Ensuring Adequate Nutrition After Jaw Surgery
Today’s Dietitian
By Kate Jackson
Vol. 6 No. 6 p. 38

Imagine that you’ve had jaw surgery. Your jaw is wired shut and your mouth is sutured. You’re swollen, in pain, and tired. Clearly, you can’t eat solid food, but you’ve been instructed not to sip through a straw. To help you manage your liquid diet, a nurse brings you a device fashioned out of a urinary catheter and a 50cc syringe. The nurse explains that you must draw up the fluids with the syringe, flip the tubing inside your cheek, and with both hands apply enough pressure on the syringe to squeeze the liquid into your mouth.

The device holds only approximately 3 tablespoons, so it will take you roughly 45 minutes to ingest 8 ounces. If you’re like many patients, you’ll find this method too much effort and tire before adequate calories are consumed. You may lose excess weight following surgery or end up back in the emergency department after discharge suffering from dehydration.

Some individuals recovering from jaw surgery are now drinking and eating with ease thanks to a registered nurse’s determination to solve problems. Fifteen years in postsurgery nursing convinced Susan Beaudette that something needed to be done for jaw surgery patients who are trying to feed themselves and get adequate nutrition. With little more than will and initiative, she took matters into her own hands and invented a device to replace that primitive and awkward feeding tool and followed the success of that project by self-publishing a resource and recipe guide to help patients on liquid diets and the professionals who work with them.

With no experience in manufacturing or publishing, Beaudette credits her ability to launch these successful enterprises to her nursing career. “I’m not a manufacturer; I’m a problem solver,” she explains. “I’ve done acute care, ICU [intensive care unit], and home health nursing, and as a nurse, you become very resourceful.”

Recovery for patients who’ve experienced jaw surgery, says Beaudette, is often more complicated and frustrating than most healthcare personnel realize. Patients frequently state that difficulties with the liquid diet is tops on their list of frustrations. The arduous, messy, inefficient syringing eating system is a large part of the problem.

Beaudette was convinced there had to be a better way. “The syringe and catheter method isn’t even really a feeding device,” she says. “It’s just something that has been put together to help patients whose jaws may be wired or bandaged shut. Sucking on straws after surgery is contraindicated due to the incisions and sutures and can be painful as well. Swelling can make cups difficult to use because the patient can’t draw the fluid to the back of the mouth. Problems like these can easily lead to excessive weight loss, sometimes 20 to 30 pounds or more.”

A PLAYFUL EPIPHANY
Beaudette knew there had to be an alternative eating system; she’d been frustrated watching her patients struggle. The answer came to her at home in a most unexpected way. “One day I was in the kitchen goofing around with my kids. I put some pudding in a bag and bit the corner off and squirted the pudding into their mouths. We were just having fun, but it hit me like a ton of bricks that this was just what my jaw surgery patients needed—a way to squirt food into their mouths,” she says.

A tireless troubleshooter, Beaudette took action. “I got out tape and bags and some IV tubing and began cutting and pasting. I put together an awkward little device and tried to squeeze some stuff through it,” she says. Convinced that she was on to something, she hit the libraries, did research, found a manufacturer, and patented and trademarked the product of her brainstorm—the Zip-n-Squeeze. “We put samples together and did a trial in the hospital. Immediately, the patients were able to drink 8 ounces. They were able to drink fluids like never before and could consume in a minute blended foods that previously would take them as long as 45 minutes to ingest,” she says.

Beaudette then flooded hospitals, doctors’ offices, and oral surgery conventions with samples. The response was so overwhelming that she hasn’t had to do any other marketing. “This venture was nurtured out of love and has grown like wildfire because the patients are like individual messengers,” she says. Beaudette’s Zip-n-Squeeze has earned raves from patients, caregivers, and healthcare providers and has made its way around the world.

