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Maxillofacial Surgery: The Head Neck Arena

Maxillofacial Surgery

What Is Maxillofacial Surgery?

The branch of medicine which deals with the surgical repair of the head, face, jaws and neck inclusive of both the hard and the soft tissues is known as the maxillofacial surgery. It includes correction of facial deformities, fractures due to trauma, soft tissue space infections and ablations, tumors/cancers of the oral cavity and the neck. These are performed by oral and maxillofacial surgeons who are specialized in the fields of dentistry, oral surgery and brief training in general medicine and plastic/cosmetic surgery. As a part of training, the field of anesthesia is also included in the curriculum. Thus an oral surgeon is well trained in all of these specialties and can work well in the head, face and neck area.

Causes of Head And Neck Defects:

  • Trauma to the head causes fractures of the skull, hematomas and hemorrhages, leakage of cerebrospinal fluid
  • Facial fractures, contusions, concussions, ablations, stab injuries
  • Syndromes causing facial and cranial deformities
  • Cancers of the oral cavity such as squamous cell carcinoma, oral submucus firbrosis, verrucous carcinoma, tongue cancers
  • Temporomandibular joint disorders
  • Orofacial pain disorders
  • Cysts and tumors of the jaws; maxilla and mandible
  • Over retained teeth in the jaw
  • Impaction of teeth in the jaws; third molars followed by canines
  • Neck space infections

Signs and Symptoms Of Head And Neck Defects:

  • Fractures of the mandible cause asymmetry of the jaw, pain and tenderness
  • Cysts lead to swelling both intra as well as extra orally
  • Disimpacted teeth cause pain, swelling, bleeding and obvious discomfort
  • Clicking in the temporomandibular joint while mouth opening, pain
  • Pain in the facial muscles, orofacial discomfort
  • Facial asymmetry
  • Deviated nasal septum
  • Ptosis, hematoma, hemorrhage in the eye due to trauma or stabbing injuries

Diagnosis required prior To Maxillofacial Surgery:

  • OPG:  This radiograph gives an idea of the entire dentition in one go. Along with this, the head of the condyle, the ramus, the body of the mandible can also be appreciated for any fractures, cysts and tumors, or lower jaw asymmetry. The maxillary sinus, the nasal septum and lower border of the orbital cavity can also be appreciated in this radiograph.
  • PA view: The postero anterior view of the entire skull gives reading of the entire face. Starting from the top, the frontal bone and sinuses, the zygomatic arches, nasal cavity and conchea, maxillary and mandibular arches along with the palate and chin can also be visualized. However this will be a 2D image of the 3D structures of the human body.
  • Cone beam computed tomography CBCT: This is a three dimensional imaging technique which gives insight into all the three dimensions of the human structure in concern. This is the most confirmatory imaging technique for any type of pathology in the head and neck area.

Treatment Procedures Of Maxillofacial Surgery:

  • Cranial deformities: These involve fusion of the cranial sutures which result into various distortions in the anatomy of the human skull. Coronal synostosis leads to anterior plagiocephaly; this causes baby’s head to appear flat on the front side. Lamboidal synostosis will lead to posterior plagiocephaly and flattening of the skull from the back side. Other conditions include metopic, bicoronal and sagittal synostosis. In the surgical correction of such deformities, a maxillofacial surgeon is usually a part of the operating team which includes the anesthetist, craniosurgeon, plastic surgeon and a pediatrician. The fused sutures are resected, the interlocking is disturbed and restructured. The bones at this stage are very malleable and can be reformed easily. The surgeries are performed at a very early age when the child is about 3 to 5 months of age.
  • Facial deformities:  These are the deformities of the facial bones, muscles, fats, nerves and blood vessels which make the face look asymmetric. One of the most commonly encountered facial deformities is hemifacial microsomia. Certain syndromes like Treacher Collin syndrome also result in asymmetrical face. Jaw deformities like that of the maxilla and mandible leading to retrognathic or prognathic conditions of class II and III respectively, can be treated with surgical approaches like orhognathic surgery and distraction osteogenesis. An orthognathic surgery will cut your bone if its excess or add bone grafts/advance your bone if it is found to be defective. A distraction osteogenesis procedure will cut you bone through and through and stretch the gap so as to allow new bone to grow into the space. Both the procedures need the use of surgical screws and plates and also intra and extra oral distarctors. Thus the deformity is corrected.  Procedures such as rhinoplasty (nose jobs) can be done to correct nasal deformities along with orthognathic surgeries. Zygomatic fractures, Fractures of the upper jaw, mandible are corrected with the help of surgical procedures such as LE Fort I, II, III and bilateral sagittal split osteotomy BSSO respectively. Chin deformities are corrected taking help of geniplasty procedures.
  • Dento-alveolar surgeries: These are a host of minor operative procedures involving the oral cavity. These procedures include:
    1. Removal of carious teeth
    2. Removal of mobile teeth
    3. Removal of impacted third molars (disimpaction)
    4. Flap surgeries for exposure of bone and impacted teeth
    5. Relief of frenal attachments
    6. Removal of cysts and tumors from the oral cavity
    7. Sinus lift procedures
    8. Placement of orthodontic and surgical implants
    9. Correction of cleft lip and palate cases
  • Neck space infections: These are majorly bacterial and fungal infections which begin in the spaces present in the neck. These are spaces present in between the glands, muscles and major arteries in the neck. As for example, carotid space, sternocledomastoid space and thyroid space infections can begin due to improper drainage of pus from the roots of infected molars. Neck space infections can pose a major threat to life if not looked upon and treated well in time.

