ORO-FACIAL SURGERIES

WISDOM TOOTH REMOVAL (DISIMPACTION):
• Wisdom teeth erupt by the age of 25years, in the most unusual positions of the mouth and have odd shapes and positions. Sometimes they are malformed and sometimes they are missing. The removal of wisdom tooth requires much more specialized effort than the normal tooth extraction and also requires much care afterwards.
• Impaction is most commonly seen in the mandibular 3rd molars (the posterior most teeth in the jaws)
• The majority of the tooth portion remains embedded in the jaw bone
• Gum that overlies impacted wisdom tooth becomes inflamed and swollen, leading to a painful condition called as PERICORONITIS.
• The removal of impacted wisdom teeth is best suited for the expert training of the Oral and Maxillofacial Surgeon.
• The Oral and Maxillofacial Surgeon will often recommend the removal of wisdom teeth at an early age, because the risks involved with the removal of wisdom teeth greatly increase with age. This is also the case with recovery period.

JAW FRACTURE MANAGEMENT:

Should you or your family member or friend ever experience trauma to the face or mouth that requires a trip to the emergency room, or an immediate visit to your doctor/dentist, it is possible that you will require the services of an Oral and Maxillofacial Surgeon (OMFS). Oral and Maxillofacial Surgeons are trained, skilled and uniquely qualified to manage and treat Facial Trauma and other injuries including:

• Facial lacerations
• Intra oral lacerations
• Fractured facial bones
• Fractured jaws (upper and lower jaw)

Soft tissue Injuries of the Maxillofacial Region: when soft tissue injuries such as lacerations (cuts) occur on the face, they are repaired by "suturing" (stiches). In addition to the obvious concern of providing a repair which yields the best cosmetic result possible, care is taken to inspect for and treat injuries to structures such as facial nerves, salivary glands and salivary ducts. Oral and Maxillofacial Surgeons are well trained and proficient at diagnosing and treating facial lacerations as well as intra oral lacerations.

Bone injuries of the Maxillofacial region: fractures of the jaw are best treated and stabilized by the surgical placement of small "plates and screws" at the involved site. This technique is called "rigid fixation" of a fracture. The relatively recent development and use of "rigid fixation" has profoundly improved the recovery period for many patients by allowing them to return to normal function more quickly.

JAW CYST REMOVAL:
A cyst is a pathological epithelial lined cavity that is filled with fluid or soft material and usually grows from internal pressure generated by fluid being drawn into the cavity from osmosis (hydrostatic pressure).
As the cyst grows from hydraulic pressure it causes the bone resorption, and may cause tooth mobility or other vital structures such as nerves and blood vessels, or root resorption. Most cysts do not cause any symptoms, and are discovered on routine dental radiographs. Some cysts may not require any treatment, but if treatment is required, it usually involves some Minor Surgery to partially or completely remove the cyst in a one or two-stage procedure.

Diagnosis: Most Cysts are diagnosed by routine dental radiography. On an X-ray, Cysts appear as radiolucent (dark) areas with radiopaque (white) borders. Cysts are usually unilocular, but may also be multilocular. Sometimes Aspiration is used to aid diagnosis of a cystic lesion, e.g. fluid aspirate from a radicular cyst may appear straw colored and display shimmering due to cholesterol content. Almost always, the cyst lining is sent to a pathologist for histopathologic examination after it has been surgically removed.

Treatment:

For treatment surgical removal of the cyst is required. There are four ways to managed cysts:
Enucleation- Removal of the entire cyst.
Marsupialization- The creation of a window into the wall of a cyst, allowing the contents to be drained. The window is left open, and the lack of pressure within the cyst causes the lesion to shrink, as the surrounding bone starts to fill in again.
Enucleation following marsupialization- Sometimes marsupialization is carried out as a single procedure, but usually it is followed by a second procedure to remove the cyst. This is particularly the case when cysts are very large and their removal would leave a significant surgical defect.
Enucleation with curettage- This is removal of the cyst and some of the surrounding bone, which may contain some of the lining of the cyst.

