Patient Information Leaflets

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This leaflet provides you with information on Intravenous (IV) sedation. If after reading the leaflet, you have any questions, please speak to a member of the team. 

What is IV sedation?

This is a method used to help patients who are anxious about dental treatment.  It can also be used for other reasons, such as surgical procedures.

The IV sedation (given through a vein) does not make you go to sleep, so you are still able to follow simple instructions.  It just makes you feel more relaxed.  

A local anaesthetic (injection in the mouth) is also given to numb the surgical site in addition to the IV sedation. This is given after the sedation takes effect.

Preparing for the procedure

• Please make arrangements to bring a chaperone with you (over 18) so they can take you home and look after you for the first 24 hours. The chaperone must wait in the waiting room during the test.
• Take your medication as normal unless you are advised otherwise at your consultation appointment.
• Please bring medication with you that you may need, such as inhalers.

A pregnancy test is carried out routinely for women in the department before treatment.

Day of the procedure  

Failure to follow the instructions below may result in the cancellation of your procedure.

• Do not eat 6 hours before the appointment.
• You can drink water up to 2 hours before the procedure.
• Remove any nail varnish or false nails as this can interfere with the monitoring probe.
• Wear loose clothing as access is required to both arms to insert a cannula/take blood pressure.
• Please bring a chaperone with you.
  
  

During the procedure

• A small needle is placed in the back of your hand or arm through a vein.
• The needle is removed, leaving a small tube in the vein called a cannula.  
• Your heart rate, blood pressure and breathing will be monitored throughout the procedure.
• You will be monitored in the recovery room until we are happy to discharge you.

Contact Details

Oral and Maxillofacial Department

County Hospital
Nurse’s Office Tel: 01785 230577     
Monday to Friday 9.00 am to 4.00 pm

Stoke Hospital
Nurse’s Base Tel: 01782 674801 
Medical Secretary Tel: switchboard  01782 71544

Approved: May 2025                                                                    Review: May 2028 

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This leaflet will explain the biopsy procedures and what to expect.  If after reading the leaflet you have any questions, please speak to a member of the team. 

Procedure

The biopsy area can be inside the mouth or outside of the mouth on the skin.  The area will be made numb and lasts up to 4 hours after the procedure, so avoid biting your lip/tongue during this time.  

• Do not smoke for 48 hours after the procedure.
• Do not drink alcohol for 48 hours.
• Do not do any strenuous exercise as it may cause renewed bleeding.

The internal stitches (sutures) used are dissolvable and will come away on their own up to 6 weeks.   

After the procedure (inside the mouth)

• 24hours after the procedure, dissolve a teaspoon of salt in a glass or tumbler of warm water. Repeat this after every meal. This will keep the area clean.  
• Brush your teeth as normal, but be careful of the biopsy area.
• Eat soft food to start with and return to eating a normal diet once you feel able to do so.

After the procedure for all Procedures

• Bleeding: If bleeding occurs, apply firm pressure to the biopsy area for at least 30 minutes using a clean handkerchief or gauze.  If bleeding persists, contact the department or attend A&E outside of our working hours.
  
  
• Pain: Pain relief such as paracetamol or ibuprofen can be used to help manage any pain. This will gradually improve over 7-10 days.
  If you have an increase in pain after a few days, this may indicate an infection so please seek advice from the department.
  
  
• Swelling and Bruising: This is common after surgery and after 2-3 days will start to reduce and resolve by 7-10 days.  Bruising can occur to the face and this can take up to 2 weeks to resolve.

Follow up

A telephone follow-up appointment may be arranged for you or you may receive a letter from your clinician with the results.  A face-to-face appointment may be arranged if the healing site needs to be reviewed.

Results

Please ring the department on the number provided on the back of the leaflet 24 hours before your appointment to make sure that your results have been received.

Contact Details 

Oral and Maxillofacial Department

County Hospital
Nurse’s Base        Tel: 01785 230577     
Monday to Friday 9.00 am to 4.00 pm

Stoke Hospital
Nurse’s Base           Tel: 01782 674801     
Medical Secretary   Tel: switchboard 01782 715444

Approved: May 2025                                                                   Review: May 2028 

Click here to view/download the PDF version of this information.

This leaflet will explain the extraction procedure and what to expect. If after reading the leaflet, you have any questions, please speak to a member of the team. 

Procedure 

The extraction area will be made numb and will last up to 4 hours after the procedure.  Avoid biting your lip/tongue during this time.  

After the procedure

• Do not spit, wash or rinse your mouth out on the day of the procedure, as it may stop a healthy blood clot forming and you may get an infection. 
• Brush your teeth as normal, being careful of the extraction area.
• 24 hours after the procedure, rinse out after every meal to keep the socket(s) clean.  Use a teaspoon of salt in a tumbler of warm water.
• Eat soft food for 48 hours and gradually return to eating a normal diet. Your mouth opening may feel restricted for a few days.
• Do not smoke for 48 hours after the procedure.
• Avoid strenuous exercise and alcohol, as this can cause renewed bleeding.
• Stitches (sutures) will dissolve in about 6 weeks and come away on their own.  Once the area has healed, you can use your toothbrush to encourage them to come away quicker. 

• Bleeding: If bleeding should occur, use a clean handkerchief or gauze to apply firm pressure on the socket area for at least 20 minutes.  The pressure should stop the bleeding.  If it persists after at least 2  attempts, contact the department or attend A&E outside of our working hours.

