What is Oral and Maxillofacial Surgery?
Oral and maxillofacial surgery is a specialized field of dentistry that provides a diagnosis of several diseases as well as adjunctive treatment of serious conditions. Management of injuries, defects, and chronic conditions is an important part of OMSF, where the esthetic and functions aspects of both soft and hard tissues are treated. All in all, it is the surgical branch of dentistry.
Nature of the work
Oral and maxillofacial surgeons are well-trained and qualified to perform complicated surgical operations in the oral and maxillofacial regions. There is a wide spectrum of conditions that comes under this branch. It includes both surgical and non-surgical management of debilitating conditions.
• Whether it is hard or soft tissues of the face, neck, or jaws all come within the scope of oral and maxillofacial surgery.
• The surgeons are competent to provide the best possible care to individuals of all age groups including newborn babies, and elderly people. They provide treatment to children with deformities such as cleft lip and cleft palate or those with skull deformities.
• Following accidents and trauma, surgeons operate on patients, especially adults.
• In elderly people, oral and maxillofacial surgeons commonly treat oral cancer and skin tumors of the head and face.
• They not only have the skills to perform surgeries but can effectively manage non-surgical complications such as infections, facial pain, and oral mucosal disease.
Common procedures performed by oral and maxillofacial surgeons
Dentoalveolar surgery
The main aspect of most OSMF clinical practice is performing dental extraction of infected or impacted teeth. The impacted teeth may interfere with the successful outcome of orthodontic treatment and hence, surgical exposure of the teeth helps to achieve the goal. Surgical exposure also helps to bring the teeth into a properly functional and esthetic position.
Dentoalveloar surgery also helps in
• Preparation of mouth for denture fabrication
• Management of oral infections
• Removal of decayed teeth
• Biopsy of suspected lesions (both hard and soft tissues)
• Oral and maxillofacial surgeons play an important role as they work as the referral dentist for general dentists when any complicated or difficult oral surgical problem occurs.
Dental Implants
Dental implants consist of titanium screws that replace tooth roots. The insertion of dental implants takes place within the jaw bones and bone surrounds them so that it remains stable. They have several benefits including replacement of missing teeth, maintains effective stability, and do not dislodge easily.
Dental implants are becoming widely popular and are one of the most significant advances in dentistry. The surgeon after a thorough analysis places a dental implant and replaces the teeth. The surgeon places implants following these key components:
• Proper diagnosis
• Disease management
• Treatment planning
• Preparation of site (such as the reconstruction of bone and soft tissues)
• Maintenance and regular follow-up
Surgical management of Maxillofacial Skeletal Deformities
Maxillofacial skeletal deformities are deformities that may affect the facial skeleton, jaws, and surrounding soft tissues. Surgical correction of these deformities is managed by the oral and maxillofacial surgeon who performs different types of reconstructive procedures. There are various risk factors that may lead to these abnormalities such as developmental, functional, environmental, genetic, or any pathologic aberrations during birth. In addition, deformities can also be acquired through degenerative diseases, trauma, or neoplastic processes and may become evident with growth and development.
Facial bones are prone to musculoskeletal deformities, and the deformation can occur in all three planes (transverse, anteroposterior, and vertical). It can also affect either one jaw or both jaws, and unilateral or bilateral impact can be seen. The surgeon performs repositioning and recontouring of the facial bones in order to correct the pathologic problems.
Orthognathic Surgery
Orthognathic surgery is a surgical procedure that corrects the growth abnormalities of the facial bones and jaws. Generally, the patients may present with malocclusion and encounter several problems. These difficulties include speech and chewing problems and may affect the esthetic appearance of the face. Hence, a combination of orthodontics and surgery is helpful in these patients.
Due to varying extent of severity, the surgical treatment is done under general anesthesia. While performing the surgery the main aim is to improve the patient’s occlusion and restore the facial appearance.
Maxillofacial Trauma
Oral and maxillofacial surgery helps to repair complex and routine facial injuries, treat jaw fractures and facial bones as well as reconnect damaged nerves and ducts. This means any injury which affects the face and neck region can be managed by the surgeon.
Cleft and Craniofacial Surgery
The surgeon can manage acquired and congenital defects involving the maxillofacial region such as cleft lip and palate. Most of the cleft patients are children. A multidisciplinary team performs all types of adjunctive procedures so that optimal management of patients with such deformities is undertaken.
Treatment of Temporomandibular Joint disorders (TMJ)
OMF surgery includes diagnosis and non-surgical and surgical management of TMJ disorders. Differential diagnosis is also performed to diagnose the problem and identify the site such as pain originating from the head, neck, and face.
