Oral and Maxillofacial surgery

Sinus Augmentation

Sinus augmentation also known as sinus lift is a surgical procedure that adds bone to upper jaw in the area of molars and premolars. It is done if there isn’t sufficient bone height in upper jaw for a dental implant. The bone is added between the jaw and the maxillary sinus.

Indications- Indications of sinus augmentation are as following:

• When there is insufficient residual bone height.
• When there is bone loss due to periodontal disease.
• Poor bone quality in posterior region of maxilla.
• When maxillary sinus is too close to the upper jaw for implant placement.

Procedure

The bone used in the sinus augmentation may be taken from patient’s own body or from cadaver. To begin the procedure, your dentist will make an incision in the gums to expose the jawbone. Then a small oval shape cut is made into the bone through which the membrane that separate sinus from jaw is pushed away for better access. The space underneath is filled with bone graft material. Once the bone is in place the tissue is closed with stitches. It usually takes 4- 10 months for the bone to heal and develop completely.

Aftercare

• To prevent infection, antibiotic should be taken as prescribed.
• It is recommended to sneeze with the mouth open.
• Anything that causes pressure in the nasal cavity must be avoided.
• Smoking increases the risk of bone augmentation failure so it should be avoided.
• Bleeding and swelling is quite normal after the surgery.

Extraction

Tooth extraction is the removal of one or more teeth from the mouth. Wisdom tooth extractions are the most common. Wisdom teeth are the last molar and are the last permanent teeth to erupt. They often grow sideways. As they grow they push other teeth that results in crowding. Sometimes when there isn’t enough space for the eruption, wisdom teeth fail to erupt and become impacted. The process of removal of this impacted tooth is called extraction. Other reasons for extractions are:

• Pain
• In case of crowding
• When there is severe, irreplaceable tooth decay
• In case of periodontal disease (gum infection)
• In case of cavities and mobile tooth
• In case of an accident

Procedure

Dentist begins by giving an anesthesia. They may use any one of these anesthesias:

• Local anesthesia: It is injected at the site of extraction. It numbs the area from where the tooth will be removed.
• General anesthesia: A general anesthetic prevents pain in the whole body and will cause patient to sleep throughout the procedure.

Dentist will make an incision in the gum tissue to expose the tooth and bone. Any bone covering the tooth will be removed. If the tooth is connected to the bone, dentist will separate the connecting tissue and then remove the tooth. In some cases, the dentist cuts the tooth into smaller pieces to make it easier to remove. After the tooth is extracted stitches are given to close the wound. Some stitches dissolve over time and some have to be removed after few days.

After surgery

In most cases, the recovery period lasts only a few days. Post-operative care is very important.

• Gauze placed after surgery should be kept in place for half an hour
• Patient must take prescribed pain medication.
• While the mouth is numb, patient should be careful not to bite the inside of the cheek.
• Icepack should be placed on the cheek
• Strenuous physical activity should be avoided.

Risks

Most wisdom tooth extractions don’t result in long-term complications. Rarely, complications can include:

• Pain and swelling in the gums and tooth socket.
• Temporary or permanent nerve damage.
• Trismus: pain or difficulty in opening mouth.
• Damage to nearby tooth
• Dry socket

Mandibular Fracture

Mandibular fracture, also known as fracture of the jaw, is a common facial injury and is typically the result of trauma. Any significant force applied to the mandible can cause fractures.

Causes of mandibular fracture

Most common causes of mandibular fractures are:

• Vehicle accident
• Physical assault in the face
• Sports-related injuries.

Symptoms of broken jaw

The most common symptoms are:

• Jaw pain
• Difficulty in opening the mouth
• Discomfort while chewing
• Breathing difficulties
• Bruising, swelling and bleeding are very common

Treatment

If the fracture is minor; no treatment may be required other than pain medication. However, if the fracture is severe, surgical treatment is required. Surgical treatment of mandibular fracture is recommended in case of multiple fractures or when both sides of the mandible are affected.

Jaw wiring is the usual surgical choice. A wire is used to hold the jaw in place and to keep it from moving. Another common surgical treatment involves the use of screws and plates. This involves making a cut on the inside of the mouth through the gum. The broken bones are then put back together and held in place with small metal plates and screws.

Risk factors

In most cases, the prognosis is very good. Some rare complications may include:

• Soft tissue defect
• Facial deformity
• Hemorrhage
• Breathing problems
• Fractured teeth
• Infection
• Nerve damage
• Malocclusion

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