Oral and Maxillofacial Surgery

Oral and maxillofacial surgery is specialized dentistry which includes a set of theoretical-practical knowledge required for the prevention, diagnostics, prognostics, a comprehensive medical-surgical treatment, and the reconstruction of pathologies, traumatisms, anomalies and congenital or acquired affectations of the structures which make up the stomatognathic system, the maxillofacial complex and related organs. (AAOMS )

An oral and maxillofacial surgery specialist is capable of handling :

1. Temporomandibular Joint Disorders: temporomandibular joint disorders are a product of many causes like stress bruxisms, malocclusion, a partial or total lack of teeth, degenerative diseases of the joints, etc. An oral maxillofacial surgeon must diagnose and handle adequately a pathology, and the surgeon must sometimes work with other specialists or dentists. Each case must be evaluated individually to determine the most suitable way to handle that case.
2. Third molar surgery: Third molar surgery or wisdom teeth surgery is a surgical procedure or one of the most frequent surgical procedures in oral surgery because it is the piece that is most frequently retained. This is not only because it is the last tooth in the arch to erupt, but also because of genetic and environmental reasons (Radi J, 2013). These retentions are associated with a vast variety of lesions which determine the need for surgical removal of a dental piece.
3. Dental implants: dental implants are titanium attachments which are inserted in the bone via a procedure an oral maxillofacial surgeon performs which includes inserting an implant via a biomechanical preparation of the bone to sustain the prosthetic attachment which will be the base for a final crown. They enable patients to eat and speak again comfortably and feel self-assured. Currently, we have a type of implant called zygomatic. Zygomatic implants are longer and may be placed in another anatomic part far from a crown. It is frequently used in cases in which there is no suitable bone support for conventional implants. These surgical procedures may be performed under local anesthesia, IV sedation or general anesthesia depending on a patient’s particular conditions.
4. Maxillofacial trauma: the main cause of this trauma in our context is violence, followed by automobile accidents, contact sports and work and home accidents. Facial trauma may affect soft tissues as skin and mucous, and dentoalveolar trauma; it also causes mandibular, maxillary, zygomatic, orbitofrontal, combined or panfacial fractures which involve all the bones of the face simultaneously. An oral maxillofacial surgeon is a dental specialist trained in handling these types of lesions, specifically the oral cavity, face and maxillary bones. For intermaxillary immobilization, surgeons use wires and for the fixation of fractures, specialists use titanium plates and screws depending on the severity of the trauma and the part of the body affected. (ACCOMF-Colombian Oral and Maxillofacial Surgery Association)
5. Orthognathic surgery: orthognathic surgery or corrective surgery of the maxillaries is a set of techniques performed by an oral maxillofacial surgeon to correct anomalies or deformities, size and position of maxillaries and adjoining structures (ACCOMF). This surgery seeks to establish chewing function and improve facial aesthetics. Each case must be evaluated individually, because surgery may involve just the mandible or the chin, and other cases may require surgery which includes the two maxillaries and the chin.
6. Orofacial infections: infections in the maxillofacial region may become a vital emergency if they are not treated adequately. Pain and inflammation of the face, mandible and/or neck may indicate that they are originating in our teeth. Depending on the severity, an oral maxillofacial surgeon may work with other specialists handling those cases, either at a hospital level or at an outpatient level. In all cases, once the problem has been diagnosed, the cause must be removed, suitable antibiotics must be established and a way to drain the infection must be found. (ACCOMF)
7. Oral pathology: an oral maxillofacial surgeon is a specialist in charge of making a diagnosis and handling pathologies in the mouth and maxillofacial region. It is important to bear in mind that there may be multiple lesions (elevated, flat, infiltrated, pigmented) in oral mucosa, which in many cases indicates a need for biopsy. A biopsy is defined as a removal of all or part of living being’s tissue to examine it and then, establish a diagnostic.
8. Reconstruction of maxillaries ( Osteogenic Distraction): there are cases in which because of a patient’s pathology in maxillary bones or because of premature tooth loss, a patient may require soft and hard tissue reconstruction procedures. An oral maxillofacial surgeon is capable of reconstructing tissue via surgical procedures including autologous or heterologous bone grafting, distraction osteogenesis surgery, and tissue expansion, among others.

Maxillofacial surgeries may be performed using:

• Local anesthesia
• Sedation with nitrous oxide
• General Anesthesia

Must supernumerary teeth be removed?

Yes, they must. This is because the root of the tooth with which it has contact may be reabsorbed, and this could originate cysts and tumors.

What is the age limit for the removal of wisdom teeth, and how old should a person be for this surgery?

The age limit is 25. Because after 25, the bone is firmer, and this may originate more difficulties in the removal of wisdom teeth. It is advisable to remove wisdom teeth between the ages of 15 and 20, but there are cases in which you may remove them before.

What complications may occur during wisdom teeth surgery?

There may be hemorrhaging, and nerve lesions which lead to face sensitivity that could be transitory or permanent. This is why, it is important that a qualified professional perform the removal. Furthermore, patients must undergo the procedure as young as possible to decrease complications.

After the removal, will I have pain? Will I have inflammation? And will I bleed?

Yes, it is going to hurt, and it is going to swell. Bleeding is minimal that is why we prescribe medications to control all these symptoms.

What special care must I take after an oral surgery?

Brush your teeth very well; brush according to your doctor's recommendations including:

1. Do not manipulate or use attachments or substances that have not been recommended by your dentist in wound of the procedure. Do not bother your sutures because sometimes they come loose or they come undone, yet that is normal because of the inflammation
2. Rest the first 24 to 48 hours, and preferably sleep with a high pillow Apply cold therapy (ice outside the mouth), in other words, constant ice compresses at 15-minute intervals during the first 12 to 48 hours after the surgery
3. Do not spit
4. Constantly drink cold liquids
5. Apply hot water compresses on the area that was operated on the third day after surgery
6. Avoid ingesting hot food at least during the first 12 hours after surgery
7. Do not smoke at least during the first 24 hours after surgery
8. Intake soft food and liquids the first day or first days until you tolerate a normal diet
9. Brush your teeth carefully and slowly in the area of your mouth you were operated on
10. Avoid exercise, the sun or night outings during the first 7 days after surgery
11. In case there is very much bleeding or hemorrhaging, apply pressure biting a sterile piece of gauze where you are bleeding for half an hour, and then apply ice on your cheek, or place a bag of tea soaked in ice water on the place of the surgery. If bleeding continues, please contact your dentist
12. In case there is intense pain, discharge or changes in color and temperature on the third day after the surgery, contact your dentist
13. Take all the medications prescribed by your dentist strictly as they are ordered on your prescription. If you have any allergic reaction (as itching, a skin rash or a stomach ache) you must suspend the medication and contact your dentist
14. Attend punctually to your control appointments for the removal of stitches and also for examinations

NOTE: on the third day, it is possible that the swelling may increase. Suspend ice and apply warm salt water compresses for 15 minutes 3 times a day

How long is disability?

There's a normal 3-day disability for wisdom teeth surgeries; for implants, there is a 3 to 5-day disability, and for maxillofacial surgery 15 to 20 days.

Will I get stitches and do I have to go to control?

Control and removal of stitches is generally eight days after surgery.

May I play sports?

No, you cannot do any physical activity for a week, and when you have undergone maxillofacial surgery, you cannot do any physical activity for a month.