Oral cancer surgery
The oral cavity may present with tumors, especially in people with a habit of smoking and tobacco chewing. The oral surgeon removes the cancerous tissue from the mouth along with normal tissue present around cancer. Different techniques include mandible resection, maxillectomy, removal of the tongue (glossectomy), etc. If the tumor is large in size and affects a large portion then reconstruction by the surgeon helps to rebuild the area. The surgery rebuilds the structures and restores the function and esthetics to an optimum level.
Management of benign conditions
Benign tumors are different from malignant tumors as they are slow-growing and usually do not spread to other parts of the body. Although, they are not cancerous but can still pose a problem because they can cause pressure on surrounding areas, and cause disfigurement and pain. Benign conditions include cyst, tumor, swelling, etc. present on jaw, tongue, cheeks, lips, and oral cavity.
Oral and maxillofacial surgeons diagnose and manage benign tumors ensuring effective treatment of severe infections including oral cavity and salivary glands. The oral surgeon removes the tumor and following this reconstruction of the face and mouth is performed.
Reconstructive and Cosmetic Surgery
Oral and maxillofacial surgeon corrects several defects which may be caused as a result of trauma or any pathology. It may involve facial bone, jaw, and facial soft tissue problems. The surgeon restores the form and function at the target site by moving the nerves, bone, skin, and other tissues from different parts to the site requiring reconstruction.
Recent developments
Artificial Intelligence
Artificial intelligence is changing lives in a significant manner in all aspects. With recent advancements, AI is working in a manner to provide the best possible outcome in the medical and dental fields. It aims to develop and design improvised products that ensure maximum satisfaction is delivered. AI ability is improving exponentially.
• When it comes to oral surgery, surgeons will be able to delegate the tasks with the help of AI. For example, medical history-taking and scheduling patient appointments according to AI systems.
• Similarly, once biopsy is performed, and samples are taken built-in AI will be able to do reading and rapidly process it.
• AI will also be able to conduct complete readings of cone-beam computed tomography scans.
• Based on AI systems patients will be able to see how they will appear after undergoing a surgical procedure.
• In the future, AI will provide a more accurate, effective, and successful outcome, and help to assess how to alter the surgical plan to enhance the results.
Robotics
Robotics is still developing and advancing in dentistry. Research believes that robotic technology will soon be replacing human involvement in oral surgery. Robot-assisted surgery is expanding and reaching new heights. A combination of robotics with AI and imaging will enable the surgeons to examine the anatomy which is difficult to visualize and hence act as a guidance tool for the surgeons. Appropriate use of drills, other cutting tools will improve surgical precision and patient safety. Robot-assisted technology will have several advantages:
• Improve guidance
• Less surgical exposure
• Minimally invasive approach
• Efficient and better patient safety outcomes.
Customized dental implants
Recent technologies have led to the development of customized implants which have improved maxillofacial applications. Biomaterials such as natural, inert, and composite biomaterials are commonly used. These customized implants are designed digitally, and fabrication is done directly without needing any physical anatomical models and prostheses. This is possible due to advances in manufacturing technologies, computing power, and 3D modeling software. Biomechanical analysis by various software such as ANSYS and SOLIDWORKS will provide analysis of complex oral structures.
3D and 4D printing
Three-dimensional (3D) printing has gained significant attention in the past few years when it comes to the healthcare industry. It has evolved over its 40-year history. It is currently used in aerospace industries, personalized medicines, and dentistry. With the help of this technology, one can rapidly design and create custom-based complex parts. Several approaches may represent this technology such as selective laser sintering, stereolithography, inkjet printing, photopolymer jetting, fused deposition modeling, and powder binder printing. The materials commonly used in additive manufacturing are composites, ceramics, polymers, and metal alloys
Integration of 3D printing into a wide variety of dental fields has enhanced the outcome including the development of complex devices and tools whether it is orthodontics, prosthodontics, or oral surgery. Currently, a newer version is developed where 3D-printable smart materials allow “dimensional printing”, known as 4D printing. 4D printing is an advanced version combining 3D printing with time. Because it has adopted the most recent technology such printing platform can produce pre-programmable bio-objects which can modify their shapes according to the surrounding environment.
In oral surgery, 3D printed models are helping to facilitate pre-operative surgical simulations. The simplicity and ease of fabricating these models are working as an effective and accessible resource for oral surgeons. In the future, this technology will mimic the human tissues making it easier for oral surgeons to reconstruct complex oral and maxillofacial structures.
