Deprtment of Faciomaxillary surgery and Dentistry at the Apollo Gleneagles Hospital, Kolkata
Faciomaxillary & Oral Surgery - What is this speciality all about ?
Faciomaxillary Surgery (official name Oral & Maxillofacial Surgery - OMS) is the last of the nine specialities of the Senate of Surgical Specialities of the Royal Colleges. It was formally included in 1994.
Faciomaxillary Surgeons are the specific experts on diseases affecting the mouth, face, jaw and neck. As a result of their unique dual training, they diagnose and treat symptoms, pathology, deformity and trauma affecting this complex area in a comprehensive manner.
What is Orthognathic Surgery ?
"Surgery to create straight jaws" is the literal meaning of orthognathic surgery. Such corrections are largely achieved by osteotomies, surgical techniques by which parts of the jaw bone are cut to create separate fragments, which can then be moved into new positions with preservation of their blood supply.
The most common indications for such procedures are the correction of facial deformity, dental appearance, eating and biting problems caused by malocclusion and speech abnormalities. The most commonly seen conditions, which can be corrected by orthognathic surgery, are prominence or lack of development of the upper or lower jaw. Vertical discrepancies, for example when there is too much or too little exposure of the upper front teeth and "open bite" deformities where the teeth do not meet, are also managed in this way.
When there is facial asymmetry, perhaps because one side of the face has failed to develop properly or alternatively has grown too much, orthognathic surgery may be used to correct the problem. Orthognathic surgery also has an important role to play in the management of congenital craniofacial syndromes, for example clefts of the lip and palate and other deformities of development of the face and skull.
Facial deformity correction - Maxillofacial or Plastic Surgery ?
Most bony deformities of face are corrected by orthognathic surgery, which are Maxillofacial Surgical procedures, this group include Genioplasty as well. Also, there is very little dispute about Faciomaxillary Surgeons correcting deformities of face resulting from mechanical violence.
Facial burns however, are exclusively treated by plastic surgeons. Facial soft tissue remodelling is done by both specialities.
How expensive is Facial Surgery ?
It is not any more expensive than any other specialised surgery. Faciomaxillary surgery involves manipulation of very delicate structures and application of very precision techniques. These stretch the operating time. The metal plates and screws used on facial bones are all made of titanium and generally have to be imported. These make them more expensive than stainless steel plates of Orthopaedics.
However, increasing popularity of the specialty and increasing number procedures performed is seeing a sharp reduction in the prices.
What is a dental implant ?
The endosteal dental implant is a device made of a biocompatible material, usually titanium, which is placed within bone and in time becomes directly attached to vital bone tissue, a process termed Osseo integration. When placed within the jaw bone, implants can carry a fixture to provide anchorage for artificial tooth /teeth.
These prostheses would give the cosmetic, functional and psychological feel of natural dentition unlike dentures or crown & bridge. They used to be impractically expensive, but with increasing usage, price is coming down fast.
Wisdom tooth surgery - what is behind the horror stories ?
Difficult impactions can be one of the most demanding procedures in maxillofacial surgery, carrying a significant risk of nerve injury and, without question; removal is most safely carried out by an experienced surgeon. Unfortunately, in our country this procedure is not considered with due seriousness and many high street dentists without much training and experience may have a go and can cause prolong suffering for the patient.
The face inherently swells significantly after most wisdom tooth removal and no surgery immediately afterwards is absolutely painless. However, the pain and swelling is least in the hands of trained surgeons comfortable with the regional anatomy to a much greater extent. Most of all, Maxillofacial Surgeons do not recommend removal of wisdom teeth without significant reason.
Oral Cancer - how serious is the concern ?
If you find anything out of the ordinary, particularly anything that does not heal or go away in two weeks, or that has recently changed, discuss it with your oral health professional.
What can be done for jaw joints pain and dysfunction ?
The temporomandibular joint (jaw joint) is unique. Its daunting anatomy and philology suggests complexity and this indeed is the case. In general, there are two groups of patients with jaw joint disorders. Those with normal anatomy, but abnormal function, and those with abnormal anatomy whose function may be abnormal.
Surgical treatment on these patients must only be undertaken after very careful evaluation and trial of conservative treatment. In the past, surgery for TMJ disease was less scientific and the results were appropriately variable, but now there is deeper understanding, better investigation and specialisation of surgeons, which appears to improve outcome.
Non-surgical treatment is aimed at controlling inflammation and decreasing discomfort with anti-inflammatory drugs, including steroid injections, together with manipulation and physiotherapy etc.
Ankylosis is where bony fusion of the joint occurs. If this happens in childhood, mandibular growth is limited and distortion of the lower and the upper jaw, causing facial asymmetry, occurs. The treatment of this in later life can be complex involving orthodontics and orthognathic surgery and complex temporomandibular joint surgery. In adults, removing the ankylotic mass can restore movement. Sometimes joint reconstruction is necessary.
Consultants in the Dept of Faciomaxillary Surgery & Dentistry : -
Dr. Srijon Mukherjee
FDSRCS(ENG)
Dr. Samiran Das
BDS MDS
Visiting Consultants : -
(Prosthodontist) Dr. Saibal Sen
BDS (Cal) MDS (Prosth.)
(Endodontist) Dr. Soumen Chakraborty
BDS (Cal), MDS (Cons)
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