The tooth, which fails to erupt in the oral cavity due to obstruction to its path of eruption is called ‘impacted tooth’. The obstruction could be due to adjacent tooth, thick bone, fibrous tissue, any cyst or tumor. Archer1 has defined impaction as “The tooth, which fails to erupt in oral cavity in its functional position and which has lost its further potential of eruption.”
The word ‘incision’ is closely associated with surgery. Incisions are placed to drain abscess, excise growths, mobilize tissue and create access to the deeper viscera. Human tissues have an inherent property that makes their response to injury fairly predictable. Depending on this predictability, principles of surgery have evolved, which help to optimize wound healing and formation of an acceptable scar.
The periapical infections are commonly seen in the clinical practice. The periapical infections result secondary to pulpal pathologies and the involved tooth is invariably non-vital and discolored. The exposure of the pulp to the external (oral) environments secondary to caries, attrition/abrasion leads to contamination and subsequently infection of the pulp. Similarly, the thermal or chemical insult of the pulp also leads to inflammatory changes in the pulp.
From the very earliest times, humans have been plagued by dental problems and have sort a variety of means to alleviate them. Egyptians, Greeks, Japanese, Indians and many more are associated with the history of dentistry.
A very few areas of medicine are as challenging medically or surgically as the burn care. It affects mainly young and children and in both sexes equally. It may vary from small minor burn injuries, which can be managed as outpatient to more extensive injuries resulting in multiorgan system failure and subsequent mortality.
About a billion years ago, life began in the sea. The sea possessed unique properties for the maintenance of life. The water that surrounds the cells of verte brates and of humans, i.e. the extracellular water has an electrolyte composition similar to what the sea had in prerecorded times, inspite of all the countless changes in evolution that have occurred
Studies of subjects with unoperated clefts of the lip and palate have been undertaken for the past 80 years. Adults with unoperated clefts of the lip and palate provide the ideal control group for investigators studying the natural history of facial growth and morphology in these subjects.The absence of surgical intervention provides an opportunity to study the outcome of facial growth, morphology, and speech, using an absolute comparative baseline.
The middle third of the facial skeleton is the area between the imaginary lines passing superiorly through the supraorbital ridges and inferiorly through the tip of the maxillary alveolar bone, when the patient is edentulous and through the incisal edges of the teeth when the patient is dentulous.
In the past decade, the field of endodontics has seen numerous advances, the scope of which have reached all facets of endodontic treatment in both conventional and surgical aspects. These technological advances have introduced new instruments and materials that did not exist before and revolutionized the way endodontic treatment is performed.
Salivary glands may be classified as major and minor glands. Major glands are paired glands. They include parotid, submandibular and sublingual salivary glands. There are numerous minor sali-vary glands that are widely distributed in the oral cavity in the submucosal layer.
Trauma is the leading cause of death from birth to age 44 years. It is third only to cancer and atherosclerosis in all age groups. It is a leading global public health problem, affecting 135 million people a year, and it is estimated that more than 5 million people died from trauma in the year 2004. Of these, more than 1 million (20%) died from Road Traffic Accidents (RTAs).
In all cases of maxillofacial trauma, formal clinical appraisal, preferably by a specialist, should precede imaging. Some facial injuries require no imaging at all; others necessitate complex image investigation, so it is essential that the specialist’s examination focus on the most appropriate imaging.
The face is essential for the expression of emotion and physical state. Scars on the face, in particular, are a stigma in human society and can isolate a person from social contacts. Facial wounds are commonly the result of road traffic accidents, windshield injuries, assaults, animal and human bites, and war injuries. Facial wounds should be aggressively treated to avoid the consequence of an unsightly scar.
The management of midfacial fractures includes the treatment of facial fractures, dentoalveolar trauma, and soft-tissue injuries, as well as associated injuries, mainly of the head and neck. The management of fractures of the maxillofacial complex remains a challenge for the oral maxillofacial surgeon, demanding both skill and expertise.
