Nutrition in Maxillofacial patients

the unexplored frontier

Dr Ravi Madan (student)

Under guidance of:
Dr A.Tripathi (Prof. & Head)
U.P. King Georges university of Dental
Sciences, Lucknow

Introduction

A patient undergoing maxillofacial surgery is

placed under considerable physical and mental
stress because of depression, shock, anger,
ostracisation and functional impairment.

The above mentioned sequel ,multiplied by the

stress of surgery and postoperative phase and
functional impairment, makes these sufferers
prone to Malnourishment

A multidisciplinary approach starting from

admission continuing life long in follow up will
translate into tremendously improved
prosthodontic prognosis

Why is nutrition important?

Preoperatively, it is important to analyze the

nutritional status of the patient as proteincalorie malnutrition results in

Impaired wound healing

Reduced immunologic function

susceptibility

to infection

tolerance to oncological therapy

Increased stay in ward

Vicious cycle

Anorexia

Malnutrition

Impaired health
and
Depression

Goals of Nutritional Therapy

Provide adequate energy and proteins

Provide fluid balance
Maintain functional performance status
Improve fitness for surgery and anaesthesia
Improve results of surgery and overall
prognosis

Methods of assessing
nutritional status

Nutritional history

% usual weight
Previous history

Anthropometric measurement

% ideal weight
% weight change

Weight
Height
Tricep skin fold thickness
Mid arm circumference

Biochemical measurement

Total lymphocyte count

Serum protein(albumin,transferrin etc)

Indications for nutrition

support

Poor preoperative nutritional status

(oral intake meets <50% of total energy)
Significant weight loss ( initial body weight
less than usual body weight by 10% )
An anticipated duration of Nil per orally
(particularly for TPN) more than 7 days
Serum albumin value less than 3.0gm/100ml

Estimation of nutritional needs

Basal metabolic rate determined by

Harris - Benedict equation
BMR (Male)

= 66+(13.7 wt in kg)
+( 5 ht in cm)
+(6.8 age in yr)

BMR (Female) = 66.5+(9.6 wt in kg)

+(1.7 ht in cm)
+(4.7 age in yr)

Estimation of nutritional needs

Calorie requirement = BMR AF IF

Protein requirement=6.25cal req/150
Activity factor (AF)
lying in bed BMR 1.2
ambulatory BMR 1.3
Injury factor (IF)
maintenance 0 30%
anabolic
40 60%

POST OPERATIVE PHASE

In this period the utilization of oral cavity for

feeding may be hindered by the size of
resection or side effects of chemotherapy.

So alternatives should be sorted out ,like

Nasogastric tube
Total parentral nutrition
Gastrostomy

POST OPERATIVE PHASE

NASOGASTRIC TUBE

Indications

Short term clinical situations

Complications

Aspiration
Ulceration of nasal & esophageal mucosa

POST OPERATIVE PHASE

TOTAL PARENTRAL NUTRITION (TPN)

Indications

Obstruction of GIT
Swallowing is impaired
Immediate post operative phase

Complications

Mechanical thrombus, embolism

Metabolic- fluid and electrolyte derangement
Infections catheter induced sepsis, exit site
injection

POST OPERATIVE PHASE

GASTROSTOMY
Indications

Long term clinical situation

Swallowing disorders
Impaired small bowel absorption

Complications

Aspiration
Irritation around tube exit site
Peritoneal leak

POST OPERATIVE PHASE

To start feeding in early postoperative phase

is an important goal
Oral & pharyngeal edema is nearly subsided.
Tracheotomy tube has been changed to
non-cuffed type.
All incisional closures in mouth are heal.
The patient is able to swallow most of his
own saliva .

Common postoperative
sequelae
Loss

of appetite
Sore mouth
Diarrhoea
Xerostomia
Constipation

Loss of appetite

CAUSE

Aguesia
Xerostomia
Mechanical dysphagia
Depression
Anger

Avoid sharp crunchy foods,foods that are hot,

spicy or high in acid like citrus fruits & juices.
If one cannot eat big meals then eat little
amounts frequently.
Soups, curd & milk shakes are easy to swallow.

Sore mouth

Cause

Xerostomia
Mucositis ( due to depressed epethelial cell
division)

Avoid salty or spicy food or food with rough

texture.
Take soft non-acid blended or liquid foods
such as custards, pureed meat, cottage,
cheese.
Denture wearers should leave denture as
long as possible out of mouth.

Diarrhoea

Cause

Radiotherapy
Secondary to antibiotic therapy
infection

If diarrhoea is caused by radiotherapy,

changing diet will not help and it is
important to take antidiarrhoeals
prescribed by oncologist.
Drink plenty of fluid to replace water and
electrolyte loss (oral rehydration salts)
Eat curd or curd with banana
If it continues , consult physician.

Xerostomia

Cause

Secondary to radiation therapy and drugs

Due to severing of salivary duct and gland
Decreased liquid intake

Frequent drinks help to keep mouth moist.

Tongue coating impair the taste .So to overcome
it clean tongue with a bicarbonate soda solution.
Avoid sticky foods like chocolate and pastry
Use artificial salivary substitutes
Boiled sweets stimulate saliva production.

CONSTIPATION

Cause

Lack of fiber in diet

Stress &anxiety
Generalised muscle weakness
Drugs

Have plenty of fiber (roughage) in your diet,

good source include whole-wheat breakfast
cereals
Natural remedies for constipation

Prunes and Prune juice

Fig
Papaya 200 gm
Keep drinking water in copper utensils &drink 810 glasses of water

Thank you