The Oral and Maxillofacial SurgeonDocument Transcript
The Oral and Maxillofacial Surgeonsaving faces|changing lives ®
Oral and Maxillofacial Surgeons:An Important LinkOral and maxillofacial surgeons arethe only recognized dental specialistswho, after completing dental school, aresurgically trained in an American DentalAssociation-accredited hospital-basedresidency program for a minimum of fouryears.They train alongside medical residentsin internal medicine, general surgery andanesthesiology, and also spend time inotolaryngology, plastic surgery, emergencymedicine and other specialty areas.Their training focuses almost exclusivelyon the hard (ie, bone) and soft (ie, skin,muscle) tissue of the face, mouth, and jaws.Their knowledge and surgical expertiseuniquely qualify them to diagnose andtreat the functional and esthetic conditionsin this anatomical area. The scope of oraland maxillofacial surgery practice includes,among others:• Outpatient Anesthesia• Dentoalveolar Surgery to manage diseases of the teeth and their supporting soft and hard tissues• Surgical Correction of Maxillofacial Skeletal Deformities• Cleft and Craniofacial Surgery• Facial Trauma Surgery• Temporomandibular Joint Surgery• Pathologic Conditions, such as head and neck cancer• Facial Reconstructive Surgery• Facial Cosmetic SurgeryFor more information on oral andmaxillofacial surgery, or to find a surgeonin your community, visit aaoms.org, orcall the American Association of Oral andMaxillofacial Surgeons at 800/822-6637.
1Oral and maxillofacial surgeons arethe surgical specialists of the dentalprofession. Their extensive educationand training, their surgical expertiseand unparalleled understanding ofesthetics and function uniquelyqualify them to treat the conditions,defects, injuries and esthetic aspectsof the mouth, teeth, jaws and face.Patients who complain of pain or problems inthis area are routinely referred to an oral andmaxillofacial surgeon for help. This patientinformation pamphlet discusses the role of theoral and maxillofacial surgeon on your health-care team and some of the many servicesprovided in the OMS office.Training and Scope of PracticeFollowing dental school, oral and maxillo-facial surgeons complete a minimum of fouryears in a hospital-based surgical residencyprogram. Depending on the residency pro-gram, some surgeons may also opt to earn amedical or other advanced degree. Some may 4 to 6 years surgical 4 residency years 4 dental years school collegeAfter completing dental school, oral and maxillofacialsurgeons are surgically trained in an American DentalAssociation-accredited hospital-based residency programfor a minimum of four years.
also complete fellowships in sub-specialtyareas.At the conclusion of this demanding program,oral and maxillofacial surgeons are well-prepared to:• Manage diseases of the teeth and their sup- porting soft and hard tissues.• Surgically reconstruct inadequate bone structure in the jaw area.• Evaluate, plan a course of treatment and place dental implants to replace one, two or a mouthful of missing teeth.• Expertly treat head and neck trauma and injuries to the face, jaws, mouth and teeth.• Diagnose and treat facial pain.• Diagnose and treat oral cancer and other diseases in the maxillofacial region.• Perform corrective jaw surgery to improve the function and appearance of patients with such conditions as cleft lip and palate and other congenital defects.• Diagnose and surgically treat obstructive sleep apnea.• Perform facial cosmetic procedures to en- hance facial appearance and function.Office Surgery and AnesthesiaOral and maxillofacial surgeons are uniqueamong non-anesthesiology practitioners inhealth care, in that the oral and maxillofacialsurgery residents train with anesthesiologistsand anesthesiology residents. No other dentalor medical specialty requires this degree oftraining and, as a result, oral and maxillofacialsurgeons are the only healthcare specialists,aside from anesthesiologists, to administerall levels of sedation and general anesthesia.Anesthesia administered in the OMS officeranges from conscious sedation, to deep IVsedation and general anesthesia. The level ofanesthesia administered is carefully matchedto the specific needs of the patient and thetype of procedure that is to be performed.
