Oral & Maxillofacial surgery

Modern surgery has developed to such an extent that the body of knowledge and technical skills required have led to surgeons specialising in particular areas, usually an anatomical area of the body or occasionally in a particular technique or type of patient.There are nine surgical specialties and this briefing covers Oral & Maxillofacial surgery.

“Oral and Maxillofacial Surgery is the specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and aesthetic aspects of the hard and soft tissues of the oral and maxillofacial region.” clipboard and stethescopeIn plain English, that means OMSes are trained to do just about any surgery or cosmetic procedure to correct just about any kind of problem with the mouth, jaws, facial structures and neck.

The specialty of oral and maxillofacial surgery is unique in requiring a dual qualification in medicine and dentistry, followed by a comprehensive general and specialist surgical training, and is a recognised international specialty, which within Europe is defined under the medical directives. Most surgeons acquire a degree in dentistry before training in medicine, but it is becoming increasingly common for those acquiring a medical degree to subsequently undertake a dental qualification and then pursue a career in OMFS.

What do Oral and Maxillofacial surgeons do?

Often seen as the bridge between medicine and dentistry, oral and maxillofacial surgery is the surgical specialty concerned with the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck

The scope of the specialty is extensive and includes the diagnosis and management of facial injuries, head and neck cancers, salivary gland diseases, facial disproportion, facial pain, impacted teeth, cysts and tumours of the jaws as well as numerous problems affecting the oral mucosa such as mouth ulcers and infections

The principle subspecialties of Oral and Maxillofacial surgery

Surgeons may choose to train and specialise in one or more of these specialised fields of Oral and Maxillofacial surgery:

  • Surgical treatment of head and neck cancer – the removal of the tumours and subsequent reconstruction, including microvascualar free tissue transfer.
  • Surgery for Craniofacial Facial Deformity – the correction of congenital or acquired facial deformity primarily to improve oro-facial function, but also often to overcome facial disfigurement and restore quality of life.
  • Oral & Maxillofacial – surgery of the teeth (including implants), jaws, temporomandibular joints, salivary glands and facial skin lesions.
  • Oral Medicine – diagnosis and management of medical conditions presenting in and around the cervico-facial structures.
  • Craniofacial Trauma – treatment of facial soft and hard tissue injuries of the craniofacial structures.
  • Cosmetic surgery – surgery to enhance facial aesthetics, and improve quality of life.

Main operations

A range of oral and maxillofacial surgical operations are carried out on an outpatient basis under local anaesthesia or conscious sedation. These include: pre-implant surgery placement of dental/facial implants, removal of impacted teeth, intra-oral and facial soft tissue procedures. More major operations, for example those for salivary gland disease, trauma, facial deformity or cancer, are carried out on an inpatient basis under general anaesthetic.

  • Facial injuries, management of complex craniofacial fractures and soft tissue injuries of the mouth, face, and neck.
  • Head and neck cancer, access to tumours within the depths of the complex craniofacial anatomy, and ablation of tumours, including neck dissections.
  • Reconstructive surgery, including microvascular free tissue transfer.
  • Orthognathic surgery for the correction of facial disproportion
  • Pre-implant surgery, including the use of implants to retain facial or dental prostheses and associated bone grafting techniques as part of oro-facial reconstruction.
  • Removal of impacted teeth and complex buried dental roots.
  • Removal of cysts and tumours of the jaws
  • Primary and secondary surgery for cleft lip and palate, and other congenital facial deformities.
  • Management of  benign and malignant lesions of the salivary glands.
  • Removal of complex facial skin tumours and reconstruction
  • Cosmetic surgery including face lifts, eyelid and brow surgery and rhinoplasties.
  • Temporomandibular joint surgery

Due to the nature of the work, oral and maxillofacial surgeons often work alongside a variety of specialists in other fields such as ENT surgeons, clinical oncologists, plastic surgeons, orthodontists, restorative dentists, radiologists and neurosurgeons.

What happens before maxillofacial surgery?

If you need maxillofacial surgery, your healthcare provider (primary care provider or dentist) will refer you to a specialist.

The maxillofacial surgeon will meet with you for a consultation to:

  • Ask about your symptoms, medical history, current medications and more.
  • Examine your oral cavity and surrounding areas.
  • Order tests as needed, such as dental X-rays or 3D scans to get detailed images of the maxillofacial structures.
  • Diagnose the condition and recommend surgery or other treatment.

What happens during maxillofacial surgery?

Maxillofacial surgery varies greatly depending on the problem and procedure. Some surgeries can be done in an outpatient setting, and you can go home the same day. Other treatment plans involve multiple surgeries to achieve the desired results.

Maxillofacial surgeons are trained and authorized to deliver anesthesia to prevent pain or put you to sleep. Your healthcare team will talk to you about whether you’ll need anesthesia and what type is best for you.

Toward the end of the procedure, your surgeon may use stitches to close any surgical wounds. Your surgeon also may place packing in your mouth to protect your teeth or the wound and to absorb fluids such as blood and pus.

What happens after maxillofacial surgery?

After maxillofacial surgery, your healthcare team will move you to a recovery room so you can wake up from the anesthesia. You may have some discomfort or pain as the medication wears off.

You’ll also probably experience:

  • Bleeding.
  • Bruising.
  • Limited use of the jaw and teeth.
  • Swelling.

Your surgical team will talk to you about how the surgery went, when you can go home and how to take care of yourself during recovery.

If you receive anesthesia, you should have someone drive you home.

What are the advantages of maxillofacial surgery?

Maxillofacial surgery can permanently improve pain, function and appearance.

What are the risks or complications of maxillofacial surgery?

As with any operation, there are risks with maxillofacial surgery, such as:

  • Bleeding.
  • Dry socket, a painful condition that can occur after tooth extraction involving problems with blood clots.
  • Infection.
  • Injury to teeth, lips, tongue, cheeks, chin, nasal cavity, sinuses, or maxillofacial bones or tissue.
  • Numbness or changes in sensation in the mouth or other areas of your face.
  • Pain.
  • Possible damage to nerves that move some of the muscles of your face.
  • Root fragments, a rare complication when a piece of tooth root breaks off and stays in place after surgery.
  • TMJ disorders.

What’s recovery like after maxillofacial surgery?

Recovery after maxillofacial surgery depends on the type of procedure you have. You’ll likely experience some discomfort, sensitivity, swelling and bleeding for at least a few days. Your healthcare provider may recommend pain medications to keep you comfortable.

If you received stitches, they’ll either dissolve or be removed in about a week.

You may have to avoid certain foods and activities for days or weeks. Your healthcare provider will give you specific instructions, which may include:

  • Apply ice packs to reduce inflammation.
  • Avoid foods that are crunchy, chewy or hard.
  • Avoid tobacco products and alcohol.
  • Don’t exercise for a few days because it can increase bleeding and swelling.
  • Rest to prevent complications.
  • Rinse your teeth instead of brushing them to kill bacteria in the mouth.

Oral Maxillofacial Surgery