Hospital Overview

Oral and Faciomaxillary

What is Oral and Maxillofacial Surgery?

Oral and Maxillofacial Surgery is the speciality of dentistry which includes the diagnosis, surgical related treatments of wide spectrum of disease, injuries, defects and aesthetic aspects of the mouth, teeth, jaws, face, head and neck involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

All aspects of Maxillofacial surgical procedures are routinely performed here. Some Maxillofacial procedures requiring general anesthesia after primary screening and detailed investigations will be admitted in hospital for surgery .

Some of the procedures done by this specialty are listed below.

  • Facial bone Fracture(Craniofacial Surgery)
  • Cleft Lip / Palate surgery
  • Advanced dental and maxillofacial Implant Surgery
  • Jaw Cosmetic / Orthognathic surgery
  • Pre-Prosthetic surgery
  • Facial Pain / TMJ pain
  • Management of Oral Cancer
  • Lesion of face and oral cavity
  • Removal of Impacted teeth / wisdom teeth
  • Cyst and tumors of jaw
  • Alveoloplasty
  • Distraction Osteogenesis
  • Frenectomy
  • Apicoectomy
  • Exposing impacted teeth
  • Pre-Prosthetic
  • Biopsy
  • management of oral & facial infection
  • Soft Tissue injuries
  • Bone Grafting
  • Sleep Apnea/ snoring
  • Botox and Facial Fillers

Treatment of Facial Injury

Oral and Maxillofacial Surgeons Treat Injuries to Teeth, Mouth, Jaws and Facial Structures

At the hospital, injured patient will most likely be seen by several medical personnel, one of whom will be an oral and maxillofacial surgeon. Oral and maxillofacial surgeons, the surgical specialists of the dental profession, are specifically trained to repair injuries to the mouth, face, jaws and associated facial structures.

Treating Facial Injury

One of the most common types of serious injury to the face occurs when bones are broken. Fractures can involve the lower jaw, upper jaw, palate, cheekbones, eye sockets,frontal bone and combinations of these bones. These injuries can affect sight and the ability to breathe, speak, bite and swallow. Treatment often requires hospitalization.

The principles for treating facial fractures are the same as for a broken arm or leg. The parts of the bone must be lined up (reduced) and held in position long enough to permit them time to heal. This may require six or more weeks depending on the patient's age and the fracture's complexity.

When maxillofacial fractures are complex or extensive, multiple incisions to expose the bones and a combination of wiring or plating techniques may be needed. We use micro and mini implants to stabilize fractured bone in its original position. So after surgery patient can take food orally depending on the severity. The repositioning technique used by the oral and maxillofacial surgeon depends upon the location and severity of the fracture. In the case of a break in the upper or lower jaw, for example, metal braces may be fastened to the teeth and rubber bands or wires used to hold the jaws together if needed. Patients with few or no teeth may need dentures or specially constructed splints to align and secure the fracture. Often, patients who sustain facial fractures have other medical problems as well. The oral and maxillofacial surgeon is trained to coordinate his or her treatment with that of other doctors.

Don't Treat Any Facial Injury Lightly

While not all facial injuries are extensive, they are all complex since they affect an area of the body that is critical to breathing, eating, speaking and seeing. Even in the case of a moderately cut lip, the expertise of the oral and maxillofacial surgeon is indispensable. If sutures are needed, placement must be precise to bring about the desired cosmetic result. So a good rule of thumb is not to take any facial injury lightly.

Wisdom Teeth Removal

Most people develop 32 teeth by the time they reach 18 years of age. However, the average mouth is only big enough for 28 teeth. The last 4 teeth to erupt are the wisdom teeth, usually coming in during the late teens and early twenties. Wisdom teeth frequently become stuck as they try to erupt, remaining partially under the gum tissue. When a wisdom tooth fails to erupt normally it is termed “impacted.” Impacted wisdom teeth may cause problems in the future such as infection, periodontal disease, cysts, and crowding.