• Pain: Pain relief such as paracetamol or ibuprofen can be used to help manage any pain.  This will gradually improve over 7-10 days.
  If you have an increase in pain after a few days, this may indicate an infection, a dry socket or local irritation, so please seek advice from the department.

• Swelling and Bruising: This is common after surgery but will start to reduce 2-3 days after and resolve by 7-10 days.  Bruising can occur on the face and may affect the neck, which can take up to 2 weeks to resolve.
  

Contact Details 

Approved May 2025                                                                                       Review :  May 2028

Click here to view/download the PDF version of this information.

Generally does not require much aftercare; however, please be aware of the below:

• Some babies may become unsettled and require pain relief. If your baby is over eight weeks old, you can use an age-appropriate paracetamol. If your  baby is under 8 weeks old, you would need to contact a GP for prescribed pain relief
• Expect some bleeding, blood-tinged saliva is normal for the first couple of days after the procedure –  a gauze pack will be given to swab away if needed, and bleeding is minimal. If bleeding should occur, apply firm pressure using a gauze swab for 10 minutes. If it does not settle, contact the department or A&E (emergency only)  if required
• A diamond-shaped ulcer, which appears white/yellow, will be expected to form on the tongue tie area – do not worry, this is completely normal and part of the healing process
• Continue to feed the baby as normal – we will advise you to feed the baby straight after the procedure to provide comfort
• Issues are rare following the tongue tie procedure

If you need any further advice or issues, please contact the Maxillofacial Department on 01782 674801 between 9.00 -16.30 Monday to Friday.

Outside of our opening times you will need to visit your GP or A&E (emergency only)

Approved May 2025                                                Review :  May 2028

Click here to view/download the PDF version of this information.

This information will explain what you need to do on the day of your procedure and after the procedure.  If you have any questions after reading the information, use the contact details at the bottom to speak to one of the team.

If you are unable to make your appointment, please call us on 01782 674185.

On the day of your procedure

• Please bring a Chaperone with you (over 18) to the appointment. They must wait in the department waiting room whilst you have the procedure and then take you home.  You will then need to be looked after for 24 hours.
• Please do not eat 6 hours before the appointment.
• You can drink water up to 2 hours before the procedure.
• Please remove any nail varnish or false nails.
• Wear loose clothing so access is easy when taking your blood pressure or inserting a cannula.
• If you have contact lenses, please do not wear them.
• Please do not bring any valuable items such as jewellery.  Leave them at home.
• Bring any medication with you that you may need such as inhalers.  
• Take medication as normal with a small sip of water unless we tell you otherwise.

After the procedure 

Please drink plenty of fluids to make sure you stay hydrated and eat as normal as this will help you to recover quicker.
A responsible adult will need to be with you during the first 24 hours whilst you recover from the sedation.
 
During the first 24 hours:
•    Do not go out alone.
•    Do not drive a car
•    Do not operate any hazardous devices.  
•    Do not make important decisions or sign any documents.
•    Do not drink alcohol. 
•    Do not breastfeed if you are a nursing mother.

Contact details

Monday to Friday 8.30 am to 4 pm 01782 674801    

Approved May 2025                                                 Review :  May 2028

Click here to view/download the PDF version of this information.

Your consultant has suggested a parotidectomy and this leaflet provide information about the procedure, risks and benefits. If after reading the leaflet you have any questions, please speak to a member of the team. 

What is a Parotidectomy?

Parotidectomy is the partial or complete removal of the parotid gland.
The Parotid Gland  (known as the Spit Gland), is a salivary gland that lies either side of your face immediately in front of the ear.
Saliva drains from it through a tube that opens on the  inside of the cheek next to the upper back teeth.

Preparing for the procedure

Please inform your consultant or let one of the team know if you are taking blood-thinning medication, such as Apixaban, Warfarin.  
Please also tell them if you are taking herbal remedies or over-the-counter medication.

This is a routine procedure carried out under a general anaesthetic. 
A local anaesthetic may also be given to numb the area whilst you are asleep to help with any pain afterwards.

The procedure takes up to 3 hours. Most patients only stay only one night in the hospital.

The procedure

A consent form will be given to you to sign, and you will have the opportunity to ask any questions.

A cut will be made immediately in front of the ear.  This will extend downwards into the neck behind the ear.

Some of the skin will be lifted away to locate the gland and facial nerve. 

The gland/lump will be removed holding the incision together with clips or stitches (sutures).  These will be removed about 1 week after surgery.  

At the end of the surgery, a small tube is placed through the skin into the underlying wound to drain any blood’/fluids. This is removed the next day.

After the operation

There may be some swelling after the removal of the gland.
You may be left with a scar however, this will fade over time and is difficult to see when fully healed.

Going home

You must keep the wound dry for 1 week after surgery. Please take care when shaving or washing.

Do not do any strenuous activity such as lifting heavy weights etc.
You will need to take at least 1 week off work.  

Follow up

A follow up appointment will be made to have your stitches removed 7-10 days after your operation.  

A second follow up appointment is made with your consultant for 4-6 weeks to discuss your results and see how you are doing.

