Treatment includes:
- Hospitalization
- Securing the airway.
- Anesthetic implications .
- Early I.V. antibiotics & hydration.
- External/internal surgical exploration and drainage.
- Medical supportive therapy
- Review and re-evaluation in the post op period
Cystic Lesion of Jaws:
A cyst is a pathological cavity with fluid, semi-fluid or gaseous contents, which is not created by accumulation of pus. It is frequently lined by epithelium.
Clinical Features
- Noticeable swelling:
- Discharge into mouth
- Pain due to secondary infection
- Fluid may be aspirated and thin-walled cysts may be transilluminated
Maxillofacial Trauma:
Their broad-based and extensive dental and medical training in the hospital-based environment uniquely qualifies oral and maxillofacial surgeons to treat and repair injuries to the face, jaws, mouth and teeth.
Oral and maxillofacial surgeons are experts in treating trauma, including fractures of the upper and lower jaws and orbits, and the cosmetic management of facial lacerations.
The knowledge of how jaws come together (dental occlusion) is critical when repairing complex facial fractures.
Causes and symptoms
Road traffic accidents are a major cause, sports, fights, gun shot injuries, bull attacks, construction sites or other work related injuries, communal violence, terror attacks, being hit by an object accidentally etc.
The major symptoms of most facial injuries are pain, swelling, bleeding, and bruising, although a fractured jaw also prevents the person from using his jaw properly, and symptoms of a fractured nose also include black eyes and possible blockage of the airway due to swelling and bleeding.
Diagnosis
Trauma is usually diagnosed in an emergency room or physician's office by physical examination and/or x ray/ CT scans . Some injuries require diagnosis by a specialist. A detailed report of how the injury occurred is also taken.
Treatment
Treatment varies, depending on the type and extent of the injury. More serious fractures require complicated, multi-step treatment.
The jaw must be surgically immobilized by a qualified oral or maxillofacial surgeon. The fractured bones are properly aligned and secured with metal miniplates and screws.
Proper alignment is necessary to ensure that the bite is correct. The surgeon will prescribe antibiotics, pain relievers and muscle relaxants.
Healing time varies according to the patient's overall health, but will take at least few weeks.
Temporomandibular Joint (TMJ) Ankylosis:
What is TMJ Ankylosis?
In simple terms, TMJ ankylosis is fusion of the TMJ thus causing limitation/Complete restriction of movement of the lower jaw, further causing gross facial disfigurement.
What are the causes of TMJ Ankylosis?
- Trauma to the joint/lower jaw during an accident, fall etc
- Trauma during birth, forceps delivery etc
- Congenital or birth defect
- Disease or infection in the joint, ear infection etc
- Rheumatoid arthritis
- Ankylotic conditions such as ankylosing spondylitis may also be inherited.
What are the problems associated with TMJ Ankylosis?
Problems associated with ankylosis of TMJ are manifold and can be Functional, Aesthetic (Cosmetic), Psychological (Emotional) or Social.
Ankylosis of Temporomandibular joint may result in:
• Restricted jaw movements and mouth opening
• Inadequate masticatory (chewing) function
• Inhibited facial and physical growth causing Facial asymmetry
• Impaired speech
• Reduced growth of mandible resulting in “Bird Face”
• Difficulty in breathing and swallowing
• Snoring and difficulty in breathing on lying down
• Insufficient access for dental care resulting in multiple decayed teeth
• Misaligned teeth because of lack of space for the eruption of the normal teeth
• Emotional, social and psychological disturbances due to facial disfigurement.
What are the treatments for TMJ ankylosis?
Releasing the ankylosed joint, facial deformity and asymmetry correction by bone grafts, distraction osteogenesis, orthognathic surgeries
Before Treatment After Treatment
Before Treatment After Treatment
Orthognathic Surgery:
Often a patient may visit the orthodontist to have their teeth straightened and obtain a better and healthier bite. However there is a small group of patients that will require the expertise of the oral surgeon to help the orthodontist get the bite correct. This is because not only are the teeth crooked but also the jaw itself is not in correct alignment.
Orthognathic surgery is needed when jaws don't meet correctly and/or teeth don't seem to fit with jaws. Teeth are straightened with orthodontics and corrective jaw surgery repositions misaligned jaws. This not only improves facial appearance, but also ensures that teeth meet correctly and function properly.
Symptoms Include:
- difficulty in chewing, biting or swallowing
- protruding lower jaw or posteriorly placed midface
- open bite
- speech problems - breathing problems
- chronic jaw or TMJ pain
Who Needs Orthognathic Surgery?
People with an improper bite or jaws that are positioned incorrectly.
Disproportionate jaw growth
Injury to the jaw and birth defects which affect jaw alignment.
This type of surgeries are typically done once skeletal growth is complete.
Procedures include
LeFort I Maxillary osteotomy: Moving the upper jaw in any position.
Sagittal Split Mandibular osteotomy: Used to move the lower jaw forward or backward
Before Treatment
After Treatment
Before Treatment
After Treatment
Vertical Ramus Mandibular osteotomy: Used to move the lower jaw backward.
Anterior Mandibular horizontal osteotomy: used to adjust the chin to stay in alignment with the profile.
Distraction Osteogenesis
Distraction osteogenesis (DO) is a relatively new method of treatment for selected deformities and defects of the oral and facial skeleton. the surgical and technological advances made in the field of distraction osteogenesis have provided the oral and maxillofacial surgeons with a safe and predictable method to treat selected deformities of the oral and facial skeleton.
Frequently Asked Questions About Distraction Osteogenesis
What does the term distraction osteogenesis mean?