  • Infection: Impacted wisdom teeth create an excellent environment for bacteria to thrive. Because wisdom teeth are so difficult to keep clean, bacteria tend to multiply around them and cause infections and cavities. The best time to remove wisdom teeth is in the teens to early twenties, before they begin causing these problems.
  • Periodontal Disease:Also known as gum disease, periodontal disease is frequently seen around wisdom teeth. This is because they are difficult to clean given their position in the back of the mouth. Periodontal disease is a slowly progressive, chronic condition by which the bone supporting the tooth is lost. When present around a wisdom tooth, periodontal disease often affects the molar in front of the wisdom tooth. Additionally, the wisdom tooth can serve as a reservoir of bacteria that affect the rest of the mouth.
  • Cysts: Although rare, cysts and benign tumors can form around impacted wisdom teeth. These lesions are similar to a water balloon surrounding the wisdom tooth. As they expand they destroy the jaw bone and move other teeth.
  • Crowding: Wisdom teeth may contribute to the crowding of front teeth, particularly the lower front teeth. Orthodontists frequently request their patients have wisdom teeth removed prior to taking off braces in order to facilitate orthodontic stability.

Frequently Asked Questions

Do I have to have my wisdom teeth removed?

The best way to determine if wisdom teeth need to be removed is to have a consultation with our surgeons. Occasionally, a wisdom tooth erupts normally and becomes a healthy, functional tooth. In this case, it may not need removal.

When is the best time to have my wisdom teeth removed?

The best time to remove wisdom teeth is in the teens to early twenties. At this age patients tend to heal well and recover quickly. By removing wisdom teeth at an early age we can minimize the risk of complications and ensure the best possible outcome for the patient.

When can I go back to school or work?

Every patient is different, but in general most patients will take 2 to 3 days to recover and have noticeable swelling for a week

Cosmetic Jaw surgery / Orthognathic surgery

Corrective jaw, or orthognathic, surgery is performed by an oral and maxillofacial surgeon (OMFS) to correct a wide range of minor and major skeletal and dental irregularities, including the misalignment of jaws and teeth. Surgery can improve chewing, speaking and breathing. While the patient’s appearance may be dramatically enhanced as a result of their surgery, Orthognathic surgery is performed to correct functional problems.

Following are some of the conditions that may indicate the need for corrective jaw surgery:

  • Difficulty chewing, or biting food
  • Difficulty swallowing
  • Chronic jaw or jaw joint (TMJ) pain and headache
  • Excessive wear of the teeth
  • gummy smile
  • Open bite (space between the upper and lower teeth when the mouth is closed)
  • Unbalanced facial appearance from the front, or side
  • Facial injury or birth defects
  • Receding chin
  • Protruding jaw
  • Inability to make the lips meet without straining
  • Chronic mouth breathing and dry mouth
  • Sleep apnea (breathing problems when sleeping, including snoring)

Who Needs Surgical Correction of Skeletal Deformities?

People who may benefit include those with an improper bite resulting from misaligned teeth and/or jaws. In some cases, the upper and lower jaws may grow at different rates. Injuries and birth defects may also affect jaw alignment. While orthodontics can usually correct bite, or “occlusion,” problems when only the teeth are misaligned, corrective jaw surgery may be necessary to correct misalignment of the jaws.

Evaluating Your Need for Surgery

Your dentist, orthodontist and oral and maxillofacial surgeon (OMFS) will work together to determine whether you are a candidate for surgery. The OMFS determines which surgical procedure is appropriate and performs the actual surgery. It is important to understand that your treatment, which will probably include orthodontics before and after surgery, may take several years to complete. Corrective surgery may reposition all or part of the upper jaw, lower jaw and chin. When you are fully informed about your case and your treatment options, you and your dental team will determine the course of treatment that is best for you.

Correction of Common Dentofacial Deformities

Correcting an Open Bite:

Some of the bone in the upper tooth-bearing portion of the jaw is removed. The upper jaw is then secured in position with plates and screws.

Correcting a Protruding Lower Jaw:

The bone in the rear portion of the jaw is separated from the front portion and modified so that the tooth-bearing portion of the lower jaw can be moved back for proper alignment.

Correcting a Receding Lower Jaw or “Weak Chin”:

The bone in the lower portion of the jaw is separated from its base and modified. The tooth-bearing portion of the lower jaw and a portion of the chin are repositioned forward.

What Is Involved in Corrective Surgery?

Before your surgery, orthodontic braces move the teeth into a new position. Because your teeth are being moved into a position that will fit together after surgery. As your pre-surgical orthodontic treatment nears completion, additional or updated records, including x-rays, pictures and models of your teeth, may be taken to help guide your surgery.

Depending on the procedure, surgery may be performed under general anesthesia in a hospital, an ambulatory surgical center or in the OMFS office.

Your OMFS will reposition the jawbones in accordance with your specific needs. In some cases, bone may be added, taken away or reshaped. Surgical plates, screws, wires and rubber bands may be used to hold your jaws in their new positions. Incisions are usually made inside the mouth to reduce visible scarring.