Most general dentists extract teeth. However, they are usually discriminatory in their case selection—choosing teeth that present within their ability and comfort zone. Even with this precaution, unexpected situations can arise. Bleeding is one of the complications that frequently occurs, leading to intraoperative and even postoperative problems.
The temporomandibular joint (TMJ) is a diarthrodial, ginglymal, synovial joint that allows both rotation and translatory movement. The TMJ comprises the mandibular condyle articulating with the glenoid fossa of the temporal bone and is separated by a fibrocartilaginous articular disc.
Lymphoma is a general term for a complex group of heterogeneous lymphoreticular malignancies. Lymphoma is the sixth most common malignancy and the second most common neoplasm of the head and neck after squamous cell carcinoma and accounts for 50% to 59% of head and neck neoplasms in children.
Dislocation of the temporomandibular joint (TMJ) occurs when the mandibular condylar head is displaced beyond the articular eminence from its normal anatomic position within the glenoid fossa. Displacement of the condylar head is usually in an anterior and superior direction. It can also, rarely, be dislocated laterally, posteriorly, and superiorly (into the middle cranial fossa) but only in association with a fracture.
Avulsive facial injuries are a complex problem for even the most experienced surgeon. They can present with extensive loss of both hard and soft tissues. Gunshot wounds, including those that are self-inflicted, are the most common etiology of avulsive facial injuries.
Inflammatory conditions are the most common pathology affecting the salivary glands. Due to routine immunization, the incidence of mumps has declined and sialolithiasis is the most frequent salivary gland pathology in most of the developed world; 80% of cases involve the submandibular gland.
Human error is almost certainly probably as old as human kind itself and is widely recognized as a significant cause of mistakes by both organizations and individuals. Much of the human error-related work has originated from high-risk industries, particularly commercial aviation, where even simple mistakes can be catastrophic.
Despite a vast body of supportive scientific literature reaching back into the 19th century, surgical treatment of patients with temporomandibular joint disease remains controversial in the early 21st century, perhaps in part because relatively few surgeons (or patient advocates) have examined the rich history of these operations.
Local anesthetic drugs achieve their action at the voltage-gated sodium channel. In simple terms they inhibit sodium entry into nerve cells. As the entry of sodium into the nerve cell during the firing cycle is the chief driver producing depolarization, blockade of sodium transfer causes inhibition of neural activity.
The temporomandibular joint (TMJ) has a com-plex joint architecture comprising the mandibu-lar condyle, temporal bone, and an articular disc. This hard and soft tissue combination has a unique joint orchestra that makes it very difficult to image. Clinical examination alone cannot provide a complete picture of the multitude of challenges associated with the joint.
Imaging is a critical component of the diagnostic evaluation of a patient with craniomaxillofacial injuries. Although the history and physical examination remain the cornerstones of the initial assessment, two- and three-dimensional imaging techniques are adjuncts for diagnosis, treatment planning, follow-up evaluation, and outcome assessment.
The earliest performed mandibular ramus osteotomies at the turn of the last century seemed to be modifications of Simon Hullihen’s original reports of mandibular setback with various body osteotomies. Although landmark in nature, these operations had their shortcomings; they were approached extraorally, and addressed mandibular prognathism only via setting the mandible back.
The techniques for the correction of a dentofacial deformity are basically the same for the middle-aged adult as they are for the teenager and the young adult. To achieve a favorable result in the adult orthognathic patient, it is essential to recognize age-related treatment pitfalls such as medical risk factors; progressive upper airway dysfunction; dental rehabilitation needs, including periodontal and restorative aspects; the effects of facial soft-tissue aging; and the often prolonged physiologic and psychosocial responses to surgery.
A Chinese proverb says, “Ingenuity is not as wonderful as appropriate instruments” in which “instruments” refer to the device or tools. Wisdom teeth removal surgery is one of the most complex surgeries in alveolar surgery.
The history of oral and maxillofacial surgery is richly intertwined with advances in outpatient surgery and anesthesia. On October 16, 1846, William Morton successfully demonstrated the use of ether as an anesthetic for removal of a neck mass. Like Crawford Long and Horace Wells before him, Morton helped usher in a new era of medicine.