Simply stated, distraction osteogenesis means the slow movement apart (distraction) of two bony segments in a manner such that new bone is allowed to fill in the gap created by the separating bony segments.
Is the surgery for distraction osteogenesis more invasive than "traditional surgery" for a similar procedure?
No. Distraction osteogenesis surgery is usually done on an outpatient basis with most of the patients going home the same day of surgery. The surgical procedure itself is less invasive so there is usually less pain and swelling.
Is distraction osteogenesis painful?
Since all distraction osteogenesis surgical procedures are done while the patient is under general anesthesia, pain during the surgical procedure is not an issue. Activation of the distraction device to slowly separate the bones may cause some patients mild discomfort. In general, the slow movement of bony segments produces discomfort roughly analogous to having braces tightened.
What are the benefits of distraction osteogenesis versus traditional surgery for a similar condition?
Distraction osteogenesis surgical procedures typically produce less pain and swelling than the traditional surgical procedure for a similar condition. Distraction osteogenesis eliminates the need for bone grafts, and therefore, another surgical site. Distraction osteogenesis is associated with greater stability when used in major cases where significant movement of bony segments is involved.
What are the disadvantages of distraction osteogenesis?
Distraction osteogenesis requires the patient to return to the surgeon's office frequently during the initial two weeks after surgery. This is necessary because in this time frame the surgeon will need to closely monitor the patient for any infection and teach the patient how to activate the appliance.
In some cases, a second minor office surgical procedure is necessary to remove the distraction appliance.
Can distraction osteogenesis be used instead of bone grafts to add bone to my jaws?
Yes. Recent advances in technology have provided the oral and maxillofacial surgeon with an easy option to place and use distraction device that can be used to slowly grow bone in selected areas of bone loss that has occurred in the upper and lower jaws.
Does distraction osteogenesis leave scars on the face?
No. The entire surgery is performed within the mouth and the distraction devices used by Drs. Reznick, and Lee remain inside the mouth. There are no facial surgical incisions made so no unsightly facial scars result.
Are there any age limitations for patients who can receive osteogenesis?
No. distraction osteogenesis works well on patients of all ages. In general, the younger the patient the shorter the distraction time and the faster the consolidation phase. Adults require slightly longer period of distraction and consolidation because the bone regenerative capabilities are slightly slower than those of adolescence or infants
Cleft Lip and Palate Surgery:
What is cleft lip and palate?
At around six weeks of pregnancy, your baby's upper lip and palate develop from tissue lying on either side of the tongue. Normally these tissues grow towards each other and join up in the middle.
When the tissues that form the upper lip fail to join up in the middle, a gap forms in the lip. When the palate fails to join up, a gap is left in the roof of the mouth, going up into the nose.
The various difficulties faced by the babies include difficulty in feeding, speech, hearing, teeth eruption, psychological problems etc
Causes
A combination of genetic factors, an illness during pregnancy or being exposed to certain substances such as tobacco smoke or certain medicines. Smoking and drinking alcohol have been shown to increase the risk of babies being affected, and can cause other birth defects.
Prevention
Genetic counselling
Research has shown that taking a daily supplement of 400 micrograms of folic acid in the month before conception and in the first two months of pregnancy can help prevent cleft lip.
Avoiding anti-epileptic medicines such as phenytoin (eg Epanutin) and sodium valproate (eg Epilim) has been shown to decrease risk of clefts
Steroid tablets and methotrexate (eg Metoject) that is used to treat some cancers and inflammatory conditions, such as rheumatoid arthritis, may also increase the risk. If you are on these medicines, you should discuss the benefits and possible risks with your doctor before trying for a baby.
Treatment
Our centre is specialized to handle these surgeries at free of cost in association with
‘The Smile Train’ USA. The surgery, medicines, food, stays in the hospital along
With mother for babies is provided at no cost. We are also associated with
Chirantana, an NGO non profitable organization who bring these patients to our unit
A multidisciplinary specialist "cleft team" that may include surgeons, speech and language therapists, audiologists (hearing experts), dentists, orthodontists, psychologists, geneticists and specialist cleft nurses form the team. Care and support of the child and the family should last from birth until your child stops growing at about age 18.
Surgery
The operation to close the gap in the lip will be done about six months after the baby is born with atleast 6 kg weight of baby.
Surgery to close the gap in the palate is usually done at about nine months and baby’s weight being atleast 9 kg.
Both operations are done under general anaesthesia and involve a hospital stay of 3 to 7 days.
As the child grows older, further surgeries may be needed to improve the appearance of the lip and nose and the function of the palate.
If there is a gap in the gum, a bone graft will normally be done when your child is between 9 and 12 years old.
This will help their second teeth to anchor properly into the gum. Bone is usually taken from the hip or shin and grafted into the gap in the gum.
Cancer and Recontsructive Surgery:
Oral cancer
Oral cancer is part of a group of cancers called head and neck cancers.Cancer cells spread to other parts of the neck, the lungs, and other parts of the body.
The various risk factors include Tobacco, Alcohol, excessive exposure to sun, genetic predisposition.
In our Unit Oral Cancer is treated by well experienced maxillofacial surgeons.
Methods of treatment
Oral cancer treatment may include surgery, radiation therapy, or chemotherapy. Some patients have a combination of treatments.
Surgery
includes removal of the cancerous part and replacing the lost part or tissue with tissue like skin, muscle, bone alone or in combination from healthy sites
our centre is specialized to handle microvascular surgeries which is harvesting of tissue free from the donor site and connected with the nearby blood vessels
Aesthetic Facial Surgery:
The various other facial Aesthetic procedures performed include
