Oral and maxillofacial pathology is a branch of dental science concerned with diseases, injuries, abnormalities and cancers of the mouth, jaws and face. Oro and maxillofacial (OMF) surgeries are procedures performed in the treatment of these disorders and diseases.
The OMF speciality has been recognized by several organizations and professional associations including the American Dental Association, the Royal College of Surgeons of Edinburgh, the Royal College of Surgeons of England and the Royal Australasian College of Dental Surgeons.
Dentists who decide to become an OMF surgeon have a basic degree in dentistry followed by several years of core training that is specific to OMF surgery. To practice as an OMF surgeon, a joint qualification in dentistry and medicine is required and the profession is often viewed as a bridge between these two disciplines, with skills and expertise required from both backgrounds. The surgeons apply this combined knowledge in the treatment of conditions such as salivary gland disease, facial pain, impacted teeth, head and neck cancers, jaw cysts or tumors and many other problems involving the oral mucosa such as infections and ulcers. In many cases, the OMF surgeon focuses on one or more of these areas to develop sup-specialist interests within the more general scope of the specialty.
The main sub-specialist areas that OMF surgeons practice are described in more detail below.
Orthognathic surgery translates literally as “surgery to create straight jaws.” To achieve this, a technique referred to as osteotomy is usually performed, which involves cutting parts of the jaw to create removable fragments of bone that can be repositioned to form a straight jaw.
The most common indications for osteotomy are difficulty eating or biting due to malocclusion, facial deformity, speech abnormality and poor dental appearance.
This area is concerned with conditions that affect hard and soft tissue in the face and head. Some examples of craniofacial conditions include the following:
All of these conditions develop early on in life and patients are usually children under the age of 2. Treatment involves a multidisciplinary team that combines neurosurgery and maxillofacial reconstruction. This surgery is major and is associated with significant blood loss and intensive care is often required for complex cases or when breathing is compromised.
This refers to the surgical treatment of problems involving the teeth and the supporting tissue that surrounds them. Examples of the procedures performed include the following
Disorders of the oral mucosa are common and can be categorized into four main groups which include ulcers, blistering, sore mouth and red and white patches. The most commonly occurring type of oral mucosal disorder is recurrent oral ulceration, which affects around 10 to 15 % of people, usually while they are young. The majority of these ulceration disorders are minor aphthous ulceration, which presents with small, flat ulcers and these heal within two weeks of surgical removal, without any scarring occurring. The remainder of the ulcers are major aphthous ulcers, which are larger and deeper ulcers that take up to six weeks to heal 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 through to complex injuries involving the nerves or brain.
OMF surgeons manage such injuries in a variety of settings and may be found practising in an emergency services setting or on the battlefield, for example, where they provide services to the military. The healthcare they provide ranges from simple would cleaning through to complicated craniofacial reconstruction. For particularly severe injuries, the OMF surgeon make work closely with experts from various other fields such as neurology or ophthalmology.
This field is included as part of the training for more advanced OMF surgical trainees, with these individuals having extensive skills and knowledge regarding the anatomy, growth, development and function of the face and jaw, as well as the inter-relationships between all of these components. Some of the most common procedures performed in facial aesthetics include the following:
Jaw joint problems are common, affecting as much as 40% of people at some stage in their lives, although these problems are m re common among females. Pain and clicking in the joints usually begins in adolescence, but this usually resolves and does not recur. In a small group of people, the problem continues into early adult life before the symptoms resolve. For a very small proportion of individuals, the problems continue and eventually causes chronic pain and discomfort.
Temporomandibular joint problems generally fall into two groups – those where the anatomy is normal but function is not, and those where the anatomy is abnormal and function may or may not be normal. For the first group, the first therapeutic measure taken is usually conservative such as exercise, diet changes, medication to reduce muscle spasms and anxiety and alteration of the dental bite. In around 50% of patients these measures are enough to resolve the problem. For the second group however, problems arising due to disorders of the bone itself such as arthritis or problems with soft cartilage tissue may require surgical treatment. These surgeries are often complex and are only carried out after comprehensive conservative treatment has failed to work. These procedures range from restoration of the meniscus through to adjustment of the joint anatomy and surgery to replace joints.