Oral and Maxillofacial Pathology

Oral and maxillofacial pathology is a specialized field that focuses on identifying, understanding, and treating diseases that affect the oral and facial regions. It involves studying the causes, development, and consequences of these diseases. Oral and maxillofacial pathologists use various methods, including clinical, radiographic, microscopic, and biochemical examinations, to diagnose and manage patients with these conditions. This field encompasses both research and clinical practice. (1)

Definition and Overview

Oral and maxillofacial pathology involves the study and diagnosis of diseases that affect the mouth, jaws, and related structures, such as salivary glands, facial muscles, and the skin around the mouth. These areas serve many important functions, but they are also susceptible to various medical and dental conditions. 

Oral and maxillofacial pathology is often considered a combination of dentistry and pathology and is concerned with understanding the causes and effects of these diseases. Some practitioners in this field may also deal with disorders of the ear, nose, and throat, which may overlap with the expertise of endocrine pathologists. Head and neck pathology is sometimes used as an alternative term to describe this area of study. (2)

Procedures

Oral and Maxillofacial Pathology operations can include a variety of procedures such as:

• Dentoalveolar Surgery

The extraction of diseased or impacted teeth is a common procedure in most Oral and Maxillofacial Surgery (OMS) practices. In addition, a significant part of the dentoalveolar surgical practice involves surgically exposing impacted teeth to facilitate their orthodontic-assisted eruption into a functional and aesthetically pleasing position.

• Dental Implant

Dental implants are cylindrical metal structures made of titanium that are used to replace tooth roots. These implants are surgically placed into the jawbone, where the bone eventually grows around and fuses with the implant, securely anchoring it in place.

• Surgical Correction of Maxillofacial Skeletal Deformities

Maxillofacial skeletal deformities can be corrected through surgical procedures that aim to reconstruct the jaws, facial skeleton, and related soft tissues. These deformities may arise due to various reasons such as genetic, environmental, developmental, functional, and pathologic abnormalities, trauma, neoplastic processes, and degenerative diseases.

• Orthognathic Surgery

Orthognathic surgery is a procedure performed to correct developmental growth abnormalities that affect the jaws and facial bones. Individuals with these abnormalities often present with malocclusion, which can impact their ability to chew and speak properly, as well as their overall health and facial appearance.

• Cleft and Craniofacial Surgery

OMSs perform surgical procedures to correct both congenital and acquired defects of the maxillofacial region, such as cleft lip and palate. Most cleft and craniofacial surgeries are performed in children.

• Maxillofacial Trauma

OMS treats a range of injuries to the face and neck, from routine to complex. They are skilled in repairing fractures of the jaw and facial bones, reconnecting severed nerves and ducts, and managing other injuries to the face and neck region.

• Temporomandibular Joint

This field of practice involves the identification, diagnosis, and both surgical and non-surgical management of temporomandibular joint (TMJ) disorders. In addition, it also encompasses the differential diagnosis of pain in the head, neck, and facial regions.

• Pathologic Conditions

Oral and Maxillofacial Surgeons (OMSs) specialize in diagnosing and treating patients with diseases that affect the oral and maxillofacial region. These diseases include cysts, benign and malignant tumors, soft tissue issues, and severe infections of the oral cavity and salivary glands.

• Reconstructive and Cosmetic Surgery

The purpose of this surgery is to correct issues with the jaw, facial bones, and soft tissues that result from previous trauma or the removal of pathology. (3)

Candidates

Patients who may be candidates for Oral and Maxillofacial Pathology operations include those people:

• who are born with or develop deformities of their skull or face,
• who need surgery after an injury or accident,
• who have oral cancer or skin tumors of the face and head,
• who have facial pain, disease, and infections. (4)

Risks and Side Effects

Like any surgery, oral and maxillofacial surgery carries risks. Even common procedures, such as tooth extractions, can result in serious complications. Oral and maxillofacial surgery presents specific risks include 

• unintended changes in appearance, 
• alterations in jaw alignment and bite, 
• changes in the flow of air through the nose and sinuses, 
• damage to facial nerves, which may result in numbness, 
• loss of facial muscle control, 
• unrelenting nerve pain. 

Additionally, there are specific conditions that may arise such as alveolar osteitis or "dry socket," condensing osteitis which is characterized by jaw inflammation and pain during movement, and tissue necrosis, which is tissue death resulting from severely restricted blood flow to tissues post-surgery. (5)

Post-Procedure and Follow-up

It is highly recommended to cease smoking for at least two weeks before and after undergoing surgery. Smoking causes a significant narrowing of blood vessels, which leads to decreased blood and oxygen flow to the surgical site. This can negatively affect the healing process and increase the risk of treatment failures, such as graft loss or improper bone bonding. (6)

Recovery 

Although most people can resume normal activities within a few days of having a wisdom tooth extraction, the recovery time can vary for different types of surgeries. Recovery from orthognathic surgery, for instance, may take several months. Factors such as pre-existing health conditions, wound care, and smoking habits can affect recovery time.

It's important to follow the recommended dietary plan after surgery, whether it is a soft or liquid diet. A dietitian can be consulted if necessary to ensure proper nutrition. Surgeons typically suggest consuming smaller meals and snacks in the initial week to avoid irritating the surgical site.

Results

The results of Oral and Maxillofacial Pathology operations can vary depending on the specific procedure and individual factors. In some cases, the results can be immediate and dramatic, while in other cases, it may take several weeks or even months to see the full benefits of the surgery.

In general, the goal of Oral and Maxillofacial Pathology operations is to improve or restore the function, appearance, and overall health of the oral and maxillofacial region. This may include reducing pain, improving speech or chewing ability, correcting abnormalities or deformities, or treating diseases or infections.