Oral and Maxillofacial Surgery is a dental specialty that entails the diagnosis, surgery, and adjuvant treatment of diseases, injuries, and anomalies affecting both the functional as well as the oral and maxillofacial region’s hard and soft tissues.
Modern surgery has progressed to the point where the volume of information and technical abilities required has resulted in surgeons specializing in specific areas, usually an anatomical portion of the body, but also occasionally in a specific technique.
Oral and maxillofacial surgery is a rare specialty that requires a dual degree in medicine and dentistry, as well as extensive general and specialist surgical training. It is a recognized international specialty that is established by medical directives in Europe.
A.Who Are Oral and Maxillofacial Surgeons?
A maxillofacial surgeon is a dental professional who has an extensive medical understanding of disorders that affect not just the teeth and jaws but also the bones and soft tissues of the face, as well as the training needed to treat these conditions surgically and safely administer anesthesia.
Because the mouth includes the teeth, is closely connected to the jaws, and is an integral aspect of the face, these doctors are commonly referred to as oral and maxillofacial surgeons.
An oral and maxillofacial surgeon (OMS) is a doctor that specializes in diagnosing and treating diseases, injuries, and abnormalities of the face, mouth, and jaw. This can involve anything from wisdom tooth extraction to cleft lip and palate surgery.
An OMS often spends four to six years in a hospital-based residency program after graduating from dentistry school. They may become board-certified, pursue a second medical degree, or finish specialist fellowships.
Your OMS will acquire considerable training and experience in all facets of anesthetic administration during this period.
Airway management, endotracheal intubation, establishing and maintaining intravenous lines, and dealing with difficulties and emergencies are all part of this process. The many procedures that an OMS performs necessitate this anesthetic skill.
Oral and maxillofacial surgery’s major subspecialties
Surgeons can train and specialize in one or more of the following areas of oral and maxillofacial surgery:
- Surgical treatment of head and neck cancer, involving tumor removal and repair, incorporating microvascular free tissue transfer.
- Craniofacial Facial Deformity Surgery: the repair of congenital or acquired facial deformity to improve oro-facial function, but also to overcome facial disfigurement and restore quality of life.
- Oral and Maxillofacial Surgery: surgery of the teeth, jaws, temporomandibular joints, salivary glands, and facial skin lesions (including implants).
- Oral Medicine: Diagnosis and treatment of medical disorders affecting the cervicofacial structures and their surrounding areas.
- Craniofacial Trauma: facial soft and hard tissue injuries to the craniofacial structures are treated.
- Cosmetic surgery: It is a type of surgery used to improve facial appearance and quality of life.
B. What Are Common Oral and Maxillofacial Surgeries?
For a variety of reasons, your dentist may send you to an OMS. The following are some of the most common oral and maxillofacial operations.
1. Maxillomandibular osteotomy
A surgical procedure that repositions the upper and lower jaws to improve breathing and treat obstructive sleep apnea
2. Radiofrequency needle ablation
This is a minimally invasive surgery that uses high-frequency radio waves to disrupt nerve pathways that cause trigeminal neuralgia, migraine, and other chronic pain problems. A study estimates that RFA gives relief to headaches.
3. Septoplasty with turbinate reduction
A treatment that involves correcting a deviated septum and removing nasal bones and tissues (turbinates) to enhance breathing, reduce snoring, and treat sleep apnea.
4. Wisdom Teeth Removal and Management
The wisdom teeth of many people do not erupt properly. Overcrowding, erupting in the wrong place, or becoming impacted can all be caused by the third molar.
Wisdom teeth that represent a risk to your dental health are frequently removed by an OMS.
5. Surgical Procedures for Dental Implants
The holes caused by lost teeth can be filled with a dental implant. An OMS replaces the tooth’s root region with a metal screw-like post during dental implant surgery.
This offers a stable foundation for the crown, which will look, feel, and function like a natural tooth.
6. Facial Trauma and Injury Surgery
With their considerable knowledge of how the jaw joins together, an OMS may help treat and restore face injuries and trauma.
Fractures of the jaw, as well as the orbits enclosing the eyes, maybe involved.
7. Treatment for the oral, head, and neck cancer
An OMS can also identify and treat cancers of the head, neck, and mouth by surgery. Oral cancer surgery usually entails removing the malignant tissue and rebuilding the surgical site to improve aesthetics and function.
8. Surgical Correction of the Jaw
Corrective jaw surgery also termed orthognathic surgery, can help with a variety of functional issues by realigning the teeth and jaw.
Problems chewing, speaking, or breathing is among the reasons for corrective jaw surgery. Other reasons to get jaw surgery include treating sleep apnea or improving the appearance and function of your bite with orthodontia.
9. Surgery for Cleft Lip and Palate
Cleft lip and palate surgery on newborns and young children can also be performed by an OMS.
The jaw and face components are restored, allowing for normal function and appearance. The OMS is a crucial member of the healthcare team that treats cleft lip and palate patients.
10. Treatment for TMJ Disorder and Facial Pain
If non-surgical treatments for TMJ pain are ineffective or there is evident joint damage, surgery may be required.
An OMS may perform an arthroscopy or use a direct surgical approach to heal injured tissue.
11. Cosmetic Surgery of the Face
Aesthetic therapy to improve the appearance of your face, mouth, teeth, and jaws is frequently provided by many OMSs.
Nasal reconstruction, cosmetic chin, and ear surgery, botox injections, lip enhancement, injectable fillers, facelifts, and more are among the procedures available.