Risks

• Pain, bleeding, swelling and leakage from the wound. Advice will be provided before you go home.
• Infection: Sometimes a lump can form in the gland and can cause repeated infections.
• Numb or tingling earlobe: This can happen when the nerve is removed to gain access to the gland.
• Nerve damage: This is usually temporary and can happen from bruising, causing weakness of the muscles to one side of your face.  It takes a few months to recover fully.
• Excessive ear sweating can happen after the parotid gland is removed.  It is noticeable around mealtimes when the skin can turn red and feel warm. Simple treatments help and no further surgery is required.

Contact Details

Approved:       June 2025      Review Date:  May 2027

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This leaflet provides you with information on atypical facial pain and will help you to understand the causes and symptoms. If after reading the leaflet, you have any questions, please speak to one of the nursing staff.

What is atypical pain?

This is a pain affecting the cheeks, eyes, jaws and non-muscular areas of the face. It is a chronic long-term pain condition also known as persistent orofacial pain.

Examination of the mouth and face usually reveals no abnormalities or obvious sources of pain. This does not mean that we think you are imagining your symptoms. The pain is real and arises in cramped muscles and dilated blood vessels as a response to stress.

Some experience a continuous pain or severe discomfort in the teeth or tooth sockets of previously extracted teeth.  Where there is no true dental cause, this is called atypical odontalgia.  Dental treatment can increase the pain, sometimes moving from tooth to tooth.

Patients sometimes suffer from other stress-related problems such as tension headaches, migraines, chronic lower back pain, painful periods, irritable bowel and itchy skin. 

Antidepressant medications may be prescribed as these can help relieve the pain in some patients. To be effective, these need to be taken over several months. 

Causes of atypical facial pain

The cause is unknown however, in some patients, the pain starts after they have had surgery, dental treatment or an injury to the face/mouth. 

It is thought due to the pain-conducting nerves becoming overly sensitive that instead of the pain ceasing, the pain will continue to persist even when everything has healed. This can lead to atypical facial pain.

Symptoms of atypical facial pain

Symptoms include:

• A dull ache.
• Crushing or burning sensation.
• Throbbing in the face or mouth.

The pain may not always stay in one area but may move to other parts of the face.

The pain is usually continuous but may come and go. Common painkillers do not usually help the pain.

Diagnosing atypical facial pain

There is no diagnostic test for atypical facial pain.  The diagnosis relies largely on the description of symptoms and examination of the face, neck, jaw, mouth, teeth and gums.

In order to exclude other causes of facial pain, X-rays of the teeth, head and neck may be required.

Treatment of atypical facial pain

There is no cure and so treatment is given to reduce the severity of symptoms and pain.

Anti-depressant drugs can be used to reduce the severity of any pain by reducing the sensitivity of the nerves controlling the pain.

Other treatments may include cognitive behavioural therapy which helps to be able to cope with any long-term symptoms.

Hints and Tips

• Keep active and maintain a healthy lifestyle and balanced diet
• Learn more about managing chronic pain as this will help you to come to terms with your symptoms
• Visit your dentist regularly and ask for advice about good oral hygiene.  This will help prevent tooth decay or gum disease which can make pain symptoms worse.
• Treatment is available if you develop a low mood, are feeling sad or unable to cope.  Please ask for professional help.

Contact Details

Approved: June 2025            Review Date: September 2028

Click here to view/download the PDF version of this information.

This leaflet provides you with information on what to expect during your treatment.

What is lichen planus?

Lichen planus is a well-recognised condition which generally occurs in 30 to 70-year-olds and in all sexes.  It affects:

• The skin.  Usually the arms, especially the wrist, legs and the shins.
• The lining of the mouth.  This can range from slightly raised white lines in an interwoven lacy ring-like pattern to the most common form of white patches, redness and ulcers.
  The white patches last on average 4 years but can last up to 10-15 years.
  If it occurs on one cheek, it will usually be the same on the other (symmetrical). Sometimes it may not be symmetrical if the cheek or tongue is in contact with a metal (amalgam) filling.
• Gastrointestinal tract. This is the tube which leads from the throat to the stomach.  Further information will be provided at the appointment.
• The reproductive organs in all sexes.

What causes lichen planus?

It is not known or fully understood what causes lichen planus; however, it is non-infectious.
Certain drugs, such as those used in the treatment of diabetes, high blood pressure and rheumatoid arthritis, can cause lichen planus type lesions.  These are not usually symmetrical and are called ‘lichenoid reactions’.

Lichen planus treatment

The consultant may wish to take a small sample (biopsy) of any affected area to confirm the diagnosis if lesions are found.

This is a simple procedure and is carried out with a local anaesthetic. The treatment can reduce the soreness that lichen planus can cause.

The treatment often involves the use of steroids as they dampen down the immune response. These can be in the form of a mouthwash and sometimes an injection to the area.

What can I do to help the condition?

You can help yourself by:

• Avoiding spicy foods.
• Eating plenty of fresh fruit, vegetables and yoghurt.
• Maintaining good oral hygiene.
• Making regular visits to the dentist/oral surgeon.

Contact Details

Click here to view/download the PDF version of this information.

This leaflet provides you with information on what to expect during your treatment and will help you to understand what is involved.  If, after reading the leaflet, you have any questions, please speak to one of the nursing staff.

What is a mandible lower jaw fracture?

Your lower jaw has been broken, and the number of fractures that have occurred that require treatment to help them heal has been established by the doctor who examined you.

