Nutritional Intervention in Oral and Maxillofacial Surgery: An Overview

Introduction

Any disease of the oral and maxillofacial region or surgery of the maxillofacial or oral structures would naturally result in a more impaired state of food intake. Improper food intake can happen before or after the oral procedure or surgery. The severity and duration of this impairment are dependent more on the individual's extent of disease or disease state. Hence, the nutritional requirements of patients undergoing maxillofacial surgeries should be given importance by the oral surgeon even before any surgical intervention.

What Are the Nutritional Interventions for Various Oral Procedures Undertaken by the Patient?

Nutrition needs vary amongst the different fields of dentistry and oral surgery. These are as follows:

1. Maxillofacial Surgery - These surgeries are usually performed to fix a disease, abnormality, or injury affecting the mouth, jaw, and face. These surgeries often delay or lengthen the process of oral wound healing. Therefore, the oral surgeon usually opts for minimally invasive procedures or controlled injury in this location that needs to be excised, or even reconstructed. However, this again depends upon the extent of orofacial injury or the cause of the condition. The body is more dependent on retaining its energy through proper diet and nutrition after oral maxillofacial surgery. The patient's exhaustion can be relieved only by meeting their nutritional requirements at a higher range.

Common examples of maxillofacial surgery impacting nutrition would be in individuals who have their post-cancer treatment by chemotherapy or through radiotherapy. Therefore, in such cases, as a side effect of these interventions, dry mouth or xerostomia, oral mucositis (inflamed or sore gut) or chemotherapy-induced mucositis, radiation therapy-induced mucositis, or altered taste sensations can be common clinical symptoms. In these patients, proper nutrition and dietary counseling are essential or else weight loss would be a further complication leading to physical strain or loss of endurance.

2. Post-wisdom Tooth Extraction or Removal - Mostly the procedure is done after administration of local anesthesia or at the times when a wisdom tooth or impacted tooth extraction is performed under general anesthesia, post-operative care or protocols have to be followed by patients in proper measure. For example, after a routine single-day postoperative period, patients are advised to refrain from consuming hot and spicy foods or eat only soft, and bland diets. Also, drinking through a straw, smoking, or consuming alcohol would further aggravate dental complications and interfere with wound healing. Therefore, proper soft, and bland diet nutrient-rich food is usually advised by the oral surgeon or dentist to prevent oral wound healing complications.

3. After Dental Implantation or After Exposure of an Impacted Tooth - The oral surgeon or oral implantologist advises the patients to drink more or increase the intake of fluids and avoid hot liquids or hot foods. Soft food and liquids are preferred on the day of surgery or dental implantation. Patients can return to their regular diet only after the follow-up is done in a period usually seven to ten days after oral wound healing.

4. Major Jaw Surgeries - In jaw surgeries, such as in the cases of maxillofacial trauma, le fort fractures (complex midface fractures), or orbital fractures (multiple bone fractures around the eye) of the oro-facial cavity, the patient's nutritional needs can be greatly impacted depending on the extent of wound injury and trauma.

In patients following the post-operative protocols of maxillofacial trauma surgeries, dentists or oral surgeons usually advise an increased energy-boosting diet or a more nutrient-based soft food diet to ensure wound healing.

For patients with severe maxillofacial trauma, extended nutrition support plays a pivotal role in wound healing. For instance, in intermaxillary fixation (it is used to support and restore dental occlusion), a liquid diet with varied fruit or veggie juices is recommended. Cooked foods for these patients should be properly blended or possess a liquidized consistency (either juice, milk, water, or broth). Also, a liquid-based diet, that is nutrient-rich, though hard to follow, would prevent food lodgment and oral wound healing issues in the affected patients.

5. Cleft Lip and Cleft Palate Corrective Surgeries - In these surgeries, the patients with cleft lip and palate would require specialized modified feeding strategies both preoperatively and postoperatively.

What Are the Types of Nutritional Interventions in Oral and Maxillofacial Surgery?

Nutrition support is primarily achieved through oral liquid nutrition supplements or enteral tube feeding in patients undergoing maxillofacial or oral surgeries. Therefore, preoperative and postoperative complications, such as prolonged discomfort and recovery, can be avoided if these individuals are supported with adequate nutrition. Following are the types of nutritional interventions in oral and maxillofacial surgery.

• Enteral Nutrition: This type of nutrition support mainly refers to the adequate provision of calories, minerals, trace elements, macronutrient protein, electrolytes, vitamins, and fluids through an intestinal route. This can be done either orally or even through a feeding tube.

• Oral Supplementation: There are wide ranges of varieties of commercially available oral supplements, such as juices, yogurts, or milkshakes. These oral supplements are available as liquid, powder, or as pre-thickened substance types. Oral supplements should contain high protein and fiber ideally. Generally, high-protein oral supplements are the most recommended for patients with extensive oral wounds, and those with oral or orofacial or jaw tumors, cancers, or malignancies. Pre-thickened supplements and puddings are also available commercially for providing much-needed nutritional support to individuals suffering from dysphagia (difficulty swallowing) as a common postoperative complication of oral surgery.

• Parenteral Nutrition: This form of intravenous (through vein or veins) nutrition is comprised of a solution that contains dextrose, amino acids, minerals electrolytes, vitamins, and trace elements. Dental surgeons or oral and maxillofacial surgeons should ensure that the patient has stabilized perioperative nutritional support to fulfill their requirements and boost bodily stamina or endurance post-oral surgery.

Conclusion

To conclude, oral surgeons must correlate with nutritionists or dieticians as an interdisciplinary field to monitor and supervise the patients undergoing any oral surgical procedures for their nutritional needs. Whether it is enteral or parenteral nutrition, monitoring the patient's weight, daily calorie, dietary intake, and fluid balance check is necessary to prevent weight loss, delayed oral wound healing, and other systemic issues postoperatively. Currently, dental researchers are investigating methods to assess the nutritional status and the impact of nutrition on oral health. The link between nutrition and dental treatment or vice versa is considered the way to new-age treatment planning in modern dentistry.