Oral and Maxillofacial Surgery

Overview

Oral and maxillofacial surgery treats complex dental problems as well as medical conditions affecting the mouth, teeth, jaws, and face. The majority of the practice is devoted to facial reconstruction, facial trauma surgery, and dental procedures involving the jawbone (like wisdom tooth extractions and dental implants).

What is Oral and Maxillofacial Surgery?

Oral and maxillofacial surgery refers to a wide range of procedures involving surgery on the mouth, jaw, and face. 

Some people consider oral and maxillofacial surgery to be a "upgraded" form of dental surgery, but it goes far beyond what a dentist can do.

Oral and maxillofacial surgeons (OMSs) are trained as dentists but must complete an additional six years of education, including two years of medical school (MD).

Some oral and maxillofacial surgeons pursue additional training to perform facial cosmetic surgery, cancer treatment, microvascular surgery of the head or neck, or correction of congenital face and skull abnormalities in children (such as cleft lip and palate).

Oral and maxillofacial surgery may be performed as an inpatient, outpatient, scheduled, elective, or emergency procedure, depending on the condition. To treat complex conditions or cases involving severe head or facial trauma, OMSs frequently collaborate with other surgeons (such as orthopedic surgeons, surgical oncologists, or otolaryngologists).

Why is Oral and Maxillofacial Surgery done?

Oral and Maxillofacial surgery is carried out to:

• Enhance jaw function.
• Pain relief

Oral and Maxillofacial surgery can treat a wide range of dental issues and conditions, including:

• Diagnosing the causes of chronic dental pain.
• Getting my mouth ready for dental implants and prostheses (such as dentures).
• Putting in dental implants.
• Taking out (extracting) impacted teeth.
• Treat dental problems.

Procedures can also be used to treat jaw problems such as:

• Bone grafting, or transplanting bone from another part of the body, is used to replace missing bone in the jaw.
• Correcting an abnormal bite by reconstructing your jaw.
• Temporomandibular joint disorders, which affect the area where your lower jaw attaches to your skull, are treated.
• Treating injuries to your face, jaw, and mouth as a result of trauma

Other reasons for performing oral and maxillofacial surgery are as follows:

• Congenital (present at birth) abnormalities such as cleft lip and palate are corrected.
• Diagnosis and treatment of head and neck cysts, tumors, cancer, and other growths.
• Identifying the causes of chronic facial pain.
• Facial trauma (injury) treatment, such as facial fractures or damaged maxillofacial tissue.

What is the purpose of oral and maxillofacial surgery?

Oral and maxillofacial surgery treats a variety of conditions affecting the craniomaxillofacial complex, which includes the mouth, jaws, face, neck, and skull. Diagnostic/therapeutic, dentoalveolar (involving the teeth, gums, jawbone, and mouth), reconstructive, or cosmetic procedures can be broadly defined.

Diagnostic and therapeutic procedures

Among the diagnostic and therapeutic procedures are:

• Mandibular joint surgery: Used to treat temporomandibular joint (TMJ) disorder, masticatory musculoskeletal pain (pain while chewing), or burning mouth syndrome by repairing or repositioning the jaw.
• Maxillomandibular osteotomy: A surgical procedure that repositions the upper and lower jaws to improve breathing and treat obstructive sleep apnea.
• Radiofrequency needle ablation: A minimally invasive procedure that uses high-frequency radio waves to sever nerve pathways that cause trigeminal neuralgia, migraine, and other chronic pain conditions.
• Septoplasty with turbinate reduction: A treatment that involves straightening a deviated septum and removing nasal bones and tissues (turbinates) to improve breathing, reduce snoring, and treat sleep apnea.
• Tumor resection: The surgical removal of benign and malignant abnormal growths and masses.

Dentoalveolar procedures 

Dentoalveolar procedures include the following:

• Dental implants: include endosteal implants that are inserted directly into the jawbone and subperiosteal implants that are inserted beneath the gum but above the jawbone5.
• Orthognathic surgery: Also known as corrective jaw surgery, this procedure is used to correct a crooked bite or misaligned jaw.
• Bone grafting before the prosthesis: The surgical implantation of autologous (patient-derived) bone to provide a stable foundation for dental implants or implanted hearing devices such as a cochlear implant. 
• Wisdom tooth extraction: A surgical procedure that involves the removal of bone from around the third molar's root (wisdom tooth).