During the operation

• The treatment involves an anaesthetic which will put you to sleep completely.  Once you are asleep, the fracture site will be opened up.
• A cut will be made on the inside of your mouth through the gum.  
• In very difficult fractures, it is sometimes necessary to make a cut on the outside of the mouth through the skin. This will be discussed with you prior to signing the consent form.
• The broken bones are then put back together and held in place with small metal plates and screws.
• Sometimes screws are inserted into the jawbone above the teeth instead of wires or braces.
• Occasionally, it is necessary to remove damaged or decayed teeth at the site of the fracture.
• The gum is stitched back into place with dissolvable stitches. These can take up to 6 weeks to dissolve.
• Your jaw will be able to move freely when you wake up from surgery.
• Antibiotics will be given to you through a vein in your arm whilst you are in hospital so that your fractures can heal without any infection.

After the operation

• The position of the fractures will be checked with X-rays before you are allowed home.
• It is sometimes necessary to place wires or metal braces around your teeth so that elastic bands can be attached to them.  This helps guide your bite into the correct position following your surgery.  
• The wires or metal braces will be removed in the outpatient clinic once the doctor is happy that the fracture has healed.
• You may feel sore, and regular painkillers will be given to you to control the pain.
• The plates and screws hold the fractures in place; however, it will take around 6 weeks for your lower jaw to heal completely.
• Any discomfort you feel should only last for a few days, however, it may take a few weeks to completely disappear.

Recovery period

During the 6-week recovery period:

• Only eat a soft diet.  This will be discussed with you by the dietitian.
• Starting the day after surgery, gently rinse your mouth with a mouthwash or warm salt water. (1 teaspoon of salt dissolved in a cup of warm water).
• Continue to keep your mouth clean for the first few weeks to prevent infection, as it will be difficult to clean your teeth due to the soreness around the stitches. 

Travel and work

• Depending on the nature of your work, it may be necessary to take 2 weeks off work.
• Do not drive or operate machinery for 48 hours after your general anaesthetic.
• Avoid strenuous exercise during the first 2 weeks.
• The metal that is used is titanium, which does not set off metal detectors in airports, etc. 

Risks and side effects

• Bleeding from the cuts inside your mouth is unlikely however, 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 swab.
• The nerve that runs through the centre of the lower jaw that supplies feeling to your lower lip, chin and bottom teeth, may have been bruised at the time of the fracture.  
• If you felt some tingling before the operation in your lip and or chin, it may become worse as a result of the surgery.  
• The numbness should get better on its own over several months. Occasionally, the numbness is permanent.
• Occasionally, teeth adjacent to the fracture site may be damaged and require removal at the time of surgery or later.
• Infection is rare; however, if this happens, the plate and screws in your jaw will need to be removed.

Follow up

A review appointment will be arranged before you leave the hospital. This is so that you can be monitored over a period of several months to make sure your jaw heals correctly.

Contact Details

Reapproved: September 2025            Review Date: September 2028

Click here to view/download the PDF version of this information.

This leaflet provides you with information on what to expect during your treatment and will help you to understand what is involved.  If after reading the leaflet, you have any questions, please speak to one of the nursing staff.

What is an orbital (eye socket) fracture?

The eye socket or orbit is made up of bones surrounding your eye.  If the bones around your eye are hit hard enough, they can break. This is called an orbital fracture.
Some people with an eye socket fracture also have eye injuries that can affect their vision.

Types of eye socket fractures

Orbital rim fractures: These occur when the eye socket is struck violently with a hard object, such as a steering wheel in a car accident. 
A piece of bone may break off and be pushed in the direction of the blow.
The damage happens in more than one area of the eye socket.
A tripod fracture or a zygomaticomaxillary complex (ZMC) fracture is common and involves all 3 major parts of the eye socket. 
Indirect orbital floor fracture ("blowout fracture"): This occurs when the bony rim of the eye remains intact, but the paper-thin floor of the eye socket cracks or ruptures. 
This can cause a small hole in the floor of the eye socket that can trap parts of the eye muscles and surrounding structures. 
The injured eye may not move normally in its socket, which can cause double vision. 
Trapdoor Fracture: The bone under your eye can swing down when broken and then swing shut, trapping the muscle that moves your eye down. 
Even if the bones do not look broken, a trapdoor fracture causes pain, severe double vision, nausea, and vomiting. 
This type of fracture is more common in children because their bones are more flexible than adult bones 

Symptoms of eye socket fractures

Symptoms may include:

• Decreased vision or double vision.
• Pain, bruising, drainage, tearing, bleeding, or swelling in and around your eye, nose, or cheeks.
• Numbness in your eyelids, cheek, side of the nose, upper lip, teeth and gums.
• Nausea and vomiting which are more common in trapdoor fractures.
• Trouble moving your eye in one or more directions.
• Sunken eye, droopy eyelid or an eye that bulges out.
• Swelling caused by air under the skin and that feels crunchy when touched.

Diagnosing the Fracture

• A doctor will examine your eye movements (upwards, downwards and sideways).
• Any change in vision, especially double vision or a change in eye position, i.e. sunken.
• Double vision may occur due to soft tissue swelling, which recovers on its own, however can take several weeks.
• In the short term, an eye patch or prism can improve the double vision.
• More severe blow-out fractures require treatment to get better.
• Recovery can be complete or partial. In a partial recovery, some muscle weakness is still noticeable long-term.
• A CT or MRI scan may be needed of the facial bones to confirm the fracture. 

