Oral and maxillofacial pathology is a branch of dental science concerned with diseases, injuries, abnormalities and cancers of the mouth, maxilla and face. Oro and maxillofacial surgeries (OMF) are procedures performed in the application of these disorders and diseases.
The specialty of OMF has been recognised by several professional bodies and associations including the American Dental Association, the Royal University of Surgeons of Edinburgh, the Royal University of Surgeons of England and the Royal Australasian University of Dental Surgeons.
Dentists who decide to become an OMF surgeon have a basic degree in dentistry followed by several years of beam training that is specific to OMF surgery. To practice as an OMF surgeon, a common qualification in dentistry and medicine is required and the profession is often seen as a bridge between these two disciplines, with skills and competencies required from both backgrounds. Surgeons apply this combined knowledge in the treatment of conditions such as salivary gland disease, facial pain, impacted teeth, primary and cervical cancers, jaw cysts or tumours and many other problems concerning the oral mucosa such as infections and ulcers. In many cases, the OMF surgeon focuses on one or more of these areas to develop subspecialist interests in the broader scope of the specialty.
The main subspecialty areas that OMF surgeons practice are described in more detail below.
Head and neck cancer
Orofacial cancer is fatal if left untreated. It usually begins as a rough patch, lump or ulcer that develops on the tongue, floor of the mouth or tongue. These lesions have a tendency to spread to the lymph nodes in the cervix. However, many of these cancers remain in a pre-malignant condition before they become invasive and the patient can be cured if surgical removal is performed and risk factors are addressed in the early stages.
For those with suspected malignant disease, practitioners are now required to refer these patients to an OMF surgeon with expertise in malignant disease of the head and neck within fourteen days. It may be possible to treat some patients with small and easily accessible lesions using radiotherapy. However, patients usually require surgical resection of the tumour, followed by reconstructive surgery and rehabilitation.
Orthognathic surgery literally translates as “surgery to produce straight jawbones. “To achieve this, a technique referred to as osteotomy is usually performed, which involves cutting parts of the jawbone to produce removable chips of bone that can be repositioned to form a straight jawbone.
The most classic indications for osteotomy are difficulty eating or biting due to malocclusion, facial form defect, speech abnormality and poor dental appearance.
This area is concerned with conditions that affect the hard and soft tissue in the face and head. Some examples of craniofacial conditions include the following:
- Craniosynostosis – the premature closure of one or more of the joints between the bones in a baby’s skull
- Craniofacial syndromes of dysotosis – a group of conditions characterised by abnormality of the face, skull and sometimes the limbs. Usually, the problem is fused coronal sutures in the skull, which cause the skull to form a large and wide shape.
- Encephalocoeles – a neural tube defect where pocket-like protrusions extend from the brain and grow through openings in the skull.
- Craniofacial fissures – a large group of defects that affect the face and skull, ranging from cleft lip and palate to extensive fissures that result in significant malformation.
All of these conditions develop over time and the patients are usually children under the age of 2. The claim involves a multidisciplinary team that combines neurosurgery and maxillofacial reconstruction. This surgery is major and is associated with significant bleeding and intensive care is often required for complex cases or when breathing is compromised.
This refers to the surgical treatment of problems concerning the teeth and the supporting tissue that surrounds them. Examples of the procedures performed include the following
- Surgical removal of teeth that have to shrink, break or have problems with the surrounding bone
- Removal of impacted teeth, usually wisdom teeth or canine teeth
- Removal of cysts in the jawbone
- Tooth grafting, where a buried or impacted tooth can be removed and repositioned to fill a gap produced by a lost tooth.
- Pre-orthodontic surgery – as well as removing impacted teeth, these teeth can also be exposed by surgical removal of the overlying gum tissue or bone.
- Pre-prosthetic surgery, which refers to procedures to build or improve function with dentures.
- Dental implants, which are titanium bottom forms that are used to fill in places where teeth are missing to support a head, denture or bridge.
Disorders of the oral mucosa are common and can be categorised into four main groups which include ulcers, blowing, sore mouth and red and white patches. The most common type of oral mucosal disorder occurrence is recurrent oral ulceration, which affects about 10-15% of people, usually while they are young. The majority of these ulceration disorders are a less significant aphthous ulceration, which presents with small, flat ulcers and these heal within two weeks of surgical removal, without marking the occurrence. The remainder of the ulcers are large aphthous ulcers, which are larger and deeper ulcers that resume to heal at six weeks after removal and also form scar tissue.
Examples of trauma to the head, neck and face range from simple injuries such as small cuts or loose teeth to complex injuries involving the nerves or brain.
OMF surgeons handle such injuries in a wide range of settings and can be found practising in emergency settings or on the battlefield, for example, where they provide services to the military. The care they provide ranges from simple cleaning to complicated craniofacial reconstruction. For especially severe injuries, the OMF surgeon performs the work carefully with experts from various other fields such as neurology or ophthalmology.
This inductor is included as part of the training for more advanced OMF surgical trainees, with these individuals having considerable skills and knowledge concerning the anatomy, growth, development and function of the face and maxilla, as well as the correlations between all these components. Some of the most classic techniques performed in facial aesthetics include the following:
- Rhinoplasty to adjust the size or shape of the nose and nasal function
- Genioplasty to address chin shape defect
- Pinnaplasty to address a problem referred to as “bat ears
- Procedures to improve problems caused by aging skin include forehead lift; blepharoplasty to