After surgery, your OMS will provide instructions for a modified diet, which may include solids and liquids, as well as a schedule for transitioning to a normal diet. You may also be asked to refrain from using tobacco products and avoid strenuous physical activity.

Enjoy the Benefits

Corrective jaw surgery moves your teeth and jaws into positions that are more balanced, functional and healthy. Although the goal of this surgery is to improve your bite and function, some patients also experience enhancements to their appearance and speech. The results of corrective jaw surgery can have a dramatic and positive effect on many aspects of your life. So make the most of the new you!

TMJD/TMD

https://youtu.be/YHmNeKBpEtc

Temporomandibular joint Disorder

Millions of people suffer from chronic facial and neck pain as well as severe, recurring headaches. In some cases, this pain is due to Temporomandibular Disorder, also known as TMD.

Your Temporomandibular joints, or TMJs, connect your lower jawbone to your skull. These joints get a lot of use throughout the day as you speak, chew, swallow, and yawn. Pain in and around these joints can be unpleasant and may even restrict movement. . Individuals with a TMJ disorder may experience a variety of symptoms, such as earaches, headaches and limited ability to open their mouth.

Symptoms of TMD include:

  • Pain in the jaw area
  • Pain, ringing, or stuffiness in the ears
  • Frequent headaches or neck aches
  • Clicking or popping sound when the jaw  moves
  • Muscle spasms in the jaw area
  • A change in the alignment of top and bottom teeth
  • Locked jaw or limited opening of the mouth

Not all jaw pain is associated with TMD

If you feel that you might have TMD, it is always important to see your OMFS or dentist and receive an exam. However, not all jaw pain is associated with TMD, and if you do not have TMD, there are many different preventive steps you can take to maintain a healthy, strong smile.

  • Relax your face – “Lips together, teeth apart”
  • Avoid grinding your teeth
  • Avoid all gum chewing
  • Don’t cradle the phone receiver between your head and shoulder – either use a headset or hold the receiver to your ear
  • Chew food evenly on both sides of your mouth
  • Do not sit with your chin rested on your hand
  • Practice good posture – keep your head up, back straight, and shoulders squared

Frequently Asked Questions

Is it possible that I could need treatment for TMJ disorder?

There are some signs and symptoms that could indicate the need to visit your surgeon:

  • Your jaws ‘pop’ in and out of place
  • Your jaws get stuck in certain positions
  • You cannot open your mouth very wide
  • You hear grating or popping sounds when chewing your food or speaking
  • You have pain in your face, neck or shoulders when speaking, eating or opening your mouth
  • You have chronic headaches or upper shoulder pain

When symptoms of the TMJ trouble appear visit  oral and maxillofacial surgeons to correctly diagnose your condition.

What type of treatments are possible for TMJ disorder?

Treatment may range from conservative dental and medical care to complex surgery. Depending on the diagnosis, treatment may include short-term non-steroidal anti-inflammatory drugs for pain and muscle relaxation, bite plate or splint therapy,  stress management counseling. Sometimes stressful factors in your life may limit the effectiveness of these conservative therapies .

Will I need surgery?

If non-surgical treatment is unsuccessful or if there is clear joint damage, surgery may be indicated. Surgery can involve either arthrocentesis (washing out the TMJ and injecting steroids), or arthroscopy (the method identical to the orthopaedic surgery used to inspect and treat larger joints such as the knee). Seldom is it necessary for open joint surgery, as this is reserved for patients with chronic debilitating pain, or with some form of pathology in the TMJ.
Whether for non-surgical or surgical treatment; chronic TMJ pain may never go away completely without life-style modifications and intermittent regular treatment. Our surgeons care for your quality of life and understand that TMJ disorders may be debilitating at times.

DID YOU KNOW…

that TMJ disorders can occur at any point in life, but that they are most commonly diagnosed in young adults between the ages of 20 and 40 years old? TMJ disorders are far more common among women than men. Though there is no way of knowing exactly how many people suffer from TMJ disorders (many go undiagnosed), the National Institute of Dental and Craniofacial Research estimates that approximately more than 10 million people currently suffer with TMJ conditions.

Oral Cancer

Cancerous growth occurring within the structures of the oral cavity is known as Oral Cancer The oral cavity includes the mouth and all the structures within it ,such as the tongue, teeth ,gums ,lower jaw etc

Cancer is an abnormal disorganized growth of cells in the tissue of a person . Cancer cells keep on multiplying without paying head to the body’s command to stop. This abnormal growth of cells destroys the normal structure and the function of the affected tissue and the body in general .

