ORAL, DENTAL AND MAXILOFACIAL SURGERY

Oral, dental and Maxillofacial Surgery; is a medical profession that performs treatments of congenital diseases of oral, jaw and related soft and hard tissues, or problems caused by infectious, traumatic and any kind of pathologic reasons.

Most frequently, surgical extractions of impacted or complicated teeth, implant surgery and implant preparation, cysts and tumors of jaws, pre prothetic arrangements are known as related issues however,  there are a lot of treatment fields including; jaw fractures, salivary gland diseases, problems related with tongue, orthognatic surgery, jaw joint (temporomandibular joint TME) disorders and some facial cosmetic procedures.

Extraction of Impacted and Complicated Teeth:

Every teeth inside the oral cavity can be impacted but most frequently 3. molar teeth (wisdom teeth) and canine teeth are impacted. Those teeth have to be extracted for so many reasons like pain, sensitivity, infection, replacement of other teeth, leading a cystic formation.

Impacted teeth can be half impacted;  part of it may be seen inside the mouth or completely impacted; completely inside the jaw bone or under the gingiva.

Impacted teeth often can be extracted under local anesthesia but if the patient has a severe phobia or if the position of the tooth is too complicated than it can be extracted surgically under sedation/ general anesthesia.

Complicated tooth extraction is a term for describing erupted tooth extractions requiring additional procedures like raising a flap (opening the gum), making a releasing  incision on the jaw, suturing for bleeding control due to presence of severely broken teeth, teeth having extreme root morphology and having too hard jaw bone.

For extracting an impacted and complicated tooth it is essential to know surgical technics and have knowledge.

Endodontics Surgery (Apical Resection):

Teeth may lost their vitality due to large decays, sensitivity to applied materials, impact and chronic trauma. In these cases, removing the nerves of the teeth and making root canal treatment may be necessary. If root canal treatment is not performed or in some cases even it is performed, infectious areas can be formed around the root ends. Those areas have self growing tendency  and also they may have cystic transformation growing by the time.

Surgical  approach may be required when those inflammatory areas occur at the roots of teeth. During this surgical operation which is called apical resection it is reached at the apex of the teeth through opening a window on gingiva  and cleaned the root area involving infection and cystic area until reaching the healthy bone. If it is necessary, the cut end of the root may be isolated with filling materials which are called amalgam or MTA. The bone cavity which is occurred by removal of infectious area can be filled with bone grafts and thus the quality and rate of recovery can be increased. Your doctor can also request for endodontic retreatment.

Apical resection is a procedure which is performed for holding your teeth inside the oral cavity as long possible. Therefore, those teeth having shortened roots should be used as carefully as possible and should be stayed away from over bearings.

Jaw cysts :

Structures usually including epithelial lined cavity that fills with fluid or solid material (gel like) inside the body are called CYST. Cysts are most commonly observed in oral and maxillofacial area for various reasons.

Jaw cysts can be related with infections, trauma and additionally sometimes they can be congenital. Cysts having slow expanding tendency are mostly asymptomatic, they often noticed from x-rays coincidentally. However in some cases, over expanded cysts may lead teeth replacements, face asymmetries, pathological jaw fractures, pain and paresthesia on lip due to the pressure on nerves.

Treatment of jaw cysts consist of removing the cysts from the area together with their epithelial line.

Removal of the detected cyst together with it’s epithelial line is called Enucleation. If it is not possible or risky to remove the cyst as a single piece, then by opening a window on the epithelial cyst line it is expected the cyst to get smaller by decompressing the inner pressure of the cysts and when the cyst gets smaller enough, again it can be removed with a surgical operation. This treatment method is called Marsupialization.  

Jaw Tumors:

Tumors which can be defined as irregular and uncontrolled development of tissues inside the body are classified in two separate categories as benign or malign (cancer)

Tumors can also be observed in oral and maxillofacial area. Oral and maxillofacial tumors may include various tissue specifications and can be classified as odontogenic (originated from tooth) or non- odontogenic.

Differentiation of benign and malign tumors should be done carefully. It may be originated from intra oral tissues and also it may have intra oral symptom in a cancerous tissue which was formed in another region (metastasis).

Early findings of oral cancers may consist of symptoms including presence of painful, with or without bleeding non healing lesions in a couple of weeks and presence of white and red spots. 