Wendy Hicky, RN, and Scott L. Bolding, DDS, MS, of the Maxillofacial Surgery Center, say their patients and nurses are excited about Zip-n-Squeeze. “Many of our patients have temporary lower jaw numbness, which makes it very difficult to drink from a cup or even suck through a straw. These patients typically use the pouches for several weeks after surgery. Many of our trauma patients’ teeth are wired together after surgery for four to six weeks. The Zip-n-Squeeze pouches have definitely changed their recovery period and enabled them to stay hydrated and nourished,” they say.
Hicky and Bolding use the pouches daily in their recovery room. “All of our oral surgery patients have had local anesthesia and are numb while in the recovery room, and the pouches enable us to hydrate them before discharging them to go home. They eliminate the inconvenience of drooling and frustration of getting enough fluids by mouth postoperatively,” they say.

Other patients have been equally enthused. Beaudette has received letters from patients in distant places such as Tokyo, London, Australia, and Israel who think the device—because it’s so simple and makes eating effortless—is a lifesaver. “They can just slip this tubing in the side of their mouths and squeeze and drink,” she says. “Surgeons are telling me that they’re seeing patients recover faster because they’re able to take in the protein they need for the healing process.”

DEMYSTIFYING THE LIQUID DIET
Beaudette didn’t rest on her laurels after the success of the Zip-n-Squeeze. If anything, she was increasingly aware that there were many areas of care for jaw patients that needed improvement. At the top of the list was educating patients about the liquid diet and devising ways to make it easier and more palatable. Jaw surgery patients are discharged and instructed to maintain a liquid diet, but, says Beaudette, they often don’t understand how to follow through with it. Frequently, for example, they rely on too many smoothies and shakes, which lead to fatigue.

Having listened to and counseled jaw surgery patients on a daily basis for years, she’s aware of their needs and frustrations. Participation in an orthognathic support group was an eye opener for her as well. For several years she participated in such a group and interacted with patients, and for several more years she monitored the group, noting that patients’ questions and concerns were always the same. “It all boiled down to the food. They didn’t understand the diet once they got home, and they didn’t know what to eat,” she says.

Doctors, nurses, and dietitians do the best they can to educate patients, Beaudette explains, but when the same questions come up repeatedly, it’s clear that patients aren’t getting adequate education. Even dietitians, despite being nutrition experts, are at a disadvantage, she adds, because they often don’t really know what these patients go through with their jaws wired shut and what kind of food they can get through their feeding tubes. “It’s a tricky thing to blend foods. It’s not as if you can just scrape your whole casserole in a blender and have a meal. Sometimes you can and sometimes you can’t, but there are a lot of neat tricks to blending so that everything isn’t redundant and monotonous,” says Beaudette.

Even when professional guidance is provided, patients are often overwhelmed by the experience of surgery and amount of information they need. “They can’t soak it all up and it often goes over their heads so they forget half of what they’re told,” she says. “Once they’ve had the surgery, there’s a whole new set of questions that emerge at home that they never thought to ask about.”

To fill in this education gap, Beaudette once again took action. To address the concerns of patients and help doctors, nurses, dietitians, and caregivers understand and deliver information, she created a resource guide, The Healing Jaw and a Liquid Diet: A Liquid Diet Resource and Recipe Guidebook for Maxillary Trauma and Reconstructive Jaw Surgery. No mere cookbook, the guide helps patients prepare for surgery, understand the role of nutrition in their recovery, and maximize healing upon discharge from the hospital. She’s filled it with tips and tricks to help patients include more calories, protein, and fats that help slow absorption, making patients feel less hungry. Beaudette also addresses the stages of the liquid diet and the strategies that can make each stage less burdensome. The guide includes journals that make clear what patients need to accomplish in a day—for instance, how many feedings they require and how many calories they must consume.

It was never her intention to write a book, but Beaudette realized she was hearing and answering the same questions day after day. Daily contact with patients coupled with extensive research armed Beaudette with a knowledge about patients’ eating requirements and their nutritional needs. For example, she observes, jaw surgery patients on liquid diets need to understand why carbohydrates, proteins, and fats are important. “A lot of people forget that fats are crucial,” she says, “because they slow down the absorption process. When you’re on a liquid diet, it moves quickly through you, making you feel hungry all the time. In order to maintain the calories you need, you have to eat almost hourly.”

