Maxillofacial Surgery

Oral and maxillofacial surgery is the treatment by surgery of diseased tissues of the mouth and jaws (e.g. the removal of benign tumours and cysts in the mouth), the correction of defor­mities and abnormalities, and the repair of fractures in the region. Most malignant tumours are removed by general surgeons, as they often extend beyond the region. The removal of teeth is a traditional surgical procedure by dentists. Teeth may be extracted with forceps or, in difficult cases, be surgically removed. In these cases the gum is peeled back, bone is removed from around the tooth or root to allow its easy removal, and then the gum is sewn back into place. The removal of impacted wisdom teeth is per­haps the commonest procedure carried out by oral and maxillofacial surgeons. A wisdom tooth is impacted when it does not have room enough to fit into place in the mouth and is jammed or impacted behind the tooth in front of it. This occurs mostly in the lower jaw. Removal is preferably carried out on people when they are young.

Some oral surgery is carried out to assist other dental special­ists. For example, the surgeon may improve the shape of a jaw and re-shape tissue to allow a better denture to be made. Surgery to remove the tips of roots can help the endodontist do a better root filling. Exposing an eye tooth buried in the palate may assist the orthodontist to attach a spring to it and pull it into place. Transplanting a tooth from one part of the mouth to another can help the orthodontist, or the prosthodontist with a bridge. Pre­paring the jaws to take a titanium implant may help the prosthodontist fit a bridge where it could not be done otherwise.

Abnormalities may occur through developmental faults such as a cleft palate, which is due to bones not joining up when they should. A surgical team can correct this fault at an early age. A squat face can be lengthened by detaching the palate from the base of the skull, and inserting a bone graft made from a section of rib. The palate can be levelled if uneven, or moved to alter the shape of the face.

If the lower jaw juts out too far or recedes, giving a weak-looking chin, the surgeon can split the rear section of the jaw vertically and then move the front section backwards or forwards to the desired position. At the same time, the surgeon may cut a bit off a jutting chin or add a bone graft to a receding one. The jaw is then wired into place for a few weeks, while the patient is fed through a straw.

Problems with the temporomandibular joint (jaw joint) just in front of the ear are also often treatable by surgery.

Sometimes one side of the jaw keeps on growing after the other side has stopped, creating a lopsided appearance, and the teeth only meet on one side. Surgery can return all to normal. A bony growth called a taurus can also appear on the upper or lower jaws, and can be surgically removed.

The number of facial and jaw fractures has vastly increased with the road accident rate. Repairing and splinting these frac­tures calls for ingenuity and skill on the part of oral and maxillofacial surgeons. Some results are quite miraculous. Gun­shot wounds to the face are also becoming more common and can be very severe. Industrial accidents and sporting injuries also keep the surgeons busy.

There are many other surgical procedures: clearing blocked salivary ducts, treating the sinuses, removing foreign bodies which have become buried in the mouth and jaws, etc. The postgraduate training of the oral and maxillofacial surgeon is necessarily lengthy, wide-ranging, and continuous.