The first step to approaching a patient with oral and maxillofacial pathology is to take a thorough history and perform a physical examination. Information gleaned from the history and physical examination will provide clues to the correct diagnosis and guide the clinician in selecting the appropriate tools to validate the diagnosis.
All surgery in children and adults with clefts of the lip and/or palate aims to reconstruct normal anatomy and function in so far as it is possible. The evolution of lip and palate repair demonstrates this well. Consequently cleft surgeons anticipated the need to repair the alveolar cleft long before it was possible to achieve clinically. It was even recognized that repair should involve separate nasal and oral layers.
This chapter is not intended to be a treatise that addresses all of the details involved in facial soft-tissue aging and rejuvenation options. Rather, the discussion that follows provides perspective concerning the fundamental importance of the maxillomandibular skeletal structures in the aging process of the neck and the lower face. An approach to the management of the anterior neck soft tissues in specific clinical settings is also described.
This chapter focuses on anesthetic and airway considerations in the management of the patient with oral and maxillofacial surgery injuries. This chapter emphasizes the basic principle of management as well as different pre-, intra-, and postoperative anesthetic strategies.
This chapter discusses the need for sedation, the risks of various modalities of sedation, techniques to minimize the risks, and two safe techniques to control fear and apprehension in the dental office. The biggest risk of sedation is respiratory depression. Mechanisms of respiratory control will be reviewed, and various forms of monitoring will be discussed along with respiratory conditions that complicate sedations.
The application of light for processing materials was first described by Arristophanes in his comedy The clouds 423 B.C. In the 2500 years that passed until the laser was invent‐ ed, light had been used both for processing material and for medical purposes in various ways. But only the laser has paved the path for widespread therapeutic use of optical radiation.
Tagaki performed the first arthroscopic examination in 1918. He used a cystoscope to look at a cadaver knee. Several further attempts to look into the knee joint were made, but the equipment was problematic. Watanabe then developed several working arthroscopes and described their use in various joints in 1957.
Autogenous bone has long been considered the gold standard of graft materials. It has earned this distinction from both a historical and biologic perspective. Autogenous bone has been used for many years in oral and maxillofacial reconstruction including trauma repair, preprosthetic surgery, and repair of mandibular discontinuity or ablative defects.
Ballistic injuries to the face are uncommon in civilian practice, but the increased military activity in Iraq and Afghanistan, together with terrorist events has led to a number of cases being treated in centres throughout the UK. Although the classic military ballistic injury is produced by the high-velocity round, the vast majority of cases today are from explosive devices, commonly the improvised explosive device (IED).
Despite advances in dental restorative techniques, simple extractions remain common, and the need to remove impacted teeth has remained a fixture in the repertoire of oral and maxillofacial surgeons. Extensive training, skill, and experience are necessary to perform extraction of an impacted tooth with minimal trauma.
Bimaxillary dental protrusion can occur in any racial group, but facial divergence (i.e., convexity) and lip prominence are strongly influenced by racial and ethnic characteristics. Greater degrees of lip and incisor prominence tend to occur in Asians, Africans, and Latinos as compared with Caucasians. In Caucasian populations, dental protrusion is more common among individuals of Mediterranean background than among those from more northern European regions.
The popularity of cosmetic surgical procedures continues to increase. Between 2000 and 2015 the num-ber of surgical and nonsurgical treatments increased by 39%. In 2015 it was estimated that the U.S. population spent $13.5 billion on surgical and nonsurgical cosmetic procedures. Approximately 13 million procedures were per-formed in 2015. The number of procedures has increased by 538% since 1997.
In 1939, Noyes first described a patient whose face was characterized by a flat nasal tip and a retruded maxillary–nasal base. He did not recognize this as an entity unique from other known forms of maxillary retrusion. It was not until 1962 that von Binder came to recognize the specific entity of nasomaxillary hypoplasia that is now called Binder syndrome.
Beer published the first medical illustration of the aging eyelid in 1807. Von Graefe first used the term blepharoplasty to describe a case of eyelid reconstruction following a cancer resection. Since then, the blepharoplasty procedure remains one of the most popular surgical procedures for both functional and esthetic reasons.