Reconstructive procedures 

Reconstructive procedures include:

• Craniofacial surgery: is used to repair traumatic fractures or to correct congenital malformations such as cleft palate or craniosynostosis (the premature fusing of bones in a baby's skull) (include jaw fractures, cheekbone fractures, nasal fractures, eye socket fractures, and LeFort fractures of the mid-face).
• Lip reconstructive surgery: is performed following the removal of skin cancer of the lips (typically squamous cell carcinoma, but also melanoma) to restore not only the appearance but also the function of the lips.
• Microvascular reconstructive surgery: is used to reroute blood vessels after a tumor is removed in patients with head and neck cancer.
• Skin grafts and flaps: A post-surgery procedure in which skin is taken from another part of the body to replace resected tissues or partially removed and repositioned to cover an adjacent area of resection.

Cosmetic procedures 

Cosmetic procedures include the following:

• Eyelid surgery 
• Cheek enhancement: Cheek implants
• Aesthetic chin surgery includes genioplasty and mentoplasty.
• Transplantation of hair
• Liposuction of the neck
• Otoplasty is the surgical reshaping of the outer ear.
• Rhinoplasty 
• Rhytidectomy 

Craniofacial surgery

This area of expertise is concerned with conditions affecting the hard and soft tissues of the face and head. The following are some examples of craniofacial conditions:

• Craniosynostosis: are the premature closure of one or more of the joints that connect the bones of a baby's skull. 
• Craniofacial dysotosis syndromes: are a group of conditions characterized by facial, skull, and sometimes limb abnormalities. The problem is usually fused coronal sutures in the skull, which causes the skull to form in a tall, wide shape.
• Encephalocoeles: are a type of neural tube defect in which pouch-like protrusions from the brain push through openings in the skull.
• Cranio-facial clefts: are a broad category of defects affecting the face and cranium, ranging from cleft lip and palate to extensive clefts causing significant malformation.

How to Prepare for Oral and Maxillofacial Surgery?

Depending on the condition being treated and the goals of the surgery, the preparation for oral and maxillofacial surgery can vary. If oral and maxillofacial surgery is recommended, you will meet with your surgeon to go over the pre-operative results and go over the recommended procedure step by step.

To fully understand what is involved, do not be afraid to ask as many questions as possible about not only the procedure but also what to expect during recovery.

Preparation for the operation includes steps before and after the operation such as:

• Food and Drink

Patients must follow certain food and drink restrictions prior to surgery if you are under general anesthesia or any form of sedation.

Most doctors will advise you to stop eating at midnight the night before your surgery. You will be allowed a few small sips of water the next morning to take any morning pills, but nothing else.

There may be no such restrictions if local or regional anesthesia is used. The only exception is when local or regional anesthesia is used in conjunction with intravenous sedation. The same food and drink restrictions apply in such cases.

• Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) and anticoagulants (blood thinners) are generally avoided in the days preceding surgery. Both of these classes of drugs can cause bleeding and interfere with wound healing.

NSAIDs such as aspirin, Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), and Voltaren (oral diclofenac) are generally discontinued a week or two before surgery. Coumadin (warfarin) and Plavix (clopidogrel) are typically discontinued five days before surgery.

To avoid complications, patients inform the surgeon about all drugs that he uses, whether prescription, over-the-counter, nutritional, herbal, or recreational.

• Pre-Op Lifestyle Changes

Smoking should be avoided for at least two weeks before and after surgery. Cigarette smoke causes blood vessels to constrict significantly, reducing the amount of blood and oxygen that reaches the surgical wound. This not only slows healing but also raises the risk of treatment failure, such as the loss of a skin graft or improper bone bonding.

If quitting smoking proves difficult, consult your doctor about prescription smoking cessation aids that can reduce cravings. Many of these aids are provided free of charge under the Affordable Care Act's Essential Health Benefits (EHB) mandate.

What to Expect on the Day of Oral and Maxillofacial Surgery?

Oral and maxillofacial surgery expectations are as varied as the procedures used. Having said that, there are some common elements in all of these procedures, and learning more about them can help you prepare.

• Prior to Surgery

Patients will go through pre-operative preparations after you have checked in and completed all of the necessary medical and consent forms. These preparations are heavily influenced by the type of anesthesia you will be undergoing.

