MAXILLOFACIAL SURGERY Posted in: Reconstructive Surgery

This Section is written by my wife,

Dr. Elizabeth Salinas Talán
Maxilofacial Surgeon
Trained at:
Adolfo Lopez Mateos Hospital
ISSSTE, Mexico City

Maxillofacial Surgery is a specialty branch from Odontology, and includes different types of surgeries pertaining to the face’s upper, middle and lower thirds; this specialty encompasses:

RECONSTRUCTIVE SURGERY:

Involves surgery of fractures of the face (jaw, maxilla, orbits). For restoration of which mini Titanium plates and screws are placed, leaving them perfectly aligned and having the advantage that patients leave surgery being able to open the mouth, i.e. mouth without wires. These surgeries are performed mostly under general anesthesia and at the hospital.

ORTHOGNATHIC SURGERY:

It is an Esthetic and functional surgery of the facial bones and one that corrects what is called a bad bite. It is a dentofacial correction surgery, which is correcting bone deformities in upper and lower jaws, and at the same time giving occlusal correction and stability of the patient. The most frequent cases are:

Prognathism (mandible or maxilla)
Long Face.
Gummy smile.
Facial deviation.
Short or Long Chin.
Short jaw.

All the cases of said alterations will bring, if not operated, long term problems in the functional and psychological aspects. Some patients are chronic mouth breathers.

One of the requisites of Orthognatic Surgery is that it requires previous Orthodontics to give shape to dental arches and treatment last for about a year approximately, thus preparing the case with clinical photographs, cephalometric X-rays, to study the measurements of the face bones in relationship to the skull and thus establishing a good diagnosis. Later on, plaster study models of teeth are taken and a surgical prediction through the radiographies and a “surgery” is made on plaster models prior to the patient’s actual surgery.

These surgeries are required to be performed in the hospital, under general anesthesia and may have a hospital stay of two days approximately and then released to their homes.  The cuts in the bones are done with a Stryker saw and the bones are set with mini plates and screws made of titanium and thus they will be able to come out with the possibility to open their mouth, without need of wiring the teeth.  The minimum age of patients for these surgeries is of 18 years of age, the one when the growth and development of the bones of the face finishes.

ORAL SURGERY:

This is any type of surgery carried out in the oral cavity, whether in mucosae as cheeks, gums, lips, tongue-ties and also in bone: whether to remove third molars included in bone, or any another tooth included in bone that is not able erupt to the oral cavity. In these surgeries is very important to remove a layer that is called Mucoperiostium, a tissue in which they are wrapped since leaving this layer can give formation of cysts or tumors of the maxillary bones.  The minimum age to remove this tooth is 17 years of age although nowadays they can be present since age 13.

In oral surgery it is also frequent the removal of bone or soft tissues cysts or tumors.

Apicectomy surgeries are also another oral surgery that is often performed. They consist of the cut of the tip of the roots of the teeth, after unsuccessful endodontic procedures, presenting infections and cysts.  In this case removal of the cyst and apicectomy, along with retrograde obturation (that is, from underneath upwards) is mandatory.

SURGERY AND TREATMENT OF THE TMJ (TEMPORO-MANDIBULAR JOINT)

This is the most frequent disorder that is presented inside this category and is produced when the patient clenches the teeth at night because of stress with the consequence of headache and face muscles aches.  Another cause for illness is the facedown position at sleep, or by blows or accidents in the mandible.  Another cause for this disorder is when the patient presents a bad bite, and some others arthritis or diabetes.

The treatment depends on the clinical and radiologic diagnosis.  It is very important first to establish the cause of the problem to be able to resolve it.

THE MOST FREQUENT TREATMENTS ARE:

  • Soft Diet.
  • Physiotherapy with heat, Ultrasound, Laser rays, or TENS (transcutaneous Electrical Nerve Stimulation)
  • Anti-inflammatory medicines, analgesics.
  • Oclussal Guards.
  • Orthodontics.
  • Prosthetic Rehabilitation (crowns, bridges)
  • Endoscopic surgery of the joint of the mouth (microscopy)
  • Open Surgery of the joint of the mouth when is necessary.

DENTAL IMPLANTS

More and more frequent, dental implants are requested by people who have lost tooth due to disease or trauma: These are metal screws made of long-lasting Titanium, that are implanted in healthy gum, in a procedure that is usually performed under local anesthesia In our surgical facility

It involves three phases:
1st Stage: Diagnostic and planning of the operation
2nd Stage: Insertion of the implant and proper time of waiting to its
complete integration under the oral mucosa.
3rd Stage: some months afterwards, rehabilitation with final esthetic
crowns, by a rehabilitation personnel.

Usually, these implants are very well tolerated and can help resolve serious functional and esthetic problems in the oral cavity.

Next, I present recommendations for before and after their operation.

BEFORE SURGERY:

Do not take aspirin or aspirin products for 2 to 3 weeks; click Non-Recommended Medicines for more details. Wash your face very well once a day for three consecutive days before operation, with Isodine (US: Betadine) foam. If not found, use any antiseptic soap recommended by your pharmacist. Do not drink any water; much less eat lunch or snacks from 12 the night before surgery. Do not wear makeup the day of surgery, or nail polish, false eyelashes and earrings, necklaces, rings, etc. Carry only the most necessary clothing, (a change only), and comfortable shoes. If you get a cold or pimples pop out inside the nose, call the office before.

If you have any questions, call us within office hours is from 10am-8pm, at phone: 664) 684-25-51 (US: (619) 730-1917). We are here Monday through Friday.

AFTER SURGERY:

Go straight home and stay in bed for 24 to 48 hours. You can get up to the bathroom and three meals. If you don’t have discomfort or nausea, you can eat normally.

Avoid the sun, hot meals, hot baths or warm places for a week.

Put crushed ice into a bag and wear it on the cheeks, without touching the lip surgery, 15 minutes every 4 hours. Usually patients do not complain of any pain, but if it happens, take your pain medication as indicated. You can have a hot tub bath until I indicate so.

Do not expose yourself to trauma, don’t touch yourself or let the patient touch the lip surgery. Take your medicine as indicated. You cannot drink alcohol during this treatment. Typically you are asked to come back to the office to the 3rd and 7th days and thereafter every 7 to 15 days.

I usually leave the arms splinted in extension; that way they do not touch the operation.

If it is your child’s surgery, and if you’re going to take care of him or her at home, give her/him this care and I will gladly support you over the phone in any questions, day or night, at my cell phone: (664) 283-0976 or the office: (619) 730-1917 or (664) 684-2551.

To see some of these surgeries of operated cases, click Photo Gallery.

Any doubts about this surgery, please call the office, 684-2551  (US: 619-730-1917) or my cell 664-283-0976. We wish you a speedy recovery and an excellent experience with your esthetic lid surgery, send an email or click Contact us for more information

« PLASTIC SURGERY AND REJUVENATION
CLEFT LIP AND PALATE »