PRE-PROSTHETIC SURGERIES:
The preparation of your mouth before the placement of a prosthesis is referred to as pre-prosthetic surgery. Some patients require minor oral surgical procedures before receiving a partial or complete denture, in order to ensure the maximum level of comfort.

Aim of pre-prosthetic surgery:

• • Provide adequate bony tissue support for the placement of complete dentures.

• • Provide adequate soft tissue support and optimal vestibular depth.

• • Elimination of pre-existing bony deformities e.g. tori, prominent mylohyoid ridge and prominent genial tubercles.

• • Correction of maxillary and mandibular ridge relationship.

• • Elimination of pre-existing soft tissue deformities e.g. flabby ridges, hyperplastic tissues etc.

• • Maintain function and Esthetics.

Types of pre-prosthetic Surgery:

• • Frenectomy

• • Alveoloplasty

• • Vestibuloplasty

• • Sinus lift surgeries

• • Ridge augmentation procedures

Frenectomy: Frenum is a thick fibrous band which attaches lip to underlying bone in the midline. Many times there is high frenum attached near to the crest of the ridge which may be too broad and can interfere in getting proper peripheral seal in denture. The case below is showing a high frenum attachment.

Lingual frenectomy/ tongue tie: Lingual frenum may sometimes be too short and may be attached till the tip of the tongue which interfere with normal tongue movements and causes speech problem to the patient, so surgical correction is advocated in these cases.

Alveoloplasty: Alveoloplasty is a pre-prosthetic procedure performed to smoothen or reshape the jawbone. In this procedure, the bony edges of the alveolar ridge and its surrounding structures is made smooth, redesigned or recontoured so that a well-fitting, comfortable, and esthetic dental prosthesis may be fabricated. This pre-prosthetic surgery prepares the mouth to receive a dental prosthesis.

Vestibuloplasty: Vestibuloplasty is a surgical procedure designed to restore alveolar ridge height by lowering the muscles attached to buccal, labial or lingual aspects of jaws. It is most often seen when preparing the mouth for dentures or an implant.

Sinus lift surgeries: Maxillary sinus floor augmentation(also termed sinus lift, sinus graft, sinus augmentation or sinus procedure) is a surgical procedure which aims to increase the amount of bone in the posterior maxilla (upper jaw bone), in the area of the premolar and molar teeth, by lifting the Schneiderian membrane (sinus membrane) and placing a bone graft.

The goal of the sinus lift is to graft extra bone into the maxillary sinus, so more bone is available to support a dental implant.
It takes about six months for the sinus augmentation bone to become part of the patient's natural sinus floor bone. It at times both the

Ridge augmentation procedure:

A ridge augmentation is a common dental procedure often performed following a tooth extraction to help recreate the natural contour of the gums and jaw that may have been lost due to bone loss as a result of a tooth extraction, or for other reason.

Rebuilding the original height and width of the alveolar ridge may be required for dental implant placement or for aesthetic purposes.

BIOPSIES/ CANCER SCREENING:
Biopsy is the removal of a sample of tissue or cells taken from your body for microscopic examination to check fro cancer cells or other abnormalities.
Types of Biopsies that are routienly performed in a dental clinic our Excisional biopsy, Incisinal biopsy, Fine needle aspiration cytology (FNAC). These procedures are carried out under local anesthesia.
Any non-healing ulcer (presrnt for more than 2 months), Abnormal growth or lesion, swellings etc are indicated by biopsy.

LOBULOPLASTY (EAR LOBE REPAIR):
Is a surgery intended to restore the appearance of ear lobes. Torn or stretched earlobes are a common complaint from women. Earlobes can tear or stretch due to trauma, repeated wearing of heavy earing repairing ear lobe repair. An earlobe repair is a relatively simple, uncomplicated procedure performed under Local anesthesia (L.A.). The torn skin edges are excised and margins are sutured together. These sutures need to remain in place for around a week and ears can be re-pierced at the same site after a minimum of 8 weeks.

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