Post-Operative Care Instructions – SARPE (Surgically Assisted Rapid Palatal Expansion) or DOME (Distraction Osteogenesis Maxillary Expansion)


  • Minor nosebleeds may happen and can last from a few days, up to two weeks. If bleeding becomes excessive and cannot be controlled by pressure and tilting your head, contact our office.


  • Always take medications with food or a glass of water to avoid stomach upset.
  • Take 200 – 600mg of ibuprofen (Motrin, Advil, etc.) as soon as possible and before the numbing wears off. Then, follow up with 500 – 1,000mg of acetaminophen (Tylenol) three hours later. Repeat this cycle every three hours for at least the first day. If you are unable to take ibuprofen or acetaminophen, please inform our staff, and we will create an alternative pain management plan for you.
  • If you find you require additional pain relief, you may substitute acetaminophen with your narcotic pain medication (if prescribed). Always take ibuprofen and choose either acetaminophen or the narcotic pain medication for the second dose.
  • If you find that you feel nauseated after taking the narcotic pain medication, discontinue use. If vomiting occurs, please contact our office for further assistance.
  • Make sure not to exceed 3,200mg of ibuprofen or 4,000mg of acetaminophen within a 24-hour period.
  • Swelling may continue to increase for up to 3 days after your procedure. To help reduce it, elevate your head when lying down.
  • Antibiotics (if prescribed): Begin taking them this evening or the morning following your procedure. Continue to take them, as directed, until gone. Always take antibiotics with food to avoid stomach upset.


  • Follow a no-chew diet for two weeks. Consume foods that do not need chewing, like meal replacement shakes, to ensure proper nutrition and calorie intake.
  • For the next four weeks, follow a soft food diet. Consume soft foods such as mashed potatoes, yogurt, smoothies, soups, eggs, pasta, etc.
  • Stay hydrated by drinking plenty of clear liquids.


  • You may brush your teeth, being careful to avoid the surgical site(s). For the first 72 hours following your procedure, GENTLY rinse your mouth allowing the remains to fall into the sink rather than spitting them out. After 72 hours, you may rinse more vigorously.
  • The day of your procedure, begin rinsing at least 3 – 4 times daily with a saltwater solution (1 cup of water and 1 tsp of table salt) for one week. During the initial 72 hours, GENTLY rinse with the saltwater solution. After 72 hours, you may rinse more vigorously.
  • Chlorhexidine (Peridex) mouth rinse (if prescribed): The day of your procedure, begin rinsing before bed and then the next morning, after breakfast. Continue this routine for one week. Rinse GENTLY for the first 72 hours. After 72 hours, you may rinse more vigorously.


  • Sutures will dissolve or fall out 3 – 7 days after your procedure. It is okay if they come out sooner than 3 days. If there is no active bleeding, you will continue to heal as normal.


  • Avoid strenuous activity for at least one to two weeks after your procedure. Strenuous activities can exert pressure on your surgical site, resulting in bleeding or leading to increased pain.
  • If you play musical instruments such as the saxophone, clarinet, or trumpet, please avoid playing them for 7 to 14 days following your procedure.
  • If you were sedated with an IV, you need to have a responsible adult monitor you for the 12 hours following your procedure. Do not drive or operate heavy machinery for 24 hours following your procedure.
  • Avoid vaping or smoking for five to seven days after your procedure. Vaping and smoking can slow healing, significantly raise the risk of infection, and may lead to a painful condition known as dry socket.


  • Avoid blowing your nose or sneezing with your mouth closed for three weeks post-procedure, or as advised by your surgeon. Instead, gently wipe your nose to prevent excess pressure in the sinus, which could hinder the healing process.
  • Take an over-the-counter decongestant like Sudafed for one week or as directed by your oral surgeon to keep nasal passages clear and reduce the urge to blow your nose.
  • You can use saline nasal spray in the weeks following the procedure. You may also use a nasal decongestant spray like Afrin for up to three days after the procedure.


  • Your surgeon will start turning your appliance at your first post-op follow up appointment.
  • After you see your surgeon for your first follow up appointment, you will begin to turn your key twice daily, once in the morning and once in the evening, keeping track of the number of turns.
  • If you misplace the key, contact our office or your orthodontist promptly.
  • If you notice a foul taste or discharge, reach out to our office immediately, as it could indicate an infection.
  • Ensure you have a follow-up appointment scheduled with our office or your orthodontist one week after the procedure. If necessary, call to schedule or confirm this appointment.

Prescriptions: Any prescriptions will be sent electronically to your pharmacy. It may take up to 6 hours for your prescriptions to be ready. Please contact our office if it has been more than 6 hours.

Contact Our Office: If you have questions or concerns, please contact our office at (269)323-1527. We have a surgeon on call 24/7. For after-hours calls, our answering service will assist you. Please leave the patient’s name, date of birth, and a callback number. The on-call surgeon will contact you at the earliest opportunity.