Treating the fracture

Eye sockets do not always need surgery and your doctor will tell you if your fracture can heal on its own.
In the short term, an eye patch or prism can improve any double vision. 
If you avoid blowing your nose for several weeks after the injury, this can prevent any infection spreading from the sinuses to the eye socket tissue.
Antibiotics may be prescribed to help prevent any infection from occurring.

Surgery

There may be a reason why surgery is necessary, which may include:

• Experiencing double vision for days after the injury. Double vision can be a sign of damage to one of the eye muscles that help move your eye.
• The eyeball falls back or sinks in the socket (enophthalmos). 

The surgeon may decide to wait for a few weeks after the injury so the swelling can go down. This will help with a more accurate examination of the eye socket.
If surgery is needed, a general anaesthetic is used so you are asleep and will not feel any pain.
A small incision (cut) is made at the outside corner of the eye in the skin crease just below the lower eyelashes or on the inside of your eyelid. 
The break in the bones may be repaired with metal plates, which usually stay in and are not removed.

After surgery

• You will be required to stay overnight in the hospital and will be closely monitored.
• You may need to take 2 weeks off work, depending on the type of work you do.
• Please rest and avoid any strenuous exercise.
• Do not operate machinery or drive for at least 48 hours after surgery.
• Antibiotics will be prescribed and painkillers for 1 week.
• You will need to use ice packs on the area for a period of 1 week. Avoid blowing your nose.
• Any follow up appointments will be arranged for you with your surgeon.

Possible complications

• Any cuts made on the face will produce a scar.  These will fade with time and after a few months, are usually difficult to see.
• Eye sight problems due to bleeding in and around the eye socket, but this is rare.
• As a result of a cut made in the lower eyelid skin, the outside corner of the lid may occasionally be pulled down slightly (an ectropion). This tends to settle on its own but may need further surgery.
• If your vision or pain in and around your eye becomes worse when you get home, return to the hospital immediately.
• It is rare to have any infection problems due to the plates or screws in your cheekbone; however, if this occurs, they will be removed.  
• Nerve damage can occur during surgery, causing numbness and tingling.  This will get better on its own for most people, but it takes a few months. It rarely results in any permanent reduction in sensation.

Double vision surgery correction

The Orthoptist will check, test and measure the position and movement of the eyes to help predict the likely surgical outcome
In severe cases of orbital blowout fractures, permanent damage to the eye movement muscles can occur.  
Surgery on eye movement muscles can improve double vision for some people however, there may be some residual eye muscle weakness after a period of recovery or the muscles may not recover.
The success of the surgery depends on how many muscles have been affected and to what extent.

Prisms

Prisms come in different strengths.  At first, you will be given a temporary prism which will be stuck onto your own glasses or a plain pair of glasses from the hospital.  
Some prisms can be incorporated long-term into your glasses lens. This would usually be 6 months or more after the injury.
Prisms can sometimes be used to join double vision back to single. The prism bends light to move the displaced images closer together.

Contact Details

Reapproved: September 2025            Review Date: September 2028

Click here to view/download the PDF version of this information (which includes images).

This leaflet provides you with information on wisdom teeth.  If after reading the leaflet, you have any questions, please speak to a member of the team. 

Wisdom Teeth

Most people have 4 wisdom teeth, one in each corner.  These grow at the back of your gums during the late teens or early twenties and are the last teeth to come through. 
There is not always enough room in the mouth for the wisdom teeth to grow properly due to the other 28 teeth which are in place.
Due to a lack of space in the mouth, wisdom teeth can come through partially, at an angle or get stuck.  Wisdom teeth that grow through like this are known as ‘impacted’.

Removal of wisdom teeth

Your wisdom teeth will not need to be removed if they are ’impacted’ and not causing any problems.
Wisdom teeth, which have not fully broken through the surface of the gum, however, may cause dental problems.  
A buildup of plaque can happen as a result of food and bacteria getting trapped around the edge of the wisdom teeth.  If this happens, it can cause:

• Tooth Decay.
• Pericoronitis.  Infection of the soft tissue surrounding the tooth.
• Cellulitis.  Bacterial Infection in the cheek, tongue or throat.
• Abscess.  Bacterial Infection leading to a collection of pus in or around the wisdom teeth.
• Cysts and Benign Growths.  Very rarely, a wisdom tooth that hasn't cut through the gum develops a cyst (a fluid-filled swelling).

Antibiotics and antiseptic mouthwash can help treat many of these problems.
Wisdom teeth removal is only recommended when other treatments have not worked, unless it is heavily broken down or fractured.

Before wisdom teeth removal

Investigations, including a radiographic image of the tooth, are carried out before the removal procedure to make sure this is the best option.  
You will need to sign a consent form to confirm your understanding of the risks and benefits involved with a wisdom tooth extraction.
Options of anaesthesia will also be discussed with you so that you can decide on a local or general anaesthetic or sedation.

