OMS Surgical Services
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Click To Login To MyChartOrthognathic Surgery
Orthognathic surgery - jaw surgery - corrects facial and jaw abnormalities in which the facial bones and teeth are not correctly developed. Facial and jaw abnormalities may result in difficulty with chewing, speech, jaw function, as well as the overall appearance of facial features. Our oral and maxillofacial surgeons perform orthognathic surgery to correct these jaw and facial abnormalities, often working in conjunction with an orthodontist. After corrective surgery, the teeth will come together properly, improving chewing, speech and function. The initial surgical consultation involves a careful examination by the surgeon, including photographs and radiographs used to individualize each patient’s treatment plan. The latest digital imaging technology is used for computerized treatment planning and visualization of post-operative changes to the facial appearance, optimizing the patient's understanding of both the functional and aesthetic benefits of the procedure. The two most commonly performed operations are the sagittal split osteotomy of the mandible, or lower jaw, and the Le Fort I osteotomy of the upper jaw. Surgical procedures to the chin, cheek, eye, nose, neck and skin, in conjunction with the corrective jaw procedure, may be required to further enhance facial appearance. Prior to corrective jaw surgery, close consultation with an orthodontist is important as the patient may require a period of pre-surgical and post-surgical orthodontics that could last 6 to 12 months.
Sagittal Split Osteotomy (lower jaw)
The sagittal split osteotomy of the lower jaw is performed through incisions placed inside the mouth near the back of the cheek where it attaches to the lower jaw. The jaw bone is then divided in the area of the angle of the jaw in a front-to-back plane. This allows the tooth-bearing part of the lower jaw to slide backwards, in the case of a protruding lower jaw, or forward in the case of a deficient or short lower jaw. In the past, thin wires were used to support the new position of the bone post-surgery and, because it was unstable the patient also had to endure periods of 6 to 12 weeks of “maxillomandibular fixation", otherwise known as wiring the teeth and jaw together. This was of course not only uncomfortable but led to poor oral hygiene and significant post-operative weight loss. Fortunately, small titanium screws have been developed developed to hold each segment together, significantly reducing maxillomandibular fixation to roughly one week.
Le Fort 1 Osteotomy (Upper Jaw)
The Le Fort I osteotomy of the upper jaw is performed through incisions placed inside the upper lip. A horizontal transection of the upper jaws’ attachment to the base of the nose and sinuses is performed, allowing for the movement of the upper jaw into positions necessary to correct the bite and/or facial anomaly. Like the sagittal split osteotomy, the post-operative plan and recovery time is much the same. Rubber bands are used to keep the jaws together for about a week and patients are placed on a soft diet for approximately five weeks.
Head and Neck Surgery
Our interdisciplinary team offers comprehensive, specialized care for patients with benign and malignant oral, head, and neck tumors including those found in the mouth, pharynx (throat), larynx (voice box), on the jaw, tongue, thyroid and salivary glands. In the pursuit of treating head and neck cancer, our surgeons will consult with microvascular surgeons, maxillofacial prosthodontists, general dentists, and medical radiation oncologists to customize a treatment plan inherent to the needs of each patient.
What Happens After Diagnosis?
Patients with evidence of a tumor will undergo an initial assessment involving a complete evaluation to include diagnostic procedures and additional radiographic studies. It is during this initial assessment that the patient will be further educated on their diagnosis as they and their care team discuss treatment options and outcomes. Treatment can come in many forms including surgery, radiation, a combination of both or, in some cases, chemotherapy. At the Texas A&M College of Dentistry, our team specializes in and focuses on the reconstructive rehabilitation of patients with functional and cosmetic defects as a result of an ablative surgery and, as medical doctors as well as dentists, we plan and execute the surgical treatment plan from start to finish as head and neck surgeons.
Reconstructive Surgery
Our multidisciplinary team allows us to provide the best possible care for our reconstructive patients. The surgical team includes board certified physicians with training in oral maxillofacial surgery, microvascular surgery, cosmetic surgery, maxillofacial prosthodontics, anaplastology, and general dentistry. Maxillofacial prosthodontics specialists are available for facial and oral prosthetic rehabilitation, including replacement of missing teeth using dental implants. Our anaplastologist can create any structure within the face including prosthetic noses, ears, and eyes. Further information regarding maxillofacial prosthetics and anaplastology can be found on the Center for Maxillofacial Prosthodontics page.
Microvascular Reconstruction
Microvascular surgery is a technically demanding procedure during which tissue grafts harvested (taken) from the arms, legs, abdomen, or back are transferred to the mouth, throat, or face to replace missing tissues. Candidates for this type of surgery include patients who require surgery for oral/head and neck cancer, or suffer from the effects of radiation therapy given to treat head and neck cancer, as well as patients with severe traumatic injuries of the face or neck. Areas commonly reconstructed include the jaws and mouth, the throat, and all areas of the face, scalp, and neck. A successful outcome in this type of reconstructive surgery depends upon meticulous suturing of one to three milimeter blood vessels using a microscope and suture, finer than human hair, to reestablish blood flow to the tissue graft. For patients undergoing surgery to remove a cancer, use of this technique allows for immediate reconstruction of the bone or soft tissue defect and generally ensures that the patient undergoes only one surgical procedure.
Nasal Reconstruction
Our oral and maxillofacial surgeons are experienced in reconstructing nasal injuries or deformities and functional breathing problems arising as a result of a broken nose, previous nasal surgery, treatment of nasal skin cancer, and congenital problems, including the nasal deformity commonly associated with cleft lips. Patients who have suffered a recent broken nose are advised to be evaluated between 5 to 10 days after the injury has occurred, as they may be considered for the reconstruction of the problem by means of septorhinoplasty, which addresses both the function and the appearance of the nose.
Facial Bone Reconstruction
Surgical team members are highly skilled and experienced in treating patients who have suffered fractures involving the jaw bones, the cheek bones, the orbital bones, and the skull. Surgery can often be accomplished using incisions which are well hidden by placement inside the mouth, in hair bearing scalp skin, and on the inside of the eyelids, often avoiding visible facial scars. Patients with recent fractures or problems that persist after remote facial fractures are often considered to be candidates for reconstruction surgery.
Mohs Reconstruction
Mohs reconstruction of the head and neck is a procedure performed by our surgeons after Mohs Surgery is performed to remove skin cancer. Depending on the complexity of the reconstruction, the procedure can be done under local anesthesia though sedation and general anesthetic plans may be indicated.
Temporomandibular Joints
Temporomandibular Joints better known as TMJ are the paired joints that connect the lower jaw (mandible) to the temporal bones of the skull, located just in front of each year. These are among the most complex joints in the body as they are responsible for the function of the mouth including chewing and speaking. When the four, key components to these joints become diseased signs and symptoms can present themselves as a persistent clicking, pain, and/or limitation in one’s ability to open their mouth. With precision and extensive knowledge, our surgeons provide the most current techniques in the treatment of TMJ disease ranging from minimally invasive approaches to total joint replacement.