Oral and Maxillofacial Surgery

Oral & Maxillofacial Surgery is a recognized international surgical specialty and it is one of the nine specialties of dentistry. Most think of Oral and Maxillofacial Surgery as a dental specialty, but the type of work needed is usually much more intricate and complex than what a general dentist does. Contemporary training in medicine, surgery and dentistry enables Oral & Maxillofacial Surgeons to provide comprehensive treatment for conditions affecting the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region.

A facial and/or oral abnormality not only interferes with one’s ability to function normally, but also has major social and psychological implications. This reduces one’s self confidence and thus reduces the overall quality of life. Oral and Maxillofacial Surgeons have the knowledge and skills necessary to restore a person's function and aesthetics, but more importantly, they empower a person to live a normal life confidently.

Patients are referred to an Oral and Maxillofacial Surgeon by both general and specialist dental and medical practitioners. In many instances, Oral and Maxillofacial Surgeons work in collaboration with other specialists such as Orthodontists, Ear Nose and Throat surgeons, Plastic and Reconstructive surgeons and Oncologists as part of multidisciplinary teams to optimise the treatment of major conditions and diseases of the mouth, faces and jaws.

Oral prosthetics is the replacement of missing teeth (lost or congenitally absent) and contiguous oral and maxillofacial tissues, with artificial substitute. Pre-prosthetic surgery is carried out to reform and/or redesign the oral soft and hard tissues, by eliminating any biological hindrances to receive comfortable and stable prosthesis, such as an implant or a denture.

Pre-prosthetic surgery thus comprises of a wide range of procedures, some of which are mentioned below:

Oral prosthetics is the replacement of missing teeth (lost or congenitally absent) and contiguous oral and maxillofacial tissues, with artificial substitute. Pre-prosthetic surgery is carried out to reform and/or redesign the oral soft and hard tissues, by eliminating any biological hindrances to receive comfortable and stable prosthesis, such as an implant or a denture.

Pre-prosthetic surgery thus comprises of a wide range of procedures, some of which are mentioned below:

Maxillofacial fractures implies fracture of one or more facial and/or jaw bones. These are often a result of trauma due to accidents or acts of violence. These injuries not only cause fractures of the bone, but also cause significant disfigurement of the overlying soft tissues.

Treatment of maxillofacial fractures involves anatomic reduction and fixation of the fractured bones, to restore their function. The overlying soft tissues are to be debrided (cleaned) and sutured (stitched) back to their original positions. Scars formed as a result of the injury can be corrected by secondary surgery.

Maxillofacial infections can arise due to dental or non-dental cause. These infections can be of bacterial, viral or fungal origin, and they mostly present as painful swellings in the orofacial region. Severe infections may cause swellings large enough to make breathing and swallowing difficult. Before treating the infection, it is extremely important to diagnose the root cause of the infection and determine the extent of its spread. For smaller lesions, a simple tooth extraction or drainage of the swelling may suffice. More severe infections may require hospitalisation and surgical drainage and debridement.

A cyst is a pathological cavity that may be filled with semi-solid, liquid or gaseous substances. A non- malignant tumour is any pathologic swelling that is solid in nature. Cysts and tumours in the orofacial region may be of dental or non-dental origin. They cause pain, discomfort and swelling, and impair normal function. These lesions are usually benign, but few may also progress to cause malignancy. Hence it is best to undergo biopsy and arrive at a correct diagnosis of the lesion. Once diagnosed as a non-malignant cyst or tumour, the treatment usually involves excision of the lesion and ensuring that the surrounding tissues are free of pathologic tissue. In case of large defects, reconstruction may be required.

Management of Trigeminal Neuralgia

Trigeminal neuralgia is a chronic pain disorder that affects the trigeminal nerve (main nerve of the face). The typical form results in episodes of severe, sudden, shock-like pain in one side of the face that lasts for seconds to a few minutes. Groups of these episodes can occur over a few hours. It is one of the most painful conditions and can result in depression.

Unilateral, sharp, shooting, stabbing, lancinating, shock-like, cutting, burning, paroxysmal pain along the distribution of one or more branches of the Trigeminal Nerve is the patient’s chief complaint. Pain is triggered by a non -painful stimulus such as talking, chewing, touch, temperature, wind and shaving. Pain does not occur at night, does not wake patients from sleep. Patients usually have a frozen or mask like face.

Depending on the severity of the pain and the branches of the Trigeminal Nerve involved, treatment may be conservative or surgical. Conservative management includes drug therapy and/or Accupuncture. Surgical treatment includes Peripheral alcohol injections, Peripheral neurectomy, Cryotherapy and Radiofrequency Thermocoagulation of the offending branches.

Management of Trigeminal Neuralgia

Orthognathic surgery refers to “alignment of the face and jaws using surgery” (ortho – straight, gnathic – jaws). Whereas orthodontic treatment corrects the position of the teeth, orthognathic surgery positions the bones of the jaws. One or both jaws may be surgically repositioned during the surgery. This involves making cuts in the bones and moving the cut segments into their predetermined position. The surgery is normally preceded by a period of orthodontic treatment so that post-operatively both the teeth and the bones will be in their correct position. Finally, a short period of orthodontic treatment is also required after the surgery to complete the alignment of the teeth.

Distraction osteogenesis is a method of generating new bone after making a corticotomy (cut in the outer layer of bone) or osteotomy (cut through the bone) and gradual distraction. It is based on the ‘Tension-Stress’ Principle. This method is used as an alternative to bone grafting and has the advantage of making use of newly formed native bone over a foreign bone graft. This technique has applications in Orthognathic surgery (to correct deficiency of jaws) and in augmenting the alveolar bone for implant placement. Recent research supports the use of this technique to reconstruct resected parts of jaws.