Bone grafting is an essential component of the surgeon’s armamentarium for successful treatment outcomes in implant dentistry. In the United States alone, more than 1 million bone grafting procedures are performed each year, with a 13% annual increase and a market reaching $1 billion a year.
Branchial anomalies consist of cysts, sinuses, and fistulae. Males and females are affected equally, and many lesions are diagnosed before adulthood. The majority of these anomalies involves the first and second branchial arches and may be unilateral or bilateral.
Although surgery and radiotherapy are regarded as the main curative treatment modalities in patients with locally advanced squamous cell cancer of the head and neck (SCCHN), there is a growing body of evidence that supports a role for cytotoxic and targeted drugs in this disease. Indeed, the history of devel-opment of curative therapies for SCCHN has seen an increasing trend toward combinatorial approaches in which drug treatments are integrated alongside surgery and/or radiotherapy.
Most people don’t separate the business of oral and maxil-lofacial surgery from the clinical practice. In fact, they are very distinct from one another. Clinical oral and maxillofacial surgery focuses on delivering quality patient care to the patients, whereas the business focuses on the financial and related nonclinical aspects of the practice.
According to the National Health Interview Survey (NHIS) conducted by the Centers for Disease Control and Prevention (CDC) in 2005, approximately 7% of Americans suffer from facial pain each year. The term facial pain may be used to describe any unpleasant, annoying, or descriptive sensation in the facial region, including those emanating from the oral cavity, dentition, maxilla, mandible, sinus, orbital, cranial, and nasal regions of the head and neck.
The presence of mid-face deficiency in the patient with cleft deformities remains a challenging clinical problem. Maxillary hypoplasia in the cleft patient is almost always the direct biologic consequence of prior surgical intervention. The surgical repair of the lip and/or palate during infancy, although critical for esthetics and speech development, produces scarring that affects subsequent maxillary growth.
The goal of repairs of the cleft hard and soft palate is to provide separation of the oral and nasal cavities with the creation of a functional velopharyngeal mechanism. Ideally, this should provide for normal speech and hearing, uninhibited growth, and ideal occlusion and avoid hindering psychosocial development. In the ideal scenario there would be a theoretic benefit to a single operation to achieve these goals without the creation of iatrogenic disease.
Successful management of the child born with a cleft lip and palate requires coordinated careprovided by a number of different specialties including oral/maxillofacial surgery, otolaryng‐ology, genetics, speech pathology, orthodontics, prosthodontics, and others. In most cases care of patients with congenital clefts has become a subspecialty area of clinical practice within these different professions.
Wisdom teeth removal surgery is comprised with the operation techniques of “scalpel holding,” “incision,” “flap,” “bone removal,” “cutting,” “gap increasing,” and “suture.” According to the impaction status and the anatomic structures around the wisdom teeth, the impacted teeth can be removed with appro-priate surgical technique. Smooth surgical process constitutes the clinical technique of wisdom teeth surgery.
The successful reconstruction of cleft lip and palate is inextricably connected with orthodontic care and skeletal surgery. The negative effects of the primary surgical repair of cleft palate during childhood have been known for the past 200 years.
As an oral surgeon, you will be billing to both medical and dental carriers. Your participation status notwithstanding, every service you do in your office is going to be billable to an insurance carrier whether you’re contracted or not. (The only caveat to this rule would be if you were performing a cosmetic procedure; however, the patient may still request a claim to be submitted on their behalf.)
The rectus abdominis free flap is raised as a muscle-only, myocutaneous or perforator flap based on a vascular pedicle consisting of the deep inferior epigastric artery and its venae comitans. The skin and subcutaneous component is nourished by perforating vessels that pass through the underlying muscle.
The scapula flap was developed and popularized in the 1980s by the work of Gilbert and Teot; dos Santos, Swartz and colleagues; and Cormack and Lamberty. Since then, it has been utilized for a wide range of reconstructive purposes in the head and neck area.