Beaudette stresses the importance of protein for postsurgical patients and offers pointers on getting adequate amounts and optimal sources. “Fatigue is a huge concern for these patients when they go home. Oftentimes they get fatigued because their diet is so poor. However, if patients can maintain calories and protein and eat less sugar, they feel much better,” she says. Feedback from surgeons has convinced her this is true.

Between the Zip-n-Squeeze and her resource guide, Beaudette is contributing to faster healing and quicker recoveries, say doctors and nurses. By all reports, she says, “patients aren’t losing the weight that they did previously, they’re feeling better, and getting back to work sooner.” The professionals who provide nutrition and aftercare education are also benefitting because it saves them clinical time. Not only is it impossible to impart adequate information in the time they have for education, but educators also often find that patients forget much of what is explained to them, frequently calling in or returning with the same questions over and over. With the resource guide, they can emphasize their training and give patients a concrete source of answers they can turn to as questions arise.

To devise the recipes in The Healing Jaw, Beaudette did extensive research and gave her blender a thorough workout. “All I heard was patients complaining about how horrible the food was, how hungry they were on the liquid diet, and how they wanted to eat real food,” she says.

To an avid cook determined to improve the eating experience for jaw surgery patients, that may have sounded like a dare. “I started putting things together, like a baked potato with chili, sour cream, and milk,” she says. The key to a liquid diet, she says, is understanding that you can take a number of different foods that people used to say were taboo—that couldn’t be blended and given to jaw surgery patients—and blend them. You can take that baked potato, chili, and sour cream, she says, and add a tasty cheddar cheese sauce.

The first trick is to liquify everything by adding enough thinning fluid to get the food to a pourable consistency. The second is to use something other than water —perhaps broth or juice—that’s compatible with the nature of the meal. The third is to blend thoroughly, then put everything through a fine mesh strainer. “What you’ve done in this way is to extract the nutrients and the flavor, and pull out the bits and pieces that would otherwise get stuck in the wires of the feeding device.”

These tricks work on prepared food as well. “You can bake a Marie Calender chicken pot pie in the oven as you normally would,” she explains, “then pop the whole thing in a blender, add a cup and a half of milk or broth. Then, just to perk up the flavor, a little salt and pepper, butter, and sour cream, and then blend and blend, adding more liquids as necessary. After you put it through the fine mesh strainer, what comes through tastes better than what you can eat with a fork.”

NOT JUST FOR JAW PATIENTS
Although Zip-n-Squeeze and The Healing Jaw are simplifying life for jaw patients, there’s a wider audience for these products. Beaudette recently got a call from a dietitian who attended a hospital meeting at which the broader patient population was discussed. That facility now wants to use these products for certain cancer patients, those who have had plastic or reconstructive surgery or tongue resection, those with wounds that are healing or who are losing muscle mass and need to sustain their weight, older adults who have had strokes, and people with temporomandibular joint syndrome whose joints are so degenerated that they can’t chew. “Plastic surgeons have asked if they could use it on babies after surgery to repair cleft palates,” she says.

CHANGING THE WORLD ONE MOUTH AT A TIME
Beaudette’s efforts have been so successful that she’s branching out, trying to stay one step ahead of the ideas that percolate in her head. She’s designing a series of feeding bottles for babies and a whole new line of feeding products for children, adults, and elders with disabilities. “I’m on a quest to get the word out that there are easier ways to do things,” says Beaudette. “My goal is to change the standard of care and make people aware that there’s no need to suffer anymore through these difficult recoveries because now there’s an easier way to eat and an easier method to follow.”

For more information, visit www.zip-n-squeeze.com.

— Kate Jackson is a staff writer for Today’s Dietitian.

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