Symptoms of advanced intra oral cancers are paresthesia on lips and tongue, non- healing intra oral wounds, pain and bleeding inside the mouth, halitosis, swelling of lymph glands, difficulty in swallowing.

Causes may include multiple factors like; excessive smoking, alcohol consumption, especially chronic traumas, exposing excessive sun light (for lip area), age, ethnicity, gender.

Surgery, chemotherapy and radiotherapy may be used separately or combined together for their treatments.

Early diagnosis with regular dentist control may have a vital importance.

Jaw Fractures:

The most common traumatic causes of maxillary and mandibular fractures include; traffic accidents, fights, sport accidents.

In addition to trauma, there are fractures occurring as a result of a small trauma or normal function due to thinning of jaw bone related with a cyst or tumor developed in the jaw area which are called pathological fracture.

It may concern a single jaw or bone structures consisting whole maxillofacial complex depending on the severity of trauma. In such cases usually there are multiple fracture lines.

Sometimes teeth are not affected from jaw fractures. When teeth are involved, teeth extractions can be considered depending on the conditions of the teeth.

There are many various treatment options for jaw fractures and when the fracture is dislocated in other words diverged and when fragments are separated from each other due to multiple fractures, fixation of both ends with plates and screws may be required. This procedure is usually performed under general anesthesia but it can be performed under local anesthesia or sedation when there is a single fracture line in an easily accessible area.

Pre Prothetic Surgery:

Even they are surgical procedures having reduced practice frequency with the growing popularity of  implants and prothetic treatments along with it, they can be performed for the patients to use their prothesis more comfortably and for maintaining the health of their implants. 

Many various different surgical operations are performed for both soft tissues (gingiva and muscle attachments) and hard tissues associated with different problems.

If we count briefly, Alveoloplasty is a procedure which is used for improving bone irregularities under the gingiva. When the lip and cheek junction which is called sulcus is located at a very high level then Vestibuloplasty is performed to pull it down. When the muscle junctions inside the upper and lower lip is very thick and located at the very high level Frenectomy is performed to remove those junctions. Torus operation is removing the bone swellings which are completely anatomical features and called torus from the upper and lower jaws.

Orthognatic Surgery:

The point that should be considered for treatment of dental crowding and irregularity is; determining the present problem if it is whether dental / dental- skeletal. Problem can be solved by orthodontics (bracket treatments) when the patient has a dental problem only. However, if there are skeletal problems related with the position of lower and upper jaw between each other or to the scalp and if the problem can not be solved with only orthodontics treatment then Orthognatic surgery procedures are required. By orthognatic surgery change is not include only dental structures it also includes facial features of the patients .

The most common orthognatic surgical operations are sagittal split osteotomy ( changing the position of the lower jaw) and le fort operations (changing the position of the upper jaw). SARPE operation is a technic which is used for providing a fast expansion with less force by making bone incisions at the upper jaw. Genioplasty can be performed for positioning the chin to the front or back side. Those mentioned operations can be performed according to the treatment plan which is prepared as a result of an evaluation of the patients’ condition together with the patient/ orthodontist/ maxillofacial surgeon trio.

Majority of the operations are performed under general anesthesia and at hospital conditions. It is appropriate for the patient to be hospitalized a few days.

Facial Cosmetic Procedures:

Facial Cosmetic Surgical Procedures can be performed for overcoming the problems related with facial deformities (face shape disorders) or aging. There are many procedures like Face lifting (Facelift), lip implants, zygomatic (cheek bone) implants, fat injections when there is asymmetry in facial area. Although they are commonly performed by aesthetic and plastic surgeons, there are surgical procedures for creating more masculine and angular jaw shape by placing silicon implants into the gonion area and special implants into angulus area when the gonion is not sufficient.

General Anesthesia & Sedation

Dentist and dental treatment fear (dentalphobia) is a very common situation in society. Related with this, patients are delaying their problems and causing their problems unnecessarily to get bigger and bigger, instead of solving them easily. Therefore, treatment of patients having dental phobia requires medical help according to the fear level of the patient, he/she can be completely anesthetized under operation room conditions or  being in a drunken like condition by administering some kind of medications in the dental office if we state it sketchy. In this method which is called sedation, there is no unconsciousness and the patient can response the commands of doctor but can not memorize what procedures are performed.

Both two procedures are performed by general anesthetist.