3Following are some of the many surgical pro-cedures performed by oral and maxillofacialsurgeons:Dentoalveolar surgeryDentoalveolar surgery is the surgical man-agement of diseases of the teeth and theirsupporting hard and soft tissues.Tooth ExtractionsTooth extraction is the most common type ofdentoalveolar surgery. It may be recommend-ed as a treatment for teeth that are crowded,diseased beyond restoration, impacted andunerupted, or supernumerary (extra).Wisdom Teeth (Third Molars)A tooth that fails to emerge or fully breakthrough the gum tissue is, by definition,“impacted.” While this is a common problemassociated with third molars, or wisdom teeth,which are the last teeth to develop and eruptinto the mouth, other teeth can also becomeimpacted.Oral and maxillofacial surgeons have ex-tensive surgical training and experience indiagnosing and extracting teeth. Whether theextraction is simple or complicated by impac-tion, disease or infection, their surgical skillsmake them the obvious surgeon of choice forthe patient in need.
Wisdom Teeth Growth by Age12 years 14 years 17 years 25 years Wisdom teeth are easier to remove when the patient is younger, since their roots are not completely formed, the surrounding bone is softer, and there is less chance of damaging nearby nerves or other structures. Removal of wisdom teeth at a later age becomes more complicated as the roots have fully developed (may involve the nerve), and the jawbone is denser. Orthodontic Surgery Often a patient is referred to an oral and maxillofacial surgeon for an extraction or another surgical procedure in preparation for orthodontic treatment, such as extraction of over-retained baby teeth or the exposure of unerupted teeth so that the orthodontist may position them properly. Preprosthetic Surgery Oral and maxillofacial surgeons are experts at preparing the mouth for the placement of a partial or complete denture; ensuring a comfortable fit. Because dentures rest on a bone ridge, it is very important that the bone is the proper shape and size. To ensure proper fit of the denture, the bone may need to be smoothed or reshaped. Occasionally, excess bone must be removed or recontoured before the denture is inserted. In such cases, oral and Dental Implants are Frequently the Best a b crown abutment implant Anatomy of an implant (a). Single tooth replacement (b). Multi-tooth replacement (c). Before and after implant (d).
5 maxillofacial surgeons may perform one or more of the following procedures: • bone smoothing and reshaping; • removal of excess bone; • bone ridge reduction; • removal of excess gum tissue; and/or • grafting of skin or specialized gum tissue. Dental Implants Oral and maxillofacial surgeons pioneered dental implant placement more than 25 years ago, and are still the leaders in providing the innovative techniques that offer patients long-lasting, natural looking results that last a lifetime. Because of their extensive surgical training and years of experience in the dental implant field, oral and maxillofacial surgeons are able to successfully place dental implants in most patients, even so-called “high-risk” patients suffering from chronic health conditions, gum disease or bone loss in the jaw area. Following are some of the procedures pro- vided by oral and maxillofacial surgeons to assure the best possible outcome: Immediate Loading - Advances in dental im- plant technology allow OMSs to extract teeth and place implants with crowns at one visit.Treatment Option for Replacing Missing Teeth c d
Bone Grafting - Oral and maxillofacial sur-geons are the only dental specialists trainedto obtain bone grafts and place them in areaswhere little or no bone exists. For example,dental implants, if they are to fuse with thejawbone successfully, must be placed wherethere is an adequate volume of bone. Implantsites that lack the necessary bone can beenhanced with the use of bone grafts. Graftsmay be taken from the patient, a bone al-lograft from a bone bank, or another source.Bone grafts are also used to treat bone lossresulting from traumatic injuries, tumor sur-gery or congenital defects.Sinus Lift - A sinus lift is a bone graftingprocedure that is sometimes performed whenthe amount of bone in a patient’s upper jaw isinadequate to accommodate a dental implant.Oral and maxillofacial surgeons are skilledin evaluating their patient’s unique needs anddeveloping an appropriate treatment plan.Whether they are replacing a single tooth ora mouthful of teeth, oral and maxillofacialsurgeons can perform dental implant surgerycomfortably in the office setting.Reconstructive SurgeryInadequate bone structure in the upperand/or lower jaws can result from injury ortrauma, tumor surgery or long-term denturewear. Using bone grafts from either the pa-(a) (b)Extensive maxillofacial fractures are often accompaniedby other medical problems. The oral and maxillofacialsurgeon coordinates treatment with other medicalspecialties to return the patient to their normal activitiesas soon as possible. The young woman pictured infig. (a) prior to surgery and (b) following surgery torepair her injuries.
