Things You Need to Know
What to expect form orthognathic surgery process? Here is our comprehensive instructions for patient.
First Consultation
Steps that are necessary to take in order to get the first orthognathic surgery consultation:
Consultation
Prior to your first consultation you'll get the package by mail with documents that will have to be filled out and signed. Consultation with the doctor cost $300 and includes the common case discussion.
Referral from your orthodonthist
Please, bring the referral slip from your orthodontist. This is a requriement for all patients, planning to get the orthognathic surgery done.
CT-Scan
Bring your the CT-Scan (X-Ray pictures of your jaws). If you don't have one, we can do it at our office. Insurance company will need to authorize the CT-Scan first, otherwise you can pay yourself for the CT-Scan (charge is $500).
Schedule the Surgery Date
After the first consultation, the doctor will complete the Dictation Report and send it to your orthodontist. Then your orthodontist will authorize the surgery and our staff will schedule your surgery date.
Pre-Operative Instructions
Things you need to do after the scheduling and prior to your surgery:
Checking in at the hospital
Patients should get to the hospital two hours prior to their surgery appointment. Remember that you cannot have anything to eat or drink after midnight prior to your surgery. Your stomach needs to be empty of all food and fluids – including water. When you get to the hospital, there is an information desk. At the information desk, you will be told where to go and how to check in. Once checked in, you will be asked to change into a hospital gown. Your anesthesiologist will come in and discuss the anesthesia and surgery with you. Once everything has been discussed, your anesthesiologist will start an IV and may administer some medications to help you feel more relaxed.
The Operating Room
Patients are brought into the operating room (OR) on a gurney. They will then move you to the operating table. By this point, you will have received some relaxing drugs so you will be feeling comfortable. Once you are comfortable on the operating table, the anesthesiologist will administer some drugs that will make you go to sleep. Once you are asleep, the anesthesiologist will place a tube through your nose and into your windpipe that will be used to assist your breathing during the general anesthesia. This tube will be removed before you wake up. A second tube may be placed through the nose into the stomach (nasogastric or NG tube) to keep the stomach empty. The NG tube may be left in over night after your surgery – patients generally have no problems other than an itchy nose from this tube. If your surgery is long (upper and lower jaw), a nurse will probably place a catheter into the bladder. This allows the anesthesiologist to check your hydration and urination during surgery. This catheter usually is left in overnight and can be removed the following morning when you are able to get up to use the bathroom. During the surgery, Dr. Antipov will have the nurse let your family know when the surgery is halfway over and when he is closing. When the surgery is completed, Dr. Antipov will place a jaw bra and ice packs on your face to help reduce swelling.
After the surgery
After your surgery is completed, you will be wheeled into the recovery room. You will be monitored very closely until you are awake enough to be moved to your hospital room. Dr. Antipov will let your family know you are doing well and are in recovery, but your family is not able to come back until you have been moved to your hospital room. If you have had upper jaw surgery, you will probably be moved into a single person ICU room. If you are in an ICU room, you will have one nurse closely monitoring your comfort and care. We recommend that you keep visitors to a minimum, as you will be very tired and wrapped in tight compression dressings. A family member is allowed to spend the night at the hospital with you. We recommend that a family member stay with you starting at the time you leave the ICU for regular ward floor. In your hospital room, you will have a suction device you can use to suction saliva and fluids from your mouth. If you develop any nausea, let your nurse know so that he or she can give you some anti-nausea medication. You may remove the rubber bands in order to let your mouth hang open wider if you are having problems with nausea.
Leaving the hospital
Discharge from the hospital is based on your ability to breath regularly, take fluids and medications by mouth, go to the bathroom, and walk on your own. Usually you are able to leave the hospital one to two nights after your surgery.
Orthognathic Surgery and Insurance Issues
- Orthognathic surgery (surgery for the treatment of a denofacial deformity) is never covered on dental insurance, but may be a covered benefit on medical insurance.
- Although there are some medical plans that specifically exlude orthognathic surgery, most insurance plans in California do permit the authorization of orthognathic surgery "when medically necessary." Please check whether it is a covered benefit on your insurance plan. The typical diagnosis codes (ICD-9) used: 524.00-524.06, 524.10-524.12, 524.24, 524.25. Typical procedure codes (CPT) used: 21120-21123, 21141-21147, 21193-21198.
- The issue for the insurance carrier is usually to identify the medical necessity, since to a casual observer, many patients appear fit and healthy and are not losing a lot of time off school or work, and do not have an excessive number of visits to their doctor. This is the decision of the insurance company, not UCSF.
- When you attend your initial consultation, please bring any radiographs and models that you may have with you, including those from your orthodontist, and give some thought to the issue of "medical necessity."
- Most patients require many months of orthodontic treatment prior to surgery. It is virtually impossible to receive any kind of insurance authorisation prior to commencement of orthodontic treatment, since insurance companies will not authorize a procedure that does not need to be carried out for several months. They usually require that authorization is only requested when one is ready to carry out the surgery, and in fact most authorizations are only valid 90 days once they are issued. This does mean that most potencial patients must commence the orthodonthic treatment prior to knowing whether their surgery will be authorized and patients must accept this. Your insurance company may have a different policy.