Among other cancers oral cancer is one of the most common causes of death. In male, oral cancer represents 4% of total body cancer and in female; it is 2% of all cancers. Majority of the oral cancers affect the outer layer of mucous membrane covering the oral cavity.

Causes:

Cancer in the mouth does not occur overnight. It occurs as a series changes within the tissue , which eventually promotes the development of cancer.

The factors involved are:

  1. Tobacco
  2. Alcohol
  3. Syphilis (a sexually transmitted disease caused by a
  4. bacteria)
  5. Nutritional deficiencies.
  6. Virus infection
  7. Sunlight
  8. Other miscellaneous factors such as trauma, heat, and irritation from sharp teeth, poorly restored fillings and ill-fitting dentures.

Obstructive Sleep

Apnea

Some non-medical treatments that may reduce or eliminate snoring include:

  • Weight loss, even as little as 10 pounds
  • Change of sleeping position (because you tend to snore more when sleeping on your back than on your side)
  • Avoiding alcohol, caffeine and heavy meals, especially within two hours of bedtime
  • Avoiding sedatives, which can relax your throat muscles and increase the tendency for airway obstruction related to snoring

OSA Symptoms

Those who have OSA are often unaware of their condition and think they sleep well. The symptoms that usually lead these individuals to seek help are daytime drowsiness or complaints of snoring and breathing problems observed by a bed partner.

OSA symptoms may include:

  • Snoring with pauses in breathing (apnea)    
  • Excessive daytime drowsiness
  • Gasping or choking during sleep
  • Restless sleep
  • Problem with mental function
  • Poor judgment/can’t focus
  • Memory loss
  • Quick to anger
  • High blood pressure
  • Nighttime chest pain
  • Depression
  • Problem with excess weight
  • Large neck (>17” around in men, >16” around in women)
  • Airway crowding
  • Morning headaches
  • Reduced libido
  • Frequent trips to the bathroom at night

Diagnosing Sleep Apnea

If you exhibit several OSA symptoms, it’s important you visit your oral and maxillofacial surgeon (OMFS) for a complete examination and an accurate diagnosis.

At your first visit, your doctor will take a medical history and perform a head and neck examination looking for problems that might contribute to sleep-related breathing problems. An interview with your bed partner or other household members about your sleeping and waking behavior may be in order. If the doctor suspects a sleep disorder, you will be referred to a sleep clinic, where your nighttime sleep patterns will be monitored through a special test called polysomnography.

Polysomnography (PSG) is supervised by a trained technologist and will measure various body functions.. Often a “split night” study is done during which a C-PAP (continuous positive airway pressure) device is used to help open up the collapsed airways.

Treatment of Sleep Apnea

If you are diagnosed with sleep apnea, your OMFS will help you decide which treatment is best for you. Depending on whether your OSA is mild, moderate or severe, this can range from behavior modification to oral appliances to a C-PAP device.

Lifestyle Modification

If you are diagnosed with mild sleep apnea, your doctor may suggest you employ the non-medical treatments recommended to reduce snoring described earlier. In mild cases, these practical interventions may improve or even cure snoring and sleep apnea.

Oral Appliances

If you have mild to moderate sleep apnea, or are unable to use a C-PAP device, recent studies have shown that an oral appliance can be an effective first-line therapy. The oral appliance is a molded device that is placed in the mouth at night to position the lower jaw and bring the tongue forward, elevating the soft palate and keeping the tongue from falling back in the airway and blocking breathing. Although not as effective as C-PAP systems, oral appliances are be beneficial for patients with mild to moderate OSA who prefer them, who do not respond to C-PAP, are not appropriate candidates for C-PAP, or who fail treatment attempts with C-PAP and lifestyle changes. Patients using an oral appliance should have regular follow-up office visits with their OMFS to monitor compliance, to ensure the appliance is functioning correctly and to make sure their symptoms are not worsening.