During the removal of wisdom teeth

• A local anaesthetic will be given to numb the area around the tooth.  This can last up to  4 hours.
• You will feel some pressure just before the tooth is removed, but no sharp pain.
• The surgeon may rock the tooth gently back and forth to loosen this from the tooth socket. 
• A small cut in the gum may be necessary to allow better access to the tooth.
• The tooth may need to be drilled into smaller pieces for safer removal. 
• The removal can take between 5 to 30 minutes. Dissolving stitches may also be used.

After the removal of wisdom teeth

Full instructions are given to you on how to manage any symptoms.
You may have some swelling and discomfort both inside and outside your mouth. Mild bruising and stiffness of the jaw are also likely. 
The symptoms are usually at their worst in the first 3-4 days after the dental extraction. Some, however, can last up to 2 weeks.  
Stitches can take up to 6 weeks or more to dissolve.
Please take some pain relief whilst you are still numb so that as the anaesthetic wears off, the pain relief can take effect and minimise your discomfort. 
In some cases, antibiotics are prescribed if you have any ongoing infection. 

During the first 24 hours after removal 

• Do not rinse your mouth out with liquid.
• Do not spit out blood.
• Do not drink alcohol.
• Do not smoke.
• Do not drink hot liquids such as tea or soup.
• Do not do any strenuous or physical activity.

Risks and complications

As with any type of surgery, there are risks.  Below are some complications that may arise following your wisdom tooth removal:

• Dry Socket: A blood clot fails to develop in the tooth socket, or the blood clot may become dislodged.
• Nerve injury: This can cause temporary or permanent problems such as tingling or numbness.
• Infection: Signs include a high temperature, yellow or white discharge from the extraction site, persistent pain and swelling.
• Bleeding: Small amounts are normal for at least 48 hours after removal.

Please contact your dentist if you have signs of infection or if you are bleeding heavily from the extraction site.

Follow up

• Please keep brushing as normal, avoiding the site of extraction until this area has healed.
• Bathe the mouth with warm salt water gently after meals.
• Make sure you finish any antibiotics prescribed.
• A check-up appointment may be arranged for about 1 week or so after the procedure.
• Any remaining stitches may be removed at your first appointment.

Contact Details

Reapproved: September 2025            Review Date: September 2028

Click here to view/download the PDF version of this information.

This leaflet provides you with information on what to expect during your treatment and will help you to understand what is involved.  If after reading the leaflet, you have any questions, please speak to one of the nursing staff.

What is orthognathic surgery?

Orthognathic surgery involves the modification of the jaws in order to change their alignment and position. It improves both the function and appearance of the mouth and sometimes the airway (how you breathe).

What does orthognathic surgery involve?

For the best results, orthodontics and orthognathic surgery should be planned together. 
The alteration of the positions of both your jaw and teeth is not a speedy process.
The details of what to expect will be explained to you by your orthodontist and maxillofacial surgeon.
You will be asleep under general anaesthetic whilst the surgery is carried out.

Preparing for surgery

You will be required to wear fixed appliances/braces for a period of time before surgery.

During surgery

• The surgery will aim to reposition part or all of the top and/or lower jaw(s).
• The surgeon will usually gain access to the bones inside the mouth via the gums.
• Once the areas of bone have been revealed and loosened, they are moved into a new position and fixed in place with small metal plates and screws.  
• The screws will remain in the bone.
• Sometimes, you may require a plastic splint on the teeth to locate the bite after the operation..
• Great care is taken to protect the nerves that run through the jaws, although sometimes these can be damaged during the surgery.
• Dissolving stitches are used to neatly close up the gums.
• The only visible scars will be tiny white lines along your gum line

After surgery

• You will feel sleepy when you wake up from the anaesthetic and will have swelling and soreness around the mouth and face.  
• There will be some multi-coloured bruising on your swollen face but as the swelling goes down and the bruising fades, you will start to see improvements to your face.
• Some areas of your face may feel numb however, this will recover with time.   
  You may have some bruising, especially under your chin and on your neck, due to resolving bruising from your jaw.
  You will usually be able to open your mouth when you first wake up however, you are likely to have elastic bands on the braces to guide your teeth into their new bite.
  You will spend a couple of days in the hospital and further X-rays may be taken.  You will be provided with some dietary advice, and your pain will be kept under control.
  It will take a couple of days for you to be up and about and around 1 month to get back into a normal routine.

Recovery period

The length of time it takes for people to heal depends on how old and fit you are but in general, the jaw bones are almost healed after 2 to 3 months.
To aid recovery and healing, please follow the recovery plan below:

• Depending on the nature of your work, it may be necessary to take 2 to 4 weeks off work, school or college.
  Your mouth and braces will need to be kept clean to prevent any infection, and you will be shown by the dental hygienist how to do this.
• The elastics that hold your teeth in their new alignment will need to be replaced with fresh ones as the elastic bands lose their flexibility.  This will be done by us before you leave the hospital and you will be shown how to do this yourself at home.
• You will only be able to eat small amounts for the first few months. Staff will advise you on how to prepare liquid and soft diets that are nutritious. You may need a blender to prepare easy-to-eat food.

Follow up

• You will be reviewed regularly during the month after your orthognathic surgery to monitor and assess your progress.
• You will then be seen after 3 months and after 6 months.
• Orthodontic appointments will also be arranged for you to adjust your braces in addition to the above.

