Corrective facial surgery can enhance the quality of life on many fronts, from providing standard usage of the mouth and jaw to dramatically improving physical appearance. Today, there are multiple branches of corrective facial surgery, including corrective jaw surgery or orthognathic surgery, facial trauma surgery and distraction osteogenesis. Some procedures are relatively new while others have their roots in centuries-old medical practices that have evolved and improved throughout the decades.
Individuals suffering from an improper bite or a misalignment in the positioning of the jaws may find life-changing relief from corrective jaw surgery, also referred to as orthognathic surgery. Orthognathic surgery should be performed by a maxillofacial board-certified oral and maxillofacial surgeon (OMS).
In addition to aligning the jaw, orthognathic surgery can improve the patient’s ability to chew, speak, and breathe. The patient may also realize a positive change to his or her physical appearance thanks to the surgery, but the functional benefits should be the primary consideration when determining whether corrective jaw surgery is the proper treatment option. Other signs that a patient may be a candidate for this type of corrective facial surgery include unusual wear of the teeth, chronic headaches or jaw pain, a receding lower jaw and chin, chronic mouth breathing, and sleep apnea.
Orthognathic surgery is a procedure that often requires consensus building between your OMS, dentist, and orthodontist. Orthodontic treatments will most likely occur before and after the corrective jaw surgery, and the timeline for completion may take many years. This timeline can be clarified further by your orthodontist and OMS.
The surgical response to facial trauma has become the domain of several different types of specialists, including Oral Maxillofacial Surgeons, Endodontists, Restorative Dentists, and others whose expertise may help when forming the optimal treatment path for a person who’s suffered facial trauma.
Facial trauma can be caused by a fall, a motor vehicle accident, interpersonal violence, machinery, or any variety of factors resulting in severe injury to the maxillofacial region. Injuries to the skin and gums are ordinarily classified as soft tissue injuries. Injuries to the bone are referred to as fractures.
Suturing is the predominant method used during facial trauma surgery for the repair of soft tissue damage. Maxillofacial board-certified surgeons are trained to inspect for and treat injuries to facial nerves, salivary glands, and salivary ducts when performing facial trauma surgery. Board certified surgeons will also pursue a course of repair that results in the best possible cosmetic result for the patient of corrective facial surgery.
Fractures of the bones of the face must heal in the same way bones elsewhere in the body must heal following a fracture. But, unlike with one’s arm or leg, it is not possible to use a cast to stabilize fractured facial bones. Your OMS will instead use other routes to stabilization, such as the wiring shut of the jaw to treat fractured bones in the upper or lower jaw. For other fractures in the facial region, the surgical placement of small screws and plates— known as rigid fixation— can be used instead of wiring the jaw. Rigid fixation is a more recent medical development and has been shown to facilitate a faster recovery time for facial trauma surgery patients. Board certified OMS’s are trained to use strategically placed incisions to minimize and hide scarring.
It is quite common for individual teeth to suffer direct and isolated damage from facial trauma. When a tooth is knocked out, it should be placed in salt water or milk. Do not wipe the tooth, because you may inadvertently remove the remnants of the ligament used to hold the tooth in place, and you will decrease the likelihood of a successful tooth replanting. In some cases, endodontists will need to be involved in providing root canal therapy or restorative dentists will step in to rebuild damaged teeth. If the original tooth is unsalvageable, dental implants may prove to be a feasible solution for replacement.
Distraction osteogenesis has been used since 1990 to treat deformities in the oral and facial region. Though the application of this technique to oral surgery is somewhat new, the origins of distraction osteogenesis date back to the early twentieth century. The core concept of this corrective facial surgery procedure is the slow separation, or distraction, of two bony segments so as to allow new bone to fill the gap between segments.
The earliest recorded use of the practice dates back to 1903. The procedure attracted more widespread attention when Russian orthopedic surgeon, Dr. Gabriel Ilizarov, began using it to correct deformities in the arms and legs of his patients. Dr. Ilizarov presented his findings to the Western Medical Society in the 1960s.
Though the procedure of separating segments may sound highly invasive, the reality of the procedure is that it is relatively gentle, with the associated pain and swelling being considerably less than in traditional surgeries prescribed for similar conditions. Distraction osteogenesis is usually performed on an outpatient basis, with the patients returning home on the day of the surgery.
General anesthesia is used for the procedure and a “distraction device” is placed to separate the bones, which results in mild discomfort – analogous perhaps to the pressure and strain of having one’s braces tightened. And, just as with orthodontic treatment, distraction osteogenesis requires recurring visits to the surgeon’s office, though these visits happen within the initial two weeks following the surgery and are for monitoring for infection and instructing the patient on the self-use of the distraction device.
You don’t want just anyone readjusting your face during corrective jaw surgery, facial trauma surgery or distraction osteogenesis. Seeing as the need for corrective facial surgery often arrives in the midst of heavy duress, you may not have time to thoroughly interview each and every OMS in your area.
You can, however, quickly ask whether your potential OMS has been board certified by the American Board of Oral and Maxillofacial Surgery. To practice, surgeons must have a valid license, but licensure alone doesn’t guarantee that an OMS is board certified. Board certified surgeons are not only legally allowed to practice but are also recognized as being up to date with the highest standards of practice within their industry. Your board-certified OMS can help you further understand and plan for corrective facial surgery.