Oral and Maxillofacial Surgery

Oral and Maxillofacial Surgery specializes in the diagnosis and treatment of ailments that impact the mouth, jaws, face, and neck. This field is distinct in that it necessitates a dual qualification in both medicine and dentistry and is often considered the link between the two, treating conditions that require expertise from both areas.

Examples of these conditions include head and neck cancers, salivary gland diseases, facial disproportion, facial pain, temporomandibular joint disorders, impacted teeth, cysts, tumors of the jaws, and various problems affecting the oral mucosa such as mouth ulcers and infections. Within this broad specialty, many OMF surgeons concentrate on one of these areas to establish a sub-specialist interest. (1)

Definition and Overview

The field of oral and maxillofacial surgery is distinct in that it necessitates a two-fold qualification in both medicine and dentistry. To become a specialist in this area, individuals must complete thorough training in both general and specialized surgery, and the field is recognized internationally as a distinct specialty, with specific definitions in Europe's medical directives. While most surgeons begin by obtaining a dentistry degree before pursuing medicine, there is a growing trend of medical degree holders earning dental qualifications and pursuing careers in OMFS. (2)

Procedures

For a variety of reasons, dentists may recommend patients to an OMS. There are a few of the most frequently performed oral and maxillofacial procedure types including

• Wisdom Teeth Management and Extraction

The wisdom teeth of many people do not erupt properly. The third molar has the potential to overcrowd the mouth, erupt improperly, or develop an impact. Surgery to remove wisdom teeth that are dangerous to your dental health is frequently carried out by an OMS.

• Dental Implant Surgery

A dental implant can repair the gaps left by lost teeth in the mouth. An OMS replaces the tooth's root region with a metal post during dental implant surgery. This offers a sturdy foundation for the false tooth, or crown, which will behave, feel, and appear like a real tooth.

• Facial Injury and Trauma Surgery

With their comprehensive understanding of how the jaw comes together, OMSs help treat and repair face injuries and trauma. This might result in fractures of the jaw or the eye sockets' orbits.

• Oral, Head, and Neck Pathology

Oral and maxillofacial surgeons (OMS) have expertise in identifying and surgically treating the pathology of the head, neck, and mouth. There are several benign forms of oral, head, and neck pathology. If untreated, it could, however, raise your risk of developing cancer. Leukoplakia occasionally increases the chance that a lesion will develop into cancer. 

• Corrective Jaw Surgery

Orthognathic surgery, commonly referred to as corrective jaw surgery, can address a variety of functional issues by realigning the teeth and jaw. Chewing, speaking, or breathing issues are among the causes of corrective jaw surgery. Some causes for having jaw surgery include treating sleep apnea or having orthodontics improve the look and function of your bite. (3)

Candidates

Diagnosis and treatment of a wide variety of conditions affecting the oral mucosa, such as facial injuries, head and neck cancers, salivary gland diseases, facial disproportion, facial pain, impacted teeth, jaw cysts, and tumors, as well as mouth ulcers, and infections, fall within the broad scope of this specialty. Oral and Maxillofacial Surgery patient candidates are generally;

• children with cleft lip/palate or other facial or cranial defects who are born with them,
• young adults who require surgery after an accident or injury,
• older who have skin tumors on their faces and heads or mouth cancer,
• individuals who need care for diseases, infections, and ailments such as facial pain without surgery. (4)

Risks and Side Effects

As with any other surgical surgery, oral and maxillofacial surgery comes with potential risks and side effects. Even procedures as routine as tooth extractions can result in serious complications. Besides the common surgical risks such as 

• bleeding, 
• scarring, 
• infection, 
• and anesthesia reactions 

there are specific risks associated with oral and maxillofacial surgery, particularly when it involves reconstructive surgery or treating facial injuries including

• Intended changes in appearance,
• Alterations in the alignment of the jaw and bite,
• Modifications to the airflow in the nose and sinuses,
• Damage to facial nerves resulting in numbness, loss of control of facial muscles, or chronic nerve pain,
• Dry socket also referred to as alveolar osteitis, which occurs when a blood clot fails to form or is lost before a tooth extraction wound has the chance to heal,
• Condensing osteitis, which is inflammation of the jaw bone that causes discomfort when moving,
• Tissue death, known as tissue necrosis, which can happen when the blood flow to tissues is severely restricted after surgery. (5)

Post-Procedure and Follow-up

Efforts should be undertaken to cease smoking for a minimum of two weeks before and after surgical procedures. The smoke from cigarettes instigates the significant constriction of blood vessels, thereby reducing the supply of oxygen and blood that reaches the surgical wound. This hinders the healing process and heightens the possibility of treatment failures, such as the inadequacy of bone bonding or loss of a skin graft.

Following surgery, patients are transferred to a recovery room or the post-anesthesia care unit (PACU), where they are closely monitored until full recovery from the effects of anesthesia. This typically lasts between 10 to 15 minutes for local anesthesia and around 45 minutes for general anesthesia.

After the vital signs stabilize and patients can walk steadily, they are usually released into the care of a family member or friend. However, some procedures may require hospitalization for one or more days. Alongside wound care instructions, patients may be provided with pain relief medication and oral antibiotics to prevent post-operative infections. (6)

Recovery

The duration of recovery following oral and maxillofacial surgeries may vary depending on the specific procedure. For instance, recuperation from a wisdom tooth extraction may only require a few days, while orthognathic surgery may take several months for complete recovery.

Various factors can influence the length of the recovery period, such as the patient's overall health condition before surgery, the quality of wound care, and the presence of smoking habits. (7)

It is advisable to adhere to the recommended dietary plan, which may include a soft or liquid diet, and to seek the guidance of a dietitian if necessary to ensure proper nutritional intake. Typically, surgeons recommend eating smaller meals and snacks rather than full meals during the initial week to avoid irritating the surgical site. (8)

Results

Certain oral and maxillofacial surgical procedures may necessitate prolonged rehabilitation to restore nerve sensitivity or facial muscle function. Likewise, some scars may require months of persistent care to minimize their visibility or to prevent the formation of thick, raised patches (known as hypertrophic scarring).

It is essential to collaborate closely with the healthcare provider to achieve complete recovery. Attend all scheduled appointments and maintain realistic expectations regarding the recovery process. It is not advisable to rush this phase. (9)