Oral and Maxillofacial Surgery

Oral and maxillofacial surgery corrects the defects, injuries, and diseases affecting the hard and soft tissues of the face and jaw region. The surgery involves improvement of the functional and aesthetic aspects of the face and jaw.

Indications

Indications for oral and maxillofacial surgery include:

  • Facial cyst or jaw tumor
  • Temporomandibular joint disorder (dysfunction of the jaw and skull joint)
  • Facial bone displacement after facial trauma
  • Incorrect jaw alignment
  • Facial cosmetic appeal
  • Facial pain and infections
  • Cleft lip and palate
  • Snoring/Obstructive Sleep Apnea

Oral and Maxillofacial surgical procedures

Corrective jaw or orthognathic surgery

Surgery is performed under general anesthesia to correct major and minor defects, like receding or protruding jaw, which can affect your appearance and the functioning of your jaw. Your surgeon will reposition the bones in your upper jaw, lower jaw or chin as per your requirement, and add, remove or reshape the bones. Plates, wires, rubber bands and screws will maintain the jaw in its new place.

Surgery for facial trauma

Surgery for facial trauma is performed to correctly align the broken bones in the face and allow them to heal. A combination of plating or wiring techniques and multiple incisions may be required for complex maxillofacial fractures. For instance, in case of a broken lower or upper jaw, your surgeon will fix metal braces to the teeth and fasten wires or rubber bands to hold the jaws together. If you have lost most or all your teeth, you may require dentures (removable plate holding the artificial teeth) or splints (material supporting broken bone) to align and hold the fractures. Your jaws will be wired shut during the healing process.

Facial cosmetic surgery

The facial cosmetic surgery includes many surgical procedures performed to correct physical defects caused due to age, birth defects, injury and disease. Some of the procedures are cheekbone implants, chin, ear or eyelid surgery, facelift, facial and neck liposuction, forehead/brow lift, lip enhancement, and nasal reconstruction.

Temporomandibular joint surgery

Your surgeon will perform arthroscopy (use of a camera and lighted device to view the inside of the broken joint through a small incision) or perform a direct surgical procedure for repairing the damaged tissue.

Surgery for snoring and obstructive sleep apnea

Sleep apnea can be treated based on the extent of the condition. Your surgeon will first measure your airway for abnormal air flow from your nose to lungs. Any of the following procedures can be performed depending on the cause of snoring and sleep apnea.

  • Your doctor may perform uvulopalatopharyngoplasty to remove extra tissue in your throat and enlarge the airway.
  • Hyoid suspension can be conducted to stabilize the airway by securing the hyoid bone (horseshoe-shaped bone in the throat region) to the thyroid cartilage.
  • Your doctor may perform a procedure called genioglossus advancement to open up the upper breathing passage. This repositions a muscle of the tongue and reduces the displacement of the tongue into the throat.
  • A procedure known as maxillomandibular advancement may be performed to move the upper and lower jaws forward in order to open the upper airway.

Cleft lip and palate surgery

Your surgeon will close the gap between the mouth and nose, reconnect muscles and shape the mouth. In some cases, your surgeon may use a bone from the hip region to close the area from the nose to the gum tissue in cleft hard palate.

Post-operative care

Following a surgery, your doctor will instruct you to be on a modified diet of solids and liquids. You will have to avoid the use of tobacco products and strenuous physical activities. Your doctor will prescribe medication for reducing pain. Swelling (if any) may subside after 2-3 days; you can place cold packs on the surgical site to reduce the swelling. You can maintain oral hygiene by soaking your mouth with warm salt water 3 to 6 times a day for one week.

Risks and complications

As with any surgical procedure, oral and maxillofacial surgery involves potential risks and complications. Some of them include:

  • Uncontrolled bleeding
  • Deep vein thrombosis (blood clot in the veins of the leg)
  • Pulmonary embolism (blockage of artery in the lung)
  • Nerve injury
  • Bone graft rejection
  • Functional jaw problems
  • Muscular damage

 

Dental Malocclusions

Introduction

Dental Malocclusions

In dentistry the term “occlusion” means the contact between the upper and lower teeth. Malocclusion is the improper contact between the upper and lower teeth.

Malocclusion in primary dentition or baby teeth is common. About ninety percent of school aged children have some degree of malocclusion. Malocclusion can cause problems with the child’s bite, gum tissue, jaw joint, speech development and appearance.

In order to learn more about malocclusion, it is necessary to understand the normal alignment of teeth.

Normal Alignment of Teeth

To understand the normal alignment of teeth it is necessary to understand the dental terms used to describe the surfaces of the teeth:

  • Buccal or Labial
  • Lingual
  • Mesial and Distal
  • Occlusal
  • Grooves and Cusp

Buccal or Labial: The tooth surface that is closer to the cheek is the buccal, and the one that is closer to the lips is the labial.