- Authorization requests to insurance carriers for orthognathic surgery often take 4-8 weeks for for responce back. This is because they are always sent out to secondary review and are never automatcally approved. Please be patient during this process.
- Your surgery cannot be scheduled with the operating room until we have a valid insurance authorization to cover the proposed surgery date.
Postoperative Care
What to do and expect after your surgery:
Eating
Once you are home, it is important to make sure that you obtain adequate fluids and pain medication. Fluid intake is very important, as you are no longer receiving IV fluids. In order to assure proper fluid intake, you should be constantly taking small sips of either protein shakes or other fluids. Make sure you are taking your pain pills regularly as directed for pain.
Swelling
It is also important to keep up on your ice packs for the first few days. Icing will help to keep the swelling to a minimum. The swelling can be expected to get worse up until the third day. After the third day, it will begin to subside and you may discontinue ice pack use. You should be sleeping with your head raised (either in a recliner type chair or with extra pillows) for the first week. Keeping your head elevated will also help to keep the swelling down to a minimum. It is common for bruising to occur, especially if you are fair skinned.
Speech
Immediately after surgery, your speech is often slurred and you are hard to understand because your lips are swollen and your jaws are difficult to move. You will only improve your ability to talk by repeated attempts to communicate. Patients who work on speech can easily communicate their needs (although speech may still be slurred) within 24 hours of surgery.
Nasal Stuffiness
If the surgery involved your upper jaw, you will probably have a great deal of nasal congestion. We advise you to combat nasal congestion using over the counter nasal aids such as Vic's and Afrin. DO NOT BLOW YOUR NOSE if you have had upper jaw surgery. We recommend using q-tips moistened with a mix of water and hydrogen peroxide to clean out any secretions. Hot showers clear congestion, too.
Teeth Hygiene
You will be rinsing with your Peridex mouthwash three times daily for the first ten days after surgery. We encourage you to attempt to brush your teeth as soon as possible after surgery. A soft child-size brush is very helpful in brushing as your mouth will not open as much as normal. For patients who will have a splint on their upper jaw (anyone having surgery to widen their upper jaw), a water-pick can be very useful to clean between the splint and the upper teeth. Be careful when brushing - only brush the teeth and do not brush the gums. It could irritate the incisions.
PDF Forms
Prior the surgery consultation please download, print, and fill necessary medical forms, described below:
Steps for Ortho Cases
Step-by-step guide for orthognathic surgery patient.
Patient Information Form
Form includes major patient information: DOB, address, SSN, email, employment information, your phisician and orthodonthist info, responsible party or spouse information, primary and secondary insurance information. You need to fill this form, put your signature and date and bring it with you on your first consultation.
Consent Form for Fascial Reconstruction Surgery
You have to fill, initial, and sign consent form prior the surgery and bring it on your first consultation. Please, initial each paragraph after reading. If you'll have any questions, please ask your doctor BEFORE initialing. Doctor will sign this form after you.
Pre and Post Op Care/Expectations
This form describes and asking for your initials for possible after surgery sequelaes, like: hospital stay, "Stuffy Nose", swelling, breathing difficulty, swallowing difficulty, sore throat pain, nausea and vomiting, bleeding, injury to the nerves, medications, jaws wired together, broken wires or elastics, diet and weight loss, occlusion (bite), inability to move or open jaws, physical therapy, cosmetical results, incisions, foley catheter, G.I. problems, aspiration, transfusions and reactions, etc.
Pre-Surgery and Post-Surgery
Main form topics: checking in at the hospital, the operating room, after the surgery, leaving the hospital. Second part of this form explaned how to correctly provide postoperative care: eating and diet, swelling, speech, nasal stuffiness, teeth hygiene.
Galleria Center for Corrective Jaw Surgery Dr. Alexander Antipov. Postoperative instructions.
The following information is provided to ensure that many of the details of prospective care are covered prior to your surgical procedure. This ensures a smooth and uneventful recovery. It has been our experience that the more information and preparation patients have prior to their surgery; the more easily they are able to manage their postoperative care.
This instructions includes: postoperative instructions, swelling, drinking, medications, jaw joint pain, jaw opening, ten days to four weeks after surgery instructions, four to eight weeks after surgery to do list, hygiene, eating, immediately following surgery to day 10, day 10 to day 28 after surgery, four weeks to eight weeks after surgery, returning to work, physical exercise, bleeding, X-Rays.
Items to Have Prior Your Orthognathic Surgery
Must have items to bring with in a surgery day in the hospital.
Medical History Form
Medical history form includes major questionaire regarding your medical history and health background. This form needs to be filled out and signed prior first consultation.
Pre-Op Clearance Form
Pre-operative clearance form must be signed by your primary care physician prior 6 weeks before surgery after the patient was scheduled for surgery.
Acknowledgement of Receipt of Notice of Privacy Practices
Galleria Oral and Maxillofacial Surgery will provide at patients request a copy of our Notice of Privacy Practices. The Galleria Oral and Maxillo-Facial Surgery Notice of Privacy Practices explains your privacy rights and how we may use and disclose your protected health information.