- Blepharoplasty: Eyelid surgery
- Cheek augmentation: Cheek implants
- Genioplasty and mentoplasty: Aesthetic chin surgery
- Hair transplantation
- Neck liposuction
- Otoplasty: Reshaping of the outer ear
- Rhinoplasty (nose job)
- Rhytidectomy (facelift)
Because of the nature of their work, oral and maxillofacial surgeons frequently collaborate with other experts such as ENT surgeons, clinical oncologists, plastic surgeons, orthodontists, restorative dentists, radiologists, and neurosurgeons.
C. When Is Oral and Maxillofacial Surgery Necessary?
All maxillofacial surgeons are also oral surgeons, however not all oral surgeons are maxillofacial surgeons.
An oral and maxillofacial surgeon has received more advanced medical training than an oral surgeon and is qualified to do more treatments in more parts of the face.
Maxillofacial surgery is a type of oral surgery that is more advanced. A maxillofacial surgeon can perform all of the procedures that an oral surgeon can, and much more. An oral and maxillofacial surgeon has a medical degree as well as intensive dental medicine training.
While an oral surgeon is unable to do the most advanced oral surgical treatments, a maxillofacial surgeon is not limited in the sorts of dental surgery that he or she can perform. This includes teeth extractions, dental implants, gum surgery, and other procedures.
If your problem goes beyond your mouth, you may need a maxillofacial operation. A maxillofacial surgeon, for example, may be able to undertake a treatment to rectify a nasal cavity deformity.
Maxillofacial surgeons are frequently relied upon to treat patients who have suffered facial trauma. Trauma is defined by a rapid, powerful strike that frequently breaks bones and may result in facial disfigurement.
Except for the inability to endure 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 employed in such instances.
Certain elective operations may be ruled out due to relative contraindications. Cases like these are assessed on an individual basis, with the advantages weighed against the hazards.
Among the conditions to be concerned about are:
- Blood pressure is too 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
- Osteonecrosis of the femur (bone death)
- Certain malignancies may spread if oral and maxillofacial surgery is performed.
E. Potential Dangers
Oral and maxillofacial surgery, like all operations, involves hazards. Even relatively routine treatments, such as tooth extraction, carry the risk of catastrophic consequences.
In addition to the general hazards of surgery (such as excessive bleeding, undesirable scarring, post-operative infection, and a poor reaction to anesthesia), oral and maxillofacial surgery has additional dangers, particularly in cases of reconstructive surgery or facial injuries.
These are some examples:
- Unintentional alterations in appearance
- Jaw alignment and bite modifications
- Airflow changes through the nose and sinuses
- Face nerve injury can result in numbness, loss of facial muscle control, or excruciating nerve agony.
- Alveolar osteitis, also known as dry socket, occurs when a blood clot fails to form or is lost at the site of tooth extraction before it has a chance to heal.
- Condensing osteitis: Jaw bone inflammation characterized by pain with movement
- Tissue necrosis (death tissue) is typically induced by a substantial limitation of blood flow to tissues following surgery.
F. Pre-Operative Assessment
If oral and maxillofacial surgery is recommended, the surgeon may request a set of tests to help design the procedure. These could include:
- X-ray: An imaging technique that uses ionizing radiation on plain film.
- Panorex: A type of X-ray used in dentistry to visualize the sinuses. Panoramic radiograpsh provides all the details regarding maxillary sinus.
- CT (computed tomography): A technique for creating three-dimensional “slices” of the surgical site using several X-ray pictures.
- Magnetic resonance imaging (MRI): A non-radioactive imaging technology that is superior at imaging soft tissues.
- Duplex ultrasound is a type of ultrasound that is used to assess blood flow through the arteries and veins.
- NCS (nerve conduction studies): A test that uses a modest electrical pulse to detect areas of nerve damage in the muscles of the face and head.
Recovery times for oral and maxillofacial procedures might vary, just as they can for other types of surgeries. While most people can return to work and normal activities within a few days after having wisdom teeth out, those who have orthognathic surgery may need months to fully recover.
Certain factors, such as your overall health before surgery, how well you care for your surgical wound, and whether or not you smoke, can all affect recovery times.
Follow the specified eating plan, whether a soft diet or a liquid diet, and consult a dietitian if necessary to guarantee sufficient nutrition.
For the first week or so, surgeons often advocate eating smaller meals and snacks rather than a full meal, as eating too much may aggravate the surgery site.
Some oral and maxillofacial surgery will necessitate the use of wires in your jaw. Because you’ll be on a liquid diet, you’ll need to properly rinse your mouth after brushing, as well as rinse with salt water multiple times a day, to remove bacteria from the gums and avoid plaque buildup.
Soft palate surgery patients may encounter alterations in speech articulation that require speech therapy to rectify.
An operation 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 what, if any, treatment is required.
Damage to trigeminal nerve branches is frequent after oral and maxillofacial surgery, and the majority of cases resolve on their own over time. Severe cases may necessitate the use of medicines and other treatments to alleviate the nerve discomfort.
Oral and maxillofacial surgery necessitates substantial rehabilitation to restore nerve sensations or facial muscle function. Similarly, certain scars may require months of continued care to reduce their visibility or avoid the formation of thick, elevated patches (hypertrophic scarring).
If you need oral and maxillofacial surgery for any of the reasons listed above, consult with your general dentist first. They can inspect the problem, walk you through the treatment options, and, if required, send you to an oral and maxillofacial surgeon.
We hope that this article cleared all your doubts about Oral and Maxillofacial surgery. Please share your questions, and suggestions in the comment section.
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