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Management of Oral & Maxillofacial Pathology

Oral maxillofacial surgery is the dental specialty that manages the underlying conditions, diseases, defects and injuries causing and/or contributing to functional and esthetic problems in the mouth, teeth, jaws and face. Closely linked to oral maxillofacial surgery, oral maxillofacial pathology focuses on diagnosing and understanding the nature of diseases and abnormal conditions (pathology) in the oral and facial region.

Oral Maxillofacial Surgery: Treatments and Procedures

Treatments and procedures performed by oral maxillofacial surgeons address a variety of conditions and diseases of the mouth, teeth, jaw and face. These include:

  • Diagnosis/treatment of potentially life-threatening infections of the maxillofacial region
  • Performing biopsies and other diagnostic tests
  • Diagnosis/treatment of oral cancers
  • Diagnosis/management of impacted teeth, wisdom teeth, tooth extraction and dentoalveolar surgery, which encompasses all procedures relating to the teeth, supporting tissue and bony structures in the mouth
  • Surgical treatment of facial pain problems related to the temporomandibular joint (TMJ)
  • Surgical correction of oral and facial deformities caused by differences in skeletal growth between upper and lower jaws, and congenital defects, including cleft lip and palate
  • Reconstructive jaw surgery to correct hard and soft tissue injuries in the upper and/or lower jaws resulting from trauma or tumor surgery
  • Treatment/repair of traumatic injuries to the face, jaws, mouth and teeth
  • Dental implant placement (single tooth, several teeth, entire mouth)
  • Cosmetic facial procedures

Oral Maxillofacial Surgeons

Oral maxillofacial surgeons are the dental surgical specialists whose scope of practice includes outpatient anesthesia, dentoalveolar surgery to manage diseases of the teeth and supporting soft and hard tissue, surgical correction of maxillofacial skeletal deformities, cleft and craniofacial surgery, facial reconstructive trauma surgery, facial cosmetic surgery, and TMJ surgery.

An oral maxillofacial surgeon is a graduate of an accredited four-year dental school who has completed an additional four to six years of training through an accredited, hospital-based oral and maxillofacial surgery residency program. During this residency, oral maxillofacial surgeons train alongside medical residents in medical specialty areas, such as internal medicine, general surgery, otolaryngology (branch of medicine/surgery specializing in the ear, nose and throat), plastic surgery and emergency medicine. Training prepares them to perform a variety of procedures necessary for diagnosing, treating and managing conditions, defects and injuries of the mouth, teeth, jaws and face.

Oral Maxillofacial Surgeon and TMJ Treatment

TMJ treatment ranges from conservative dental and medical care to complex surgery. Depending on the diagnosis, treatment may include short-term non-steroidal anti-inflammatory drugs for pain, and muscle relaxants, bite plate or splint therapy, and counseling for stress management.

Surgery may be necessary if non-surgical treatment is unsuccessful or if there is definite joint damage. Surgery can involve arthroscopy (method identical to the orthopedic procedures used to inspect and treat larger joints like the knee) or repair of damaged tissue by a direct surgical approach.

Oral Maxillofacial Surgery and Dental Implants

Dental implants provide a more permanent solution to missing teeth, preventing the functional and esthetic problems of bone loss and conventional alternatives, such as fixed bridges and removable dentures. The oral maxillofacial surgeon who places the implants consults with the patient and the restorative dentist who makes the crowns for the implants to ensure a collaborative treatment plan. After an evaluation that includes a comprehensive examination, X-rays and a consultation with the patient and other members of the implant team, the oral maxillofacial surgeon places the implant(s).

If there is inadequate bone at the proposed site for implant, the oral maxillofacial surgeon first will graft bone from other body areas to the implant site. When the implants have stabilized in the jaw, the restorative dentist prepares an impression of the upper/lower jaws, which is used to make the model for the crowns. After the implants and crowns have been placed, the oral maxillofacial surgeon and restorative dentist continue collaborating through follow-up examinations.

Oral Maxillofacial Surgery and Corrective Jaw Surgery

While an orthodontic approach usually can correct bite (occlusion) problems when only the teeth are misaligned, oral maxillofacial surgeons perform corrective jaw surgery to correct minor and major skeletal and dental irregularities, including misalignment of the jaws and teeth. The oral maxillofacial surgeon works with your dentist and orthodontist to determine whether you are a candidate for corrective jaw surgery. Surgery is intended to improve a patient’s ability to chew, speak and breathe. Although surgery may produce esthetic benefits, oral maxillofacial surgeons often perform this surgical procedure to correct functional problems. The oral maxillofacial surgeon determines which corrective jaw surgical procedure is appropriate and performs the actual surgery. It is important to understand that your treatment, which will likely include orthodontics before and after surgery, may take several years to complete and will involve a collaborative approach between your oral maxillofacial surgeon and other members of your dental/medical team.

