Maxillofacial Surgery

Maxillofacial surgery is a surgical field that specializes in facial reconstructive surgery, facial trauma surgery, head and neck, oral cavity, mouth, and jaws. Maxilla refers to the prominent bone in the face forming the upper jaw. Hence, maxillofacial surgery typically involves treating and managing complex injuries on the face, including broken jaws.

General dentists are responsible for ensuring good dental health through regular examinations, restorations, and minor cosmetic operations. However, in case of an oral problem involving complex procedures, the dentist can refer you to see a maxillofacial surgeon. Maxillofacial surgeon (oral and maxillofacial surgeon) specializes in handling a range of medical conditions and injuries.

Conditions that Require Maxillofacial Surgery

Maxillofacial surgery specialty covers a wide range of medical conditions and injuries affecting the neck, head, face, jaw, and mouth. In most cases, maxillofacial surgery is recommended to address the following conditions:

Dental implants

Maxillofacial surgery involves the removal of teeth and replacing them with synthetic alternatives using dental implants. These implants are permanent in your jaw and serve as a replacement tooth. They might as well be beneficial to one's health or appearance.

Cleft lip and palate

Certain congenital disabilities can result in cleft lips and palates. This problem can have long-term cosmetic and health complications for a person. Maxillofacial surgeons can perform surgery to repair this kind of birth defect.

Reparative surgery

This entails shaving bones, readjusting joints, and assisting in the reconstruction of the broken sockets. Reconstructive surgery is also essential in repairing the problem and relieving pain in a misaligned or a broken face or jaw.

Skeletal issues

Maxillofacial surgery helps correct skeletal issues such as misaligned jaws. If you suffer from chronic temporomandibular joint (TMJ) pain, your dentist can ask you to see a maxillofacial surgeon.

Cancer of the face, mouth, or neck

Maxillofacial surgery helps treat and remove cancers of the face, neck, and jaw. The surgeons performing these procedures have specialized skills in removing the tumor without causing damage to the subtle nerves running through the head and neck.

Reconstructive surgery

If you are involved in an accident and sustain a facial injury, you might require maxillofacial reconstructive surgery. This entails repairing the broken teeth, jaws, and cheekbones. In other cases, maxillofacial surgeons can place dental implants to replace the lost or missing teeth.

Jaw correction surgery

Corrective jaw surgery, also called orthognathic surgery, helps address a variety of functional issues by realigning the teeth and jaw. Corrective jaw surgery is performed for various reasons, including difficulties chewing, breathing, or speaking. Other reasons for undergoing jaw surgery include treating sleep apnea and enhancing the look and function of your bite through orthodontia.

Dentoalveolar surgery

The removal of the affected or diseased teeth is the core of most maxillofacial surgery practice. Surgically exposing damaged teeth to allow for orthodontically assisted eruption of those teeth in an esthetic and functional position is an important aspect of dentoalveolar surgery practice.

Other standard office procedures include denture preparation, oral infections treatment, and removal of the suspicious lesions of the soft and hard tissue (biopsy). Maxillofacial surgeons are also the main referral source for the general dentists who require advice or help in oral surgical issues diagnosis.

Cosmetic surgery on the face

Aesthetic treatment to enhance the appearance of your face, mouth, teeth, and jaws is regularly provided by most maxillofacial surgeons. They include nasal reconstruction, ear surgery, cosmetic chin, botox injections, injectable fillers, lip enhancement, facelifts, and other procedures.

What to Expect With Maxillofacial Surgery

Maxillofacial surgery procedures expectations are as varied as with the operations used. Hence, there are certain elements that are shared by all of these procedures, and learning more about them can help you get ready.

Before the procedure:

You will go through pre-operative preparations once you check-in and complete all necessary consent and medical forms. Such preparations are heavily influenced by the kind of anesthetic you will receive. If necessary, your surgeon can show you maxillofacial before and after photos.

Depending on the extent of the damage or injury and the surgical procedure, the surgeon can use any of these anesthesias:

Local anesthesia: Some procedures require local anesthesia, administered through injection or nitrous oxide. They might only necessitate reviewing the vital signs (such as temperature, blood pressure, and heart rate) as well as a pre-operative dental examination either with or with no x-rays.