Further surgery

Most people require at least some orthodontic treatment after surgery to fine-tune the tooth alignment and obtain the best fit of the upper and lower teeth in the new position of the jaws.  This can take from 3 to 12 months, after which the fixed braces are removed.
Once the fixed braces are removed, there is usually a settling in of the teeth.  
During this time, fixed or removable retainers are used to control unwanted tooth movement.
In the upper jaw, a removable retainer is usually used, which can be removed for cleaning.
In the lower jaw, a discreet fixed retainer is usually glued behind the lower front teeth and can be used for up to 12 months.

Numbness in orthognathic surgery

Numbness (known as paraesthesia) is a reduction in the sensation of an area where there are sensory nerves and their nerve endings.
The larger nerves that run through the upper and lower jaws are usually bruised during the surgery and can be prone to injury. 
Numbness after the operation is common but will usually improve with time and tends to fully resolve. 
Occasionally, you may be left with a long-term change in sensation in areas of your face, particularly the lower lip and chin. This happens in about 15% (15 in 100) patients. 
If injured, nerves can repair themselves if they are just bruised and if the cut ends lie closely, can mend on their own.  
The movement of the face and lips should not be affected by orthognathic surgery.

Possible risks/side effects

• You may experience some numbness in the cheeks, upper lip and teeth if we have moved your upper jaw.
• You may experience some numbness in the lower lip, chin and teeth and possibly the tongue if we moved your lower jaw.

Contact Details

Approved: September 2023          Review Date: September 2026

Click here to view/download the PDF version of this information (which includes images).

This leaflet provides you with information on frequently asked questions about Jaw Surgery and your hospital stay.
If after reading the leaflet, you have any questions, please speak to one of the nursing staff.

Before your surgery

• A number of additional appointments are necessary so that we can plan your operation in detail. 
• We will need to take a set of impressions (moulds) of your teeth and measurements, X-rays or CT scans. 
• Sometimes virtual surgical planning (VSP) will be used to guide your surgeon to fit and correct the jaw segment position during the procedure for the most best result. 

Preparing for surgery

• Your jaw surgery may be on either your upper or lower jaw (single jaw osteotomy) or both jaws (bimaxillary osteotomy).
• This is performed under General Anaesthetic (GA) and can take between 2-5 hours. 
• You are likely to be in hospital for 2-4 days, depending on your progress and how quickly you recover.

Upper jaw (maxillary osteotomy)

• An incision is made in the gum above the teeth in the upper jaw. There are no incisions made on the face. 
• The upper jaw is then cut with a small saw to allow it to be broken in a controlled manner. 
• It is then moved into its new position, which has been predetermined during surgical planning with the aid of models of your teeth. 
• A small plastic wafer is attached to the teeth to allow the new position of the upper jaw to be made.  This is then fixed into place with small metal plates and screws, which are made of titanium (an inert metal) and are safe to be used in the body. 
• The gum is stitched back into place with dissolvable stitches.

Upper jaw surgery will correct:

• A significantly receded or protruding upper jaw.
• Crossbite.
• Too much or too little of the teeth showing.
• An open bite.
• Reduced facial growth of the middle of the face (midfacial hypoplasia).

Lower jaw (mandibular osteotomy)

• An incision is made at the back of the mouth in the gum by the molar teeth to gain access to the jaw.
• The lower jaw is then cut in an oblique fashion with a small saw to allow it to be broken in a controlled manner. 
• It is then moved into its new position, which has been predetermined during surgical planning with the aid of models of your teeth.
• A small plastic wafer is attached to the teeth to allow a new position of the lower jaw to be made.  These are then fixed into place with small metal plates and screws made of titanium. 
• The gum is stitched back into place with dissolvable stitches.

A mandibular osteotomy corrects:

• A receding lower jaw.
• A protruding lower jaw.

Chin surgery (genioplasty)

• This is performed through an intra-oral incision.
• During a sliding genioplasty, a small piece of the bottom part of the chin bone is cut away from the rest of the jaw using a very small saw.
• This is then repositioned to a better cosmetic position before being fixed into its new position with very small titanium plates and screws. 
• Unlike chin augmentations using chin implants, corrects and amends the bone structure so the result is permanent.  

After your operation

Jaw healing takes about 6 weeks after surgery, but complete healing can take up to 12 weeks.
Your surgeon will provide you with instructions which include:

• What you can eat.
• Oral hygiene.
• Avoiding tobacco.
• Avoiding strenuous activity.
• Medications to control pain.
• When to return to work or school. (usually 1 to 3 weeks)

Risks and complications

As with any operation, there can be complications. This type of surgery, although rare, includes the following risks you need to be aware of:

Bleeding: Significant risk of bleeding is low, with about 1% needing a blood transfusion. This would only be given if absolutely necessary. 
If there was significant bleeding during surgery, a small incision may need to be made in a crease in the neck to gain access to the blood vessels to stop the bleeding.
Oozing from the cuts inside your mouth: This is normal on the night of the operation. Often, you will notice slight bleeding from your nose or a blocked nose, which may take a week or so to settle.  Please do not attempt to blow your nose for a few days after your operation.
Numbness: Your top or bottom lip may be numb and tingly after the operation. This feeling is similar to the sensation after having an injection at the dentist. The numbness may take several weeks to disappear.
Infection: The small plates and screws that hold your jaw in its new position are usually left in place permanently. Occasionally, they can become infected and need to be removed.  If this happens, it is usually several months after surgery.
Adjustment of the bite: A few weeks after surgery, it is necessary to put elastic bands on your orthodontic braces to guide your bite into its new position.  A second small operation may be required to reposition the fixing plates and screws if your new bite is not quite right, however, this is rare.
Non-union: Occasionally, bones do not heal as they should and a second procedure may be required.  Problems like this usually occur in smokers or in those who are immunosuppressed, such as diabetics.

