeth into position for the next few weeks so that they bite correctly after surgery.

Sometimes during the operation it is necessary to remove decayed or damaged teeth, or teeth which are involved with the fracture.

Your surgeon will be able to explain which of the above is likely to be needed in your case. Occasionally, further fractures may become obvious during the operation and may also require one of the above to fix them at the same time.

What happens afterwards?

It is common to spend the night in hospital after your operation. Some people may be able to go home on the same day, depending on what treatment they have had and what time their operation was at.

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.

You may also get some swelling and bruising inside your mouth or on your face. This can take a few days to come up and again can take a couple of weeks to fully settle. Cold compresses may help with this.

Due to the position of the fractures, some patients may experience nose bleeds after the injury, or after the surgery. Packs may be placed up the nostrils during or after the operation if necessary to help stop or prevent this. These will usually be removed after a day or two.

There is a small risk of infection and so you should keep your mouth clean with regular warm salty mouthwashes. Once your mouth is comfortable enough, you should also gently brush your teeth. You may be given antibiotics through a drip in your arm whilst you are in hospital. In some cases, your surgeon may prescribe antibiotics for you to go home with.

Although the plates and screws hold the fractures in place it takes about six weeks for your jaw to heal firmly. During this time you need to eat a soft, non-chew diet, the nature of which will be discussed with you by the doctors and nurses. You should also avoid contact sports or any further injury to your face, which could move the fractures again. For this reason, it may also be necessary to take time off work. Your doctor will offer guidance to you about this.

The injuries or operation may also cause some numbness or altered feeling to the nerves that supply feeling to the top teeth, the gums and roof of the mouth, as well as to the skin on the cheek. We would normally expect to see this recover, though it can take many months to feel improvement. Some patients can have long term altered feeling in these areas due to the position of the fractures.

You will usually be offered a follow up appointment. 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 happy that your fracture has healed.

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.