• Local anesthesia: Procedures requiring local anesthesia, administered via injection or nitrous oxide ("laughing gas"), may only necessitate a review of your vital signs (temperature, heart rate, blood pressure) and a pre-operative dental exam with or without X-rays.
• Pre-operative exam and vital sign review: Surgeries involving a regional block (an injection similar to local anesthesia that blocks nerve transmissions rather than numbing the skin) will also include a pre-operative exam and vital sign review.
• Monitored anesthesia care (MAC): This type of sedation, which is sometimes used in conjunction with local or regional anesthesia to induce "twilight sleep," is administered through an intravenous (IV) line inserted into a vein in your arm. You will also be hooked up to an electrocardiogram (ECG) machine, which will monitor your heart rate, and a pulse oximeter, which will monitor your blood oxygen levels
• General anesthesia: is used for the same procedures as MAC, but with a broader range of pre-operative blood tests, such as a complete blood count (CBC), comprehensive metabolic panel (CMP), and arterial blood gas (ABG) test.
• During the Surgery

Once you are prepped and the appropriate anesthesia has been administered, the surgery can begin. It may be open surgery (an invasive procedure involving a large incision), endoscopic surgery (also known as "keyhole surgery"), or minimally invasive open surgery (involving a small incision and minimal tissue damage).

The surgery may also be classified as being reconstructive (to repair or correct structural abnormalities) or aesthetic (used for cosmetic purposes).

Recovery after Oral and Maxillofacial Surgery?

Recovery times can vary just as much as oral and maxillofacial surgeries. While most people can return to work and normal activities within a few days of having their wisdom teeth extracted, those who have orthognathic surgery may take months to fully recover.

Certain factors, such as your general health prior to surgery, how well you care for your surgical wound, and whether or not you smoke, can all affect recovery times.

Follow the recommended dietary plan, whether a soft diet or a liquid diet, and consult a dietitian if necessary to ensure proper nutrition. For the first week or so, surgeons often recommend eating smaller meals and snacks rather than a full meal because eating too much may irritate the surgical site.

Some oral and maxillofacial surgeries will necessitate the use of wires in your jaw. Because you'll be on a liquid diet, you'll need to thoroughly rinse your mouth after brushing and rinse with salt water several times a day to remove bacteria from the gums and prevent plaque buildup.

Soft palate surgery patients may experience changes in speech articulation that require speech therapy to correct.

In fact, any surgery on the jaw, tongue, or soft or hard palate can have a temporary or permanent effect on speech. A speech pathologist can assist in determining whether or not treatment is required.

Damage to trigeminal nerve branches is common after maxillofacial surgery, and the majority of cases resolve on their own over time. Severe cases may necessitate the use of medications and other treatments to alleviate the nerve pain. 

Some oral and maxillofacial surgeries necessitate extensive rehabilitation to restore nerve sensations or facial muscle function. Similarly, some scars may require months of ongoing care to reduce their visibility or prevent the formation of thick, raised patches (hypertrophic scarring).

What are the risks or complications of maxillofacial surgery?

As with any surgery, there are risks with maxillofacial surgery, including:

• Bleeding.

• Dry socket is a painful condition that can occur after tooth extraction and involves blood clot issues.

• Infection.

• Teeth, lips, tongue, cheeks, chin, nasal cavity, sinuses, or maxillofacial bones or tissue are all at risk.

• Numbness or sensation changes in your mouth or other areas of your face.

• Pain.

• Damage to nerves that control some of your facial muscles is possible.
• Root fragments are a rare complication in which a piece of the tooth root breaks off and remains in place following surgery.

• Temporomandibular Joint (TMJ) problems

Contraindications to oral and maxillofacial surgery

Except for the inability to tolerate general anesthesia, there are few absolute contraindications to oral and maxillofacial surgery. Other types of anesthesia, such as regional blocks or local anesthesia with intravenous sedation, may be used in such cases.

Certain elective procedures may be ruled out due to relative contraindications. Cases like these are assessed on an individual basis, with the benefits weighed against the risks. Concerning conditions include:

• Blood pressure is high (generally when the systolic pressure is 180 mmHg or higher or the diastolic pressure is 110 mmHg or higher)
• Active infections that must be treated before surgery can take place
• Significant osteonecrosis (bone death)
• Certain cancers, which can spread if such surgery is performed, are frequently required in complex cases or when breathing is compromised.

Conclusion

Oral and Maxillofacial surgery is a branch of dentistry. It entails procedures to correct diseases, injuries, and defects in your face, jaw, or mouth. Maxillofacial surgeons are highly trained specialists who diagnose and treat problems related to Jaw and lower face bones, tissues (maxillofacial area), tongue's roof (palate), and Teeth.