Oral and Maxillofacial Surgery

Oral and maxillofacial is the diagnosis and treatment of diseases, injuries and defects affecting the mouth, jaws, face and neck. It’s unique in that an oral maxillofacial surgeon (OMS) is required to have a dual qualification in both medicine and dentistry.

At New Hall Hospital our oral and maxillofacial surgeons, Mr Ian Downie and Mr Jayanth Kunjur treat conditions requiring expertise in both of these fields, such as: facial pain, facial injuries and disproportion, head and neck cancer, salivary gland disease, impacted and missing teeth, jaw joint disorders, cysts and tumours of the jaw and sleep apnoea.

Wisdom teeth extraction

Your wisdom teeth are the four teeth located right at the back of your mouth. They are the last teeth to come through. Sometimes there isn’t enough room in your mouth for your wisdom teeth so they don’t emerge normally (at an angle, partially emerged). This is known as impacted teeth.

Impacted wisdom teeth can cause pain, swelling and infection. You may need your wisdom teeth removed to stop these problems. Wisdom teeth extraction is a very common procedure and often takes just a few minutes. Your oral and maxillofacial surgeon will grasp your tooth with dental tools and loosen it by rocking it back and forth and twisting slightly. They will then remove it completely.

If your tooth is difficult to remove, your oral and maxillofacial surgeon may make a cut in your gum close to the tooth so that they can remove a small piece of bone to help get the tooth out. Once the tooth is removed your wound is closed using stitches.

Dental implants

Dental implants are artificial replacements for the roots of your teeth. They are used to restore missing and damaged teeth. They are a long term solution that can restore a permanent set of teeth and allow you to enjoy life without worrying about your teeth.

Dental implants are usually made of titanium as it has the ability to fuse to bone. They are inserted into your jawbone and hold crowns, bridges and false teeth in place. A single dental implant can support one, or several, replacement teeth. It’s possible to have several dental implants fitted at the same time.

Implants have a supporting internal screw called an abutment that holds the false tooth (or teeth) in place. The implant and abutment can be fitted in one or two stages. You can have your artificial teeth attached on the same day or at a later stage.

Your oral and maxillofacial surgeon will discuss your suitability for dental implants. They are suitable for most adults with good general health.

Jaw surgery

Jaw surgery, also known as orthognathic surgery, is performed to correct a wide range of minor and major skeletal and dental irregularities, including the misalignment of jaws and teeth.

Corrective jaw surgery can improve many conditions including: difficulty chewing, biting and swallowing, chronic jaw pain, excessive wear of teeth, open bite (space between your upper and lower teeth when your mouth is closed), receding lower jaw and chin, protruding jaw, facial injury, chronic mouth breathing and sleep apnoea (breathing problems when you’re asleep). It can also enhance a patient's appearance.

Your OMS will determine which corrective jaw surgical procedure is appropriate for your needs. In some cases, bone may be added, taken away or reshaped. Surgical plates, screws, wires and rubber bands may be used to hold your jaw in its new positions. Incisions are usually made inside your mouth to reduce visible scarring.

Corrective jaw surgery can have a dramatic and positive effect on many aspects of your life with enhancements to appearance and speech as well as improved bite and function.

Facial trauma

Facial trauma is an injury of the face. There are a number of possible causes of facial trauma. The majority are due to sports injuries, accidental falls, motor vehicle accidents, assault and work related accidents.

Here at New Hall Hospital our oral and maxillofacial surgeons offer a full range of care for facial trauma injuries from the treatment of dentoalveolar fractures (injury to the tooth and surrounding bone) to the care of extensive facial lacerations and facial fractures.

Facial trauma surgery aims to: control bleeding, create a clear airway, treat any fracture and fix broken bone segments, prevent scars if possible, preclude long-term vision and eye problems and exclude any other injuries.

Sleep apnoea

Sleep apnoea is a common sleep disorder in which breathing stops temporarily during sleep. These pauses in breathing may last for over ten seconds and may recur over ten times per hour.

Sleep apnoea is usually due to an increase in airway resistance and is often associated with snoring. Oxygen levels decrease and your brain briefly awakens you to resume breathing. This is often accompanied by a loud gasping noise. Sleep apnoea can have severe effects on the lives of sufferers and their families.

Obstructive sleep apnoea (OSA) is the most common type of sleep apnoea. It’s when your airway is blocked or obstructed, by extra tissue in the back of your throat.

The gold standard test for evaluating OSA is polysomnography. It’s an overnight sleep study and involves monitoring different events occurring during sleep such as eye movements, chest wall movements and EEG. A mini sleep study is more usual and consists of heart rate and blood oxygen level monitoring and observations.

There are several types of treatment for sleep apnoea. In mild and moderate cases, lifestyle changes such as weight loss and mandibular advancement devices can be successful.

If sleep apnoea is moderate to severe, mandibular advancement devices, continuous positive airway pressure (CPAP – a nasal mask is used to keep the airway unobstructed by providing positive air pressure into the airway), oral surgery to widen the airway or laser assisted removal of soft tissues may be prescribed.

Head and neck infections/cancer

Head and neck infections are common. They can include odontogenic (teeth), nasal and sinuses, ocular (eyes), otitis (ear) and pharyngeal (pharynx). Your OMS will diagnose and prescribe the best treatment option based on your individual needs and the type of infection.

Head and neck cancer is a relatively uncommon type of cancer. Cancer can develop in over 30 different places in the head and neck area. The mouth (oral cancer) is the most common place for head and neck cancer to develop. Cancer can also develop in the voice box (larynx), throat (pharynx), salivary glands, nose and sinuses and the area at the back of your nose and mouth (nasopharynx).

Symptoms of head and neck cancers depend on where it is. Some general symptoms include: a sore in the mouth that won’t heal (the most common symptom), a lump or swelling in the neck, red or white patches in the mouth that remain for a few weeks, difficulty or pain when swallowing or chewing, changes to your voice (hoarseness) and a constant sore throat and earache on one side.

Treatment aims to remove or destroy all of the cancer and to reduce the chances of it coming back. Your treatment will depend on where the cancer is in your head or neck, the stage of the cancer, its size and your general health. It can include radiotherapy (high-energy rays used to destroy the cancer cells), chemotherapy (anti-cancer (cytotoxic) drugs to destroy cancer cells) or surgery. Our oral and maxillofacial surgeons can operate to remove the cancer and also rebuild tissue lost due to the cancer or surgery.

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