Contact Details

Approved: September 2023            Review Date: September 2026

Click here to view/download the PDF version of this information.

This leaflet provides you with information on what to expect during your treatment and will help you to understand what is involved. If after reading the leaflet, you have any questions, please speak to one of the nursing staff.

What is a fractured zygoma?

This is when it is broken due to an injury. The cheekbone forms part of the eye socket and protects the eyeball and supports it from below.
It is linked to the side of the nose and upper jaw. Your doctor will decide on the appropriate treatment depending on the number of fractures, where it occurred and how badly it is broken.

Preparing for surgery

You will be discharged the next day after your operation.  
You will have X-rays before you are allowed to go home to check the position of your cheekbone.

What does surgery involve?

You will be anaesthetised (put to sleep) and the cheekbone will be put in the right place.
A small cut, about 1 inch long, will be made through the hair in the temple.

Small metal plates and screws are sometimes used to hold your cheekbone in position.  If this is necessary during surgery, there may be 1 or more cuts required, which include:

• A cut made close to the outside end of the eyebrow.
• A cut made on the inside of the mouth through the gum above the back teeth.
• A cut made in the skin crease just below the lower eyelashes or the inside of the lower eyelid.  This can be because of the fracture in the cheekbone, producing a break in the floor of the eye socket.  

Any cuts made are put back together at the end of the operation with stitches.
Stitches on the skin need to be removed after a week however, stitches inside the mouth will be dissolvable and can take up to 6 weeks or longer to fall out.
If the bones in the floor of the eye socket are shattered and do not support the eyeball properly, it may be necessary to ‘graft’ the floor of the eye socket to support the eyeball.  As the materials used in this process include thin sheets of titanium, plastic or bone grafted from other areas of your body,     consent and your options will be discussed with you prior to any procedure.

After surgery

• You will feel sore and regular painkillers will be arranged for you.
• The discomfort is at its worst during the first few days following surgery and may take a couple of weeks to completely disappear.
• Cheekbone fractures should heal without any infection however, sometimes antibiotics are necessary, particularly if a ’graft’ has been used.  Antibiotics are given through a vein in your arm whilst in hospital and a course of antibiotics may be given to you to take home along with some painkillers.
• In the first 24 hours after surgery, you may see some bruising and swelling in the skin around the eyelids.  Occasionally, the whites of the eyes may become bruised, giving them a red appearance. These will reduce within 2 weeks.  A cold compress can help, as well as sleeping propped upright for the first few days.
• It can take up to 6 weeks for your cheekbone to heal completely. Take great care to avoid any injury to this side of your face, as it can push the cheekbone back out of position.

Aftercare

• Do not blow your nose on the side of the fracture for a period of 1 month, as it can cause swelling around the eye.
• Please make sure that stitches or dressings are kept dry until they are removed.
• If you have any incisions inside your mouth, cleaning your teeth may be difficult. To help with this, please rinse your mouth with a mouthwash or warm salt water (dissolve a flat teaspoon of kitchen salt in a cup of warm water) the day after surgery. This will help keep your mouth area free from food debris.

Time off work

• Please take 2 weeks off work to aid recovery.  
• Do not do any strenuous exercise for 2 weeks.
• Do not operate machinery for at least 48 hours following surgery.

Driving
Do not drive for 48 hours following surgery.

Follow up 

An appointment will be made for you at the hospital to remove the stitches.  A review appointment may also be provided so that the healing of your fracture can be monitored.

Possible risks/side effects

Post –op numbness: There is a nerve that runs through the cheekbone that supplies feeling to the cheek, side of your nose and upper lip. This nerve may have been bruised at the time of the fracture and as a result, you might already feel some tingling or numbness over your face. 
The tingling may also be caused or made worse by surgery.   In the majority of people, the numbness gets better on its own, although it may take several months to do so. In very few cases, the sensation never fully recovers.
Scarring: Any cuts made on the face will produce a scar. These should fade with time and after a few months are usually difficult to see.
Post op bleeding: Bleeding from the incisions is unlikely to be a problem however, 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 swab.
Post op bruising & swelling: There will be some swelling and bruising at the operation site after surgery, which will settle with time. You may also develop a black eye.
Blindness: Bleeding in and around the eye socket can very rarely cause a problem with the eyesight immediately following surgery.
You will be closely monitored in the first few hours after your operation to check if this happens, so it can be dealt with quickly.
If you experience worsening vision or pain in and around your eye when you get home, you should return to the hospital immediately.
Lower eyelid malposition: If a cut is made in the skin of the lower eyelid, the outside corner of the lid may occasionally be pulled down slightly (called ectropion). This tends to settle on its own but may need further surgery.
Plate removal: If it has been necessary to put any plates or screws in your cheekbone to hold it in position, these are not usually removed.  This is because they do not cause problems unless they become infected. 
The metal that is used is titanium and does not set off metal detectors in airports, etc.

Contact Details

Reapproved: September 2025           Review Date: September 2028