Oral surgery and maxillofacial surgery are just some names that involve variety of surgical procedures. Oral and maxillofacial surgery treat oral soft and hard tissues, jaw deformities, teeth removal and plastic surgery of affected parts of the body (e.g. nose and neck) after oral surgeries. Covering all these topics within some pages is not an easy job. We discuss the important oral and jaw surgical procedures. These surgeries can really change our life young and old. Also, people can achieve the best of functions and beauty for their oral health and appearance.
The best time to have surgery
Depending on the type of problem and severity of our condition, we can be referred from one specialist to another. When growing up is needed, we will wait! If earlier the better, so why should we or let’s say our children wait until situations get worse. Dentists can refer us to an orthodontist in case of orthodontic prevention. If not, oral surgeons are there to help us. More importantly, we can’t skip the importance of orthodontics as a presurgical way to prepare us for the needed surgery.
As just for tooth extraction, there are many symptoms that are signs to undergo surgery. These signs can be:
- Caries that can’t be restored
- Apical periodontitis (infection of root canal in the jaw)
- Overcrowded teeth
- Impacted teeth (failure of the eruption of a tooth)
- Root resorption (the condition of root shortening)
- Ankylosis (tooth submerging into nearby bone and as a result of eruption problems) because of orthodontic teeth movements
What should be done before oral surgery?
After reaching the decision, and having consultation with parents (in case of a child) and patients, oral surgeons must do these:
- Review the history of the diseases of the patients,
- Examine the patients physically,
- Check the imaging from radiographs to x-rays or any other visualization technologies.
Today computer aided technology (CAT) can offer a lot of wonderful images. Visual images of the profiles whether by orthodontic intervention or surgical procedures can make it possible for the patients to see the different changes in their appearance and mouth.
Emergencies during oral surgery
The experience of dental practitioners and reacting to possible emergency situations are some important factors at the oral surgery operation. Patients usually feel stressed and the level of anxiety for each individual is different. Also, for physiologically stressed patients, checking for history of medication and diseases is necessary. When dental practitioners detect those patients with possible emergency risks, they can prevent any harmful outcomes with necessary measurements.
Some of the emergency problems during oral surgery can be as follow:
- Difficulty in breathing (respiratory problems) like hyperventilation and having asthma
- Insulin shock
- Toxicity to local anesthetic (because of the amount of dose)
- Allergies (some drugs during surgery can cause this) or hypersensitivity reactions
- Feeling pains on the chest
The most important oral and jaw (maxillofacial) surgeries
It is certainly difficult to discuss all aspects of surgeries. Jaw and oral surgeries include variety of procedures from soft-tissue oral surgeries to upper (maxilla) and lower (mandible) jaw surgeries. Let’s not forget other affected parts of face like lips and nose, which patients need to do for functional purposes and improvement of the appearance.
The most common oral and maxillofacial surgeries are:
- Tooth extraction: you might have heard pulling a tooth many times. Extraction of a tooth can be because of series of problems like eruption problems, excessive dental caries, supernumerary teeth, ankylosis and root resorption. Sometimes extracting a tooth is to prevent the gum disease from progression.
The steps to extract a tooth can be as follow:
1- soft- tissue is separated from the root using Molt elevator
2- luxate the tooth using dental elevators like straight elevator
3- finally using forceps to remove the tooth. The amount of force and techniques are crucial in how the tooth is removed. Harming the adjacent teeth or fracturing the tooth can happen if there is no care in the operation.
- Impacted tooth: when a tooth is not erupted, it causes serious harms to adjacent teeth and results in periodontal (gum) diseases. The causes of impacted teeth can be as a result of overcrowded teeth and genetic problems. Like third molar, which is the most common impacted tooth, there are other impacted teeth including second premolar, maxillary incisors, mandibular second molar.
Extraction of the impacted tooth is followed by surgical assistance for the eruption and surgical uprighting.
One important factor in extracting impacted tooth is providing enough space for eruption of adjacent teeth. For example, we want the eruption of a canine tooth and extraction of a premolar. For this to happen, orthodontic appliances long before surgery should have been used to provide enough spacing to perform the impacted tooth surgery.
- Odontoma: in young patients because of impacted permanent teeth and eruption problems or supernumerary teeth, some odontogenic tumors (tooth-like masses) or cysts like dentigerous cysts may appear. With biopsy before surgery for cysts and removal surgical procedures like enucleation and curettage for the odontoma, we don t need to be worried and the dental surgeons will do their great job.
Soft-tissue lesions that need oral surgery or biopsy include:
- Mucocele or mucous cyst is a type of lesion caused by damage to minor salivary gland. The extravasation (leakage) of saliva as a result of injury is the cause of this cyst. Through dissection of the injured part, the infected area is removed and surrounding tissue of minor salivary gland also can be removed to ensure that this lesion will not occur again. The common part of mouth that this lesion occurs is lower lip.
- Ranula is also a mucous cyst. Ranula occurs because of injured sublingual gland and formation of a bubble of fluid. Ranula occurs in the floor of the mouth and through surgical excision, this lesion can be removed.
- We can name also some lesions like fibroma and pyogenic granuloma that occur among children.
Orthognathic is the surgery on upper and lower jaw for the correction of dentofacial disfigurement. Both upper jaw (maxillary) surgery and lower jaw (mandibular) surgery are developed along with orthodontic treatment to treat or realign jaws and achieve a correction strategy for severe jaw deformities.
Lower jaw surgery
Whether the problem is lower jaw deficiency or excess, the maxillofacial surgeons use split osteotomy surgery to lengthen or shorten the lower jaw to the desired direction and position. With lower healing time and good stability the split osteotomy is a great advantage in lower jaw surgery.
Upper jaw surgery
Le fort Ι osteotomy is an important surgical procedure which allows the desired position of the upper jaw. Depending on the deformity, upper jaw can be moved up or forward. This surgery is of great importance in making it possible to correct upper (maxilla) jaw deformities.
Ankyloglossia or tongue-tie
Ankyloglossia occurs in infants and it is the birth defect that because of short lingual frenum causes tongue movement difficulties. The importance of this condition requires team of specialist like oral surgeons, otolaryngologists (ear, nose and throat specialist) and pediatric dentists to have their opinions on this condition. It causes plenty of functional limitations from breastfeeding, articulation, swallowing and variety of orthodontic problems. Speech therapy and frenectomy procedures are also treatment ways for this condition.
The next surgery is dentoalveolar procedures
Dentoalveolar procedures include correction of alveolar parts of mouth through technique like bone graft and aligning the malpositioned teeth by periodontal surgeries. Usually, when orthodontic appliances are used and these appliance may break, some unpredictable movement on teeth can cause some serious damages. Here dentoalveolar surgeries are carried out.
It is the technique of generating new bone to fill the missing parts in severe bone deficiency situations. It can be used in conditions like craniofacial syndromes and hemifacial microsomia where bone formation is needed.
After surgical operations, patients, if necessary, need to undergo some plastic surgeries because of the affected facial body parts. For example, chin augmentation or reduction, lip procedures, rhinoplasty (nose surgery) and other surgeries like neck surgeries in older patients are required to accomplish what patients had in mind of their appearance by having oral and jaw surgeries. Patients in all these surgeries are certainly informed about the cost, time, postsurgical periods. Many useful heartwarming discussions from the dental and oral specialty team can make things a lot easier.