7tient’s own bone or bone substitutes, the oraland maxillofacial surgeon can improve boththe quantity and quality of the hard tissue.Skin grafts and soft tissue corrections canimprove the architecture of the soft tissues inthe oral and maxillofacial region. Throughoral reconstructive surgery, a solid founda-tion can be provided for dental rehabilitation,which in turn aids nutrition and speech. If thepatient is a candidate, dental implants may beused to replace lost teeth and other structures.Implants can also be used to anchor oral andfacial prostheses.Facial TraumaOral and maxillofacial surgeons are experts intreating and repairing facial trauma, includ-ing fractures of the upper and lower jaws andthe orbits surrounding the eyes, and faciallacerations. Their knowledge of how jawscome together (dental occlusion) is criti-cal when repairing complex facial fractures.In fact, the American College of Surgeons’guidelines for optimal care require Level I andII trauma centers, those that treat the mostserious and complex facial trauma patients, tohave oral and maxillofacial surgeons on callto perform complex reconstruction of themouth, face and jaws. Moreover, many of thetechniques that are standard in today’s hospitalemergency rooms were developed by oral and
Function of the TMJTemporomandibular joint — Normal closedposition. Jawbone is separated from skull by a softdisk that acts as a cushion when you chew, speakor swallow.Temporomandibular joint — Normal openposition. Disk stays in place when jaw is in use.Temporomandibular joint — Abnormal. Disk ispulled forward when jaw is in use, causing the bonestructures to grind together.maxillofacial surgeons in combat hospitalsduring World War II, Korea, Vietnam andtoday’s international conflicts.Trauma does not only result from majorevents like combat or automobile accidents.Childhood injuries caused by skateboards,sports or bicycle accidents frequently involvedental or maxillofacial trauma. Youngerchildren often sustain damage to teeth or sup-porting structures from falls. The use of safeand effective sedation techniques allow trau-matic injuries to be effectively treated in theoral and maxillofacial surgery office, avoidingcostly emergency room visits.Oro-Facial PainInfection, malocclusion, TMJ, tumors, ornerve pathology may cause oro-facial pain.Oral and maxillofacial surgeons are trained
9to diagnose the full spectrum of conditionsthat may cause pain in the mouth or face andto provide the appropriate medical or surgicaltreatment.Facial InfectionsPain and swelling in the face, neck, or jawsmay indicate an infection. Infections in thisarea of the body can sometimes develop intolife-threatening emergencies if not treatedpromptly and effectively. An oral surgeon canassist in diagnosing and treating this problem.Surgical treatment, if needed, may includedraining the infected area and eliminatingthe source of the infection.Lesion Removal and BiopsyOral surgeons are trained to identify abnor-mal growths or tissue through a clinicalexamination of the mouth and the evaluationof X-rays. Since the mouth is a most acces-sible area, the surgeon can either remove arepresentative sample (biopsy) for laboratoryexamination, or remove the entire pathology.Other PathologiesTMJ DisordersThe temporomandibular joint (TMJ) is acommon cause of facial pain and headache.Located where the lower jaw and skull meet,the TMJ is a ball and socket joint that allowsthe lower jaw (mandible) to move and func-tion. Symptoms of TMJ disorders may includeearaches, headaches and a limited range ofjaw movement. Patients may also complain ofclicking or grating sounds in the joint, or painwhen opening or closing their mouths. Somepatients experience a combination of muscleand joint problems. Causes of TMJ disordersinclude osteoarthritis, cartilage displacementor injury, rheumatoid arthritis, or stress.In order to properly diagnose and treat theproblem, oral and maxillofacial surgeons con-duct a clinical examination and use a numberof diagnostic procedures, including imag-ing studies such as radiograph, CT or MRI.