Complications And Risk Factors Associated With Maxillofacial Surgery:

  • Complications from anesthesia: This can leave behind symptoms like tingling sensations, paresthesia with mild to severe loss of sensations. Huge swelling can be seen in the blood vessels and nerves; if at all the anesthesia is administered inside them as a result of a faulty technique.
  • Infections: These are majorly bacterial, viral and fungal infections which occur at the site of administration of LA/GA, suturing.
  • Scarring: Hypertrophic keloids can occur alongwith scarring of the skin and the soft tissues. This is of a major concern in cases of distraction osteogenesis and orthognathic surgical procedures since these are majorly done on the face and scarring gives an unaesthetic appearance. 
  • Non bony reunions: This can occur in cases of fractures of the head and face when surgical plates are used to unite the bony fragments in order to re unite them. the new bone formed is called as callus and many a times may be of a poor quality resulting in relapse if the fractured segments.

Am I Good Candidate For Maxillofacial Surgery?

You can consider yourself as an ideal candidate for a maxillofacial surgical procedure when you fit into the following criteria:

  • You need removal of your third molars, they cause you tremendous amount of pain and discomfort.
  • You have been diagnosed with benign oral cancers; have been advised resection
  • You have fracture of the lower jaw, nasal fractures
  • Your cheek bones need recon touring
  • You need to cut the excess the lower jaw that you have, or the upper jaw
  • You wish to look esthetically better, want advancement of your upper and lower jaws
  • You have stab injuries in the eye, cheeks, hematomas/hamartomas
  • You have swelling in the neck area; indicating life threatening space infections

Recovery Time:

  • Exodontia/minor surgical procedures are done in the outpatient department and you are allowed to leave the setup as soon as the procedure is over. The only thing you need to take care of is the medication that you will be prescribed. These are majorly antibiotics and anti inflammatory drugs. Your surgeon may also advise you to visit the clinic at timely intervals for follow up appointments.
  • Major surgical procedures such as that for cranial and facial deformities require stay for uptil 3 to 5 days in the hospital, till the patients gain complete consciousness and are totally aware of their surroundings. It takes a minimal of 7 days for the swelling to subside; frequent visits to the surgeon are required.

Success Rate:

  • Success rate for extractions of teeth is nearly 100 percent, unless it gets complicated by a condition known as dry socket which occurs in hardly one percent of cases. 
  • Orthognathic surgeries have a success rate of 75 percent with a marginal 25 percent of relapse owing to the stretch/compression of the soft tissues such as skin, muscles, nerves and blood vessels.
  • Procedures like rhinoplasty, genioplasty have success rates of about 80 to 90 percent with little chance for relapse and an additional surgery.
  • Removal of cysts and tumors has a 60 percent success rate owing to the tendency for cancer cells to re grow.

Benefits Of Maxillofacial Surgery:

  • A surgeon can help remove a carious or a mobile tooth from your oral cavity which may otherwise would have led to infections.
  • Teeth retained in the jaws, infected with cysts and tumors can be flawlessly removed surgically.
  • Your surgeon can always add or cut bone in your face depending upon your facial requirements and enhance your look, if need be.

Cost Comparisons For Maxillofacial Surgery:

You will be required to pay peanuts for any of the major or minor oral and maxillofacial surgical procedures in India. As for example, extractions would cost you somewhere around 1000 to 5000 INR, depending upon how many teeth need to be removed. Minor surgical procedures such as sinus lift, disimpactions, frenectomies will cost you around fees in the same range as above. Orthognathic and distraction procedures go higher till one or one and a half lakh.

Why Choose India?

Team MedcureIndia highly recommends you to undergo surgical procedures for your head, neck and face area in India considering we offer you the best oral and maxillofacial surgeons, give excellent results and charges fit in your budget!

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