Pathological oral maxillofacial conditions that may benefit from corrective jaw surgery include:

  • Chronic jaw or jaw joint (TMJ) pain unresponsive to conservative therapy
  • Open bite (space between the upper and lower teeth when the mouth is closed)
  • Unbalanced facial appearance
  • Facial injury or birth defects
  • Receding chin
  • Protruding jaw
  • Inability to make lips meet without straining
  • Sleep apnea (breathing problems when sleeping; such as snoring)

Depending on the procedure, corrective jaw surgery may be performed under general anesthesia in a hospital, ambulatory surgical center or in the oral maxillofacial surgery office. Surgery may take from one to several hours.

In some cases, bone may be added, taken away or reshaped. Surgical plates, screws, wires and rubber bands may be used to hold the jaws in their new positions. Incisions usually are made inside the mouth to reduce visible scarring. After surgery, the oral maxillofacial surgeon will recommend a modified diet, which may include liquids and soft solids, before transitioning to a normal diet.

Oral Maxillofacial Surgeon and Oral and Facial Injuries

Oral maxillofacial surgeons treat injuries and fractures of the upper and lower jaws, palate, cheekbones, eye sockets or a combination of these. Particularly dangerous compared to other hard tissue fractures, injuries to the oral maxillofacial region — typically caused by some type of accident or act of violence — can affect sight, speech, breathing and swallowing. Treatment often requires hospitalization.

Oral maxillofacial surgeons may make incisions to expose the bone, use small screws and fixation appliances, or require the mouth to be wired or rubber-banded together for a healing period of six or more weeks. They will put patients on a liquid/puree diet and give instructions for continued aftercare.

When maxillofacial fractures are complex or extensive, an oral maxillofacial surgeon may need to make multiple incisions to expose the bones and use a combination of wiring or plating techniques. The repositioning technique used by the oral maxillofacial surgeon will depend on the location and severity of the fracture. For example, in the case of a break in the upper or lower jaw, metal braces may be fastened to the teeth and rubber bands or wires used to hold the jaws together. Patients with few or no teeth may need dentures or splints to align and secure the fracture. Patients who sustain facial fractures may also have other medical problems. The oral maxillofacial surgeon is trained to coordinate his or her treatment with that of other doctors.

Oral Maxillofacial Surgeon and Facial Cosmetics

Oral maxillofacial surgeons are specially qualified to perform cosmetic surgeries to correct physical malformations of maxillofacial region resulting from aging, disease, injury and birth defects. Involving the functional and esthetic aspects of the face, mouth, teeth and jaws, minimally invasive procedures are performed in the office using local and/or intravenous anesthesia; other procedures may require outpatient or same-day surgery at a hospital or surgery center. Oral maxillofacial surgeons also are equipped to provide facial cosmetic procedures on an outpatient basis from their practice office using IV sedation, or local or general anesthesia.

Common cosmetic procedures that oral maxillofacial surgeons are qualified to perform include:

Cheekbone implants (malar augmentation) to achieve higher, more prominent cheekbones and improved facial balance

Chin surgery (genioplasty) to increase/decrease the chin’s length and projection

Ear surgery (otoplasty) to change the shape, size or placement of ears

Eyelid surgery (biepharoplasty) to remove fat and excess skin from upper and lower eyelids

Facelift (rhytidectomy) to provide a younger-looking appearance by tightening facial skin and muscles, and removing excess skin

Facial and neck liposuction to sculpt the face by removing excess fat; neck liposuction often is done in conjunction with procedures such as corrective jaw surgery

Forehead/Browlift to improve brow positioning, minimize frown lines and reduce forehead wrinkles

Lip enhancement to reshape the upper and lower lip for a more attractive/youthful look; lip augmentation employs various materials to “plump” lips, creating fullness and decreasing vertical lines

Nasal reconstruction (rhinoplasty) to reduce/increase nose size, alter shape of nose tip or bridge, narrow the span of the nostrils, or change the angle between the nose and upper lip

Additionally, oral maxillofacial surgeons can perform techniques such as Botox injections, chemical peels, dermabrasion, collagen injections and lasers to treat skin that is wrinkled or damaged. The scope of the facial cosmetic procedures performed depends on the oral maxillofacial sugeon. Many oral maxillofacial surgeons work in conjunction with a plastic surgeon to achieve optimal results.