Treatment may include such non-surgicaloptions as soft diet, anti-inflammatory drugs,and physical and/or bite splints. Lysis andlavage and arthroscopic joint surgery areminimally invasive procedures that haveproven effective in resolving certain condi-tions involving TMJ pain and dysfunction.These procedures can be done under generalanesthesia on an outpatient-surgery basis at ahospital or ambulatory surgery center. Morecomplex joint surgery may be indicated foradvanced conditions.Oral PathologyOral and maxillofacial surgeons are trained toperform biopsies of both benign and malig-nant lesions in the maxillofacial region, andare experts in the clinical and microscopic di-agnosis of disorders involving the mouth andjaws. Oral lesions include benign tumors andcancers, growths of tooth origin and thosethat arise in the salivary glands, infections(both local and systemic) and manifestationsof systemic disorders.Oral cancer is no longer a disease experiencedby the middle aged patients with histories ofsmoking and alcohol consumption. Today oraland maxillofacial surgeons are seeing a grow-ing number of oral cancer patients in their 20sand 30s. A growing use of smokeless tobaccoand a rise in Human Papillomavirus (HPV)cases are considered responsible for this situ-ation. Oral and maxillofacial surgeons stressthat early detection and treatment of orallesions greatly improve the patient’s prognosis.Lesions may be managed medically and/orsurgically.Oro-Facial DeformitiesDifferences in skeletal growth between theupper and lower jaws may lead to problemswith chewing, swallowing, speech or TMJperformance. Patients may also exhibit psy-chological difficulties stemming from estheticand social concerns.
11 Common Dentofacial Deformities a b cCommon dentofacial deformities include anopen bite (a), a prognathic or protruding jaw (b) anda retrognathic or receding lower jaw (c). The oraland maxillofacial surgeon performs corrective jawsurgery to produce a more balanced and functionalskeletal relationship for the patient.Corrective Jaw SurgeryOral and maxillofacial surgeons performcorrective jaw surgery to produce a more bal-anced and functional skeletal relationship forthe patient. Often performed in conjunctionwith treatment by an orthodontist and restor-ative dentist, corrective jaw surgery is usuallydone in a hospital or ambulatory surgicalcenter under general anesthesia.Some common growth abnormalities, includ-ing under or overdevelopment of the jaws(prognathia, micrognathia, retrognathia), andskeletal malocclusions (bad bite) cannot becorrected through orthodontia alone. Theymust be addressed through corrective surgery.
As a result of their surgical and dental background,oral and maxillofacial surgeons are keenly aware of theimportance of harmony between facial appearance andfunction.Cosmetic Ear Surgerybefore afterEyelid Surgery before afterCourtesy of Joe Niamtu, III DMDCongenital ReconstructionCongenital deformities like cleft lip and palateoccur when all or a portion of the oral-nasalcavity does not grow together during fetal de-velopment. As members of a team of healthcarespecialists, oral and maxillofacial surgeons playan important role in the carefully orchestrated,multiple-stage correctional program designedto help restore the jaw and facial structuresleading to normal function and appearance.Care and treatment consider function, appear-ance, nutrition, speech, hearing, and emotionaland psychological development.Snoring/Obstructive Sleep ApneaApproximately 45% of the population experi-ence obstructive breathing patterns duringsleep. Such problems can range from snoring toperiods of true apnea, where breathing ceasesfor a brief period of time. Obstructive sleepapnea can lead to excessive daytime sleepiness,poor work performance and such cardiovascu-lar disorders as hypertension, arrhythmias and
13congestive heart failure. Oral and maxillofa-cial surgeons are trained to diagnose and treatthis condition and, in fact, pioneered many oftoday’s most successful surgical techniques forsleep apnea. When conservative methods failto correct the problem, surgery may be per-formed to treat the soft and/or hard tissues.Facial Cosmetic SurgeryAs a result of their surgical and dental back-ground and their ability to reconstruct facialstructures damaged through trauma, oral andmaxillofacial surgeons are keenly aware of theimportance of harmony between facial ap-pearance and function. Many of today’s facialcosmetic procedures can be performed on anoutpatient basis in the oral and maxillofacialsurgeon’s office. Some facial cosmetic surgerymay require the use of an outpatient or sameday surgery center, or hospital. Dependingupon the procedure, surgery may be per-formed under local anesthesia, IV sedation orgeneral anesthesia.Oral and maxillofacial surgeons are animportant link in the referral network forprimary care providers. To find an oral andmaxillofacial surgeon in your community,visit the “Find a Surgeon” database ataaoms.org, or call the American Associationof Oral and Maxillofacial Surgeons at800/822-6637. AAOMS.ORG