C-PAP (Continuous Positive Airway Pressure) and Bi-PAP (Bi-Level) Devices

A C-PAP device is an effective treatment for patients with moderate OSA and the first-line treatment for those diagnosed with severe sleep apnea. Through a specially fitted mask that fits over the patient’s nose, the C-PAP’s constant, prescribed flow of pressured air prevents the airway or throat from collapsing. In some cases a Bi-PAP device, which blows air at two different pressures, may be used. While C-PAP and Bi-PAP devices keep the throat open and prevent snoring and interruptions in breathing, they only treat your condition and do not cure it. If you stop using the C-PAP or Bi-PAP, your symptoms will return. Although C-PAP and Bi-PAP are often the first treatments of choice, they may be difficult for some patients to accept and use. If you find you are unable to use these devices, do not discontinue their use without talking to your doctor. Your OMS can suggest other effective treatments.

Surgical Options

Surgery may be a viable alternative for some patients, but it’s important to keep in mind that no surgical procedure is universally successful. Every patient has a differently shaped nose and throat, so before surgery is considered your OMFS will measure the airway at several points and check for any abnormal flow of air from the nose to the lungs. An OMFS has considerable experience and the necessary training and skill to perform the following surgical procedures:

Maxillomandibular Advancement (MMA)

MMA is a procedure that surgically moves the upper and lower jaws forward. As the bones are surgically advanced, the soft tissues of the tongue and palate are also moved forward, again opening the upper airway. For some individuals, the MMA is the only technique that can create the necessary air passageway to resolve their OSA condition.

Uvulopalatopharyngoplasty (UPPP)

If the airway collapses at the soft palate, a UPPP may be helpful. UPPP is usually performed on patients who are unable to tolerate the C-PAP. The UPPP procedure shortens and stiffens the soft palate by partially removing the uvula and reducing the edge of the soft palate.

Hyoid Suspension:

If collapse occurs at the tongue base, a hyoid suspension may be indicated. The hyoid bone is a U-shaped bone in the neck located above the level of the thyroid cartilage (Adam’s apple) that has attachments to the muscles of the tongue as well as other muscles and soft tissues around the throat. The procedure secures the hyoid bone to the thyroid cartilage and helps to stabilize this region of the airway.

Genioglossus Advancement (GGA)

GGA was developed specifically to treat obstructive sleep apnea, and is designed to open the upper breathing passage. The procedure tightens the front tongue tendon, thereby keeping the tongue from falling back in the airway and blocking breathing. This operation is often performed in tandem with at least one other procedure such as the UPPP or hyoid suspension.

Advanced Bone Graft

There are many reasons why a patient may need a bone graft. When a tooth is lost the supporting bone is resorbed over several years due to lack of function. If a patient subsequently desires a dental implant, often this bone must be recreated through a grafting procedure. Common terms for grafting in the mouth are socket preservation, guided bone regeneration, block graft, and sinus lift.

  • Socket Preservation:In this procedure a bone graft is placed in an extraction socket after a tooth is removed. This ensures maximal regeneration of bone during healing. As mentioned previously, when a tooth is removed the surrounding bone tends to resorb due to lack of function. Bone is a living tissue and responds to mechanical forces. In the absence of mechanical forces from chewing, bone can atrophy. Socket preservation is frequently used if a patient desires an implant after and extraction and is not a candidate for immediate implant placement at the time of extraction.
  • Guided Bone Regeneration:GBR is a bone grafting technique where a bone graft is placed at a deficient site and covered with a membrane to separate bone from overlying soft tissue. The graft is allowed to heal for 5-6 months before the site is re-evaluated. Membranes can be resorbable (collagen) or non-resorbable (titanium, plastic).
  • Block Graft: A block graft takes a square or rectangle of bone from another area on the jaw or body and fixates it to the recipient site. If a small graft is needed it can be harvested from other sites on the jaw. If a large graft is needed the hip (Iliac Crest) is commonly used.
  • Sinus Lift: A sinus lift can be direct/lateral approach or indirect/crestal approach. The direct/lateral approach makes a small window into the maxillary sinus, whereupon the lining of the sinus is lifted and bone graft placed underneath. In an indirect/crestal approach the graft is inserted through the hole made to place the implant. Generally, the direct/lateral approach is used for large sinus grafts and the indirect/crestal approach is used for small sinus grafts.

Patients may also lose bone as a result of trauma, infection, or treatment of a jaw tumor. In these cases a larger graft is needed. These larger grafts are typically taken from the hip (iliac crest), knee (tibia), or rib (costochondral). OMFS  have extensive training in all bone grafting procedures from major to minor.

Sources of a Bone Graft

There are 4 possible sources of a bone graft: synthetic (man made), animal (coral, cow, horse), cadaveric (human tissue bank), and the patient’s own bone. The choice depends on patient preference, surgeon’s preference, size of the bone defect, location of the graft, and final goal.