Regional block: Procedures involving a regional block will include a pre-operative examination and vital signs review. A regional block is an injection that is the same as local anesthesia that obstructs nerve transmissions instead of numbing the skin.

Monitored anesthesia care: This type of sedation, which is at times used in conjunction with local or regional anesthesia to stimulate "twilight sleep," is administered through an intravenous (IV) line inserted into the vein in the arm. The surgeon will connect you with an electrocardiogram (ECG) device to monitor heart rate. You will also be connected to a pulse oximeter, which will monitor blood oxygen levels.

General anesthetic: This involves similar procedures as in monitored anesthesia care. However, it’s mostly used a broader range of pre-operative blood tests. These include a complete blood count (CBC), arterial blood gas (ABG), and comprehensive metabolic panel (CMP).

During the procedure:

The surgery can start immediately after you have been properly prepared and appropriate anesthesia is administered. It could be;

Open surgery (a wide incision-based invasive procedure)
Endoscopic surgery (keyhole surgery)
Minimally invasive open surgery (involves creating a small incision hence less tissue damage

The surgery can also be classified as:

Reconstructive (repairing or correcting the structural problems and abnormalities) or
Cosmetic (for cosmetic purposes and to improve appearance).

After the procedure:

After the surgery, you will be transferred to a recovery room or the post-anesthesia care unit (PACU). Here, the care team will monitor you till you are completely awake from anesthesia. This normally takes about 10 to 15 minutes with local anesthesia and 45 minutes with general anesthesia.

As soon as the vital signs return to normal and you can walk well, you can go home. Doctors often recommend having a family member or friend drive you home. Other surgeries may necessitate a one or a few-day hospital stay.

Furthermore, you may receive pain relievers and oral antibiotics to help prevent postoperative pain and infection.

Recovery after Surgery

Recovery times for maxillofacial surgeries often vary, just as they can for other types of surgeries. Many people may go back to work and resume daily activities in a few days of having a wisdom tooth extracted. However, those who have orthognathic surgery could take up to months to fully recover.

Some factors can affect a person’s recovery period. These factors can include your overall health prior to surgery, how well you take care of the surgical wound, and if you smoke or not.

Always stick to the dietary plan recommended by your provider, whether a soft or liquid diet. You can also consult a dietitian if necessary to make sure you have the right nutrition. Surgeons usually suggest consuming smaller foods and snacks instead of a full meal during the first week or more. This is because too much feeding can irritate your surgical site.

Other maxillofacial surgeries will necessitate the use of wires in the jaw. Since you will be on a liquid diet, you will have to rinse the mouth after brushing thoroughly. You can also rinse your mouth with salt water many times each day to eliminate bacteria from the gums and avoid plaque accumulation.

Risks of Maxillofacial Surgery

Maxillofacial surgery, like any other surgery, carries several risks. Even the prevalent procedures, such as tooth extraction, have the risk of causing severe complications.

The general common surgery-related risks include adverse scarring, excess bleeding, post-operative infection, and negative reaction to anesthesia. On the other hand, Maxillofacial surgery carries additional risks, particularly in cases of reconstructive surgery or facial trauma.

These are some of the maxillofacial surgery risks:

Unintentional alterations in appearance
Jaw alignment and bite modifications
Airflow changes through the sinuses and nose
Facial nerve injury that can result in loss of control in facial muscle, numbness, or excruciating nerve pain.
Alveolar osteitis, also referred to dry socket, occurs when a blood clot fails to form or is lost at the tooth extraction site before it gets a chance to heal.
Condensing osteitis, a type of bone inflammation within the jaw that causes pain and discomfort with movement.
Tissue necrosis (death) typically occurs due to a serious restriction of blood circulation to tissues after surgery.

Conclusion

Maxillofacial surgery is done to treat dental injuries, diseases, cancers, and jaw, face, and mouth abnormalities. When you are referred to a maxillofacial surgeon, it’s most likely because a procedure is beyond the dentist’s or doctor’s scope you are currently seeing.

However, this does not necessarily imply that the condition is more severe. Instead, it means that the procedure will be beneficial from the expertise of a specialist surgeon trained to address the complex face, mouth, jaw, and skull structures.