Lingual: The tooth surface that is closer to the tongue.

Mesial and Distal: The surface that faces the front of the mouth is the mesial, and the one that faces the back of the mouth is distal.

Occlusal: The top surface of the tooth.

Grooves and Cusp: Grooves are intended parts of the occlusal surface. Cusp is the raised part of the occlusal surface.

Normal Occlusion refers to alignment of teeth and the way that the upper and lower teeth bite together.

With the eruption of primary first molars the first three dimensional occlusal relationship is established. The mesiolingual cusp of the maxillary molars occludes in the central fossa of the mandibular molars and the incisors are vertical.

Terminal plane: The mesiodistal relation of the distal surface of the upper and lower second primary molar is called the terminal plane when the primary teeth contact in centric occlusion (position of lower jaw when teeth are together).

Terminal plane can be classified into three types:

Flush or the vertical plane: A normal relationship of primary molar teeth is the flush terminal plane.

Mesial step: The distal surface of the lower molar is more mesial to that of the upper.

Distal step: The distal surface of the lower molar is more distal to that of the upper.

What is Malocclusion?

Malocclusion is a dental term referring to the misalignment of the teeth of the upper jaw with the teeth of the lower jaw. The word malocclusion literally means “bad bite”.

If left untreated, malocclusion can cause problems with the child’s bite, gum tissue, jaw joint, speech development and appearance.

Types of Malocclusion

  • Crowding: The teeth are placed close together and overlap each other. Crowding occurs when the teeth are larger or if the jaw is smaller.
  • Spacing: There are large and uneven spaces between the teeth. Spacing is caused by missing teeth, smaller teeth or smaller jaw.
  • Rotation: Rotation is when the tooth turns out of its position.
  • Transposition: This is when teeth erupt in one another’s place.

Causes

  • Oral habits such as thumb sucking, tongue thrusting, mouth breathing, or prolonged use of bottle – these habits cause frequent pressure on teeth and may slowly move the teeth out of place
  • Too much or too little space in the jaw
  • Extra teeth, lost teeth or abnormally shaped teeth
  • Dental caries or periapical infection leading to tooth loss can alter the permanent teeth eruptions
  • Irregular jaw size and shape
  • Premature loss of teeth
  • Severe injury which leads to misalignment of jaws

Symptoms

Symptoms of malocclusion in primary teeth include:

  • Crooked teeth
  • Problems with eating or speaking
  • Protruding teeth
  • Slurring speech – trouble in saying certain words
  • Permanent teeth coming in wrong position
  • Difficulty in brushing
  • Abnormal appearance of face

Diagnosis

A dentist usually checks for malocclusion in children during regular dental visits. Diagnosis of Malocclusion is based on the following:

  • Oral Examination
  • History
  • X-rays
  • Facial Photographs
  • Impression

Oral Examination

Oral Examination is done to determine:

  • The placement of teeth
  • Growth asymmetries between teeth and jaws
  • Contact between the upper and lower teeth

History

  • History of any oral habits

X-rays

  • X -ray of face and teeth

Facial Photographs

  • Photographs of mouth and face taken to evaluate the profile.

Impression

  • Impression of patient’s teeth and bite is taken and plaster, plastic or artificial stone models are prepared. These models duplicate the patients teeth and are very useful in treatment planning.

Treatment Options

The aim of treatment in childhood and the teen years is to move permanent teeth into correct position. Malocclusion is treated by orthodontic treatment. This is the branch of dentistry that manages the growth and correction of dental and facial structures. Orthodontic treatment uses appliances , tooth removal , or surgery. The orthodontist will time the treatments to match the child’s natural growth.

Extraction: Removal of some baby teeth to help in severe crowding.

Braces: These are appliances that correct dental irregularities and are commonly used in the treatment of malocclusion. These apply constant gentle force to slowly change the position of teeth, straighten them and properly align them with the opposing teeth.

Removable appliances: Here retainers made of plastic and wires are used . The appliance can be inserted and removed by the child.

Retainers: These are appliances that are used once the teeth have moved to their new position. Braces are removed before inserting the retainer. Retainers do not move teeth, they only stabilize them in their current position.

Jaw Surgery: In some cases the child may need jaw surgery to correct the bite problem when the bones of the jaw are involved in the malocclusion problem.

Foods to be avoided during Orthodontia treatment include:

  • Chewing gum
  • Sticky foods
  • Hard food
  • Very hot food
  • Ice-cream

Preventive Measures

Some types of malocclusion are not preventable but the following may help prevent the types that are:

  • Control of oral habits
  • Early detection and treatment