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What is maxillofacial surgery?

Maxillofacial surgery, also known by its full name of oral and maxillofacial surgery, specialises in surgery of the face, neck, mouth and jaws.  The name derives from the two facial bones – maxilla – which sit above the upper jaw as portrayed in this image. Occasionally it is referred to by its shortened name of – maxfax surgery.  The addition of ‘oral’ surgery to the full name simply emphasises that surgery connected with the mouth is also included in this specialism – oral meaning ‘relating to the mouth’.

The oral and maxillofacial specialism was originally born out of the need to treat the facial injuries, especially broken jaws, which were sustained by soldiers during the two world wars.  Since that time the discipline has grown to include facial deformities in both adults and children, cancers of the head, mouth and neck, disease of the saliva glands, dentoalveolar surgery and even cosmetic surgery.

The qualification of oral and maxillofacial surgeon has really developed over the last thirty to forty years.  It is unique as, in the UK and other countries, surgeons must have both a medical degree and a dental degree. A dual qualification is the norm in this speciality.  Originally these surgeons were called hospital dentists, then oral surgeons and finally maxillofacial surgeons; each name change reflecting the ever increasing aspects of their work.  The minimum training period for these surgeons is about 12 years and many of them go on to specialise further in a certain aspect of the surgery. Maxillofacial surgeons usually work in hospitals where they treat both in-patients and out-patients.  Very often they work alongside other specialists like oncologists and orthodontists.

Types of maxillofacial surgery

According to the Royal College of Surgeons different types of maxillofacial surgery carried out by oral and maxillofacial surgeons are:

  • Facial injuries, management of complex craniofacial fractures and soft tissue injuries of the mouth, face, and neck.
  • Head and neck cancer, access to tumours within the depths of the complex craniofacial anatomy, and removal of tumours, including neck dissections.
  • Reconstructive surgery
  • Surgery on the jaw for the correction of facial disproportion
  • Pre-implant surgery, including the use of implants to retain facial or dental prostheses and associated bone grafting techniques as part of oro-facial reconstruction.
  • Removal of impacted teeth and complex buried dental roots.
  • Removal of cysts and tumours of the jaws
  • Primary and secondary surgery for cleft lip and palate, and other congenital facial deformities.Management of  benign and malignant lesions of the salivary glands.
  • Removal of complex facial skin tumours and reconstruction
  • Cosmetic surgery including face lifts, eyelid and brow surgery and rhinoplasties.
  • Surgery on the temporomandibular joint (the 2 joints which attach the jaw bone to the skull)

Craniofacial surgery

The British Association of Plastic Reconstructive and Aesthetic Surgeons describes craniofacial surgery as, surgery used to correct a range of congenital and acquired abnormalities of the skull, face, and jaws. Paediatric craniofacial surgery is possibly the most common in this type of surgery. Problems can be caused by birth defects, disease or trauma.  Cleft lip and/or palate is one of the most common congenital problems. It is estimated that oral clefts affect one in every 700 births in the USA.  Other birth defects may cause problems with the shape of the head and face generally. Other syndromes, many of them quite rare, will lead to problems with the bones in the face and skull.  Some of these are genetic.

When it comes to adults, craniofacial surgery is most often required after some sort of trauma/accident e.g. when the bones in the face are broken, complications with broken noses or due to the affects of some types of cancer.

Craniofacial surgery is also one of the newest additions to plastic surgery, thanks to a French plastic surgeon – Paul Tessier, who improved surgical techniques connected with craniofacial deformities.  His techniques became widely accepted when he travelled to the USA in the 1970s.

Other procedures performed by oral surgeons

Of course, craniofacial surgery is only one part, albeit a very important part, of the work of an oral and maxillofacial surgeon.  There are a variety of other surgeries which they perform including dentoalveolar. It is estimated that, worldwide, dentoalveolar treatments account for more than 50% of the practice by oral and maxillofacial surgeons.  The alveolar ridges are located just above and behind the top teeth and just below and behind the bottom teeth. These ‘ridges’ hold the sockets for the teeth.

The term ‘oral surgery’ is used for any medical procedure to the teeth, jaw and/or gums.  Sometimes these procedures can take place in a dental surgery or clinic. As an example, a simple tooth extraction is oral surgery.  However, at the other end of the scale wisdom tooth extraction and, sometimes, dental implants may take place in a hospital setting with an oral surgeon.

The most frequent dental procedures performed by oral surgeons are tooth extractions, often wisdom teeth extractions.  Hospital treatment is necessary if the tooth is impacted – this means that for one reason or another the tooth cannot push through completely into the mouth.  Dental implants may also be carried out by a surgeon. Dental implants involve screwing a metal post into the jaw bone (or alveolar ridge) and later adding a crown so that the implant looks like an ordinary tooth.  Occasionally the jaw bone is not strong enough for the metal post to be attached to. If teeth have been lost due to trauma, rot and decay, or injury. the jawbone can sometimes shrink and this means that it may be too weak to place an implant in.  In this case, bone grafting is needed. Traditionally the process involves removing a piece of bone from another part of the patient’s jaw or body and transplanting it into the jawbone. Alternative options today include obtaining bones from other sources, which prevents operating in a second place on the patient’s body.

Oral Surgery Problems - When is maxillofacial surgery needed?

Impacted Teeth

Most often when we think of impacted teeth we associate this with our wisdom teeth.  However, this is not always the case, there may be different types of impacted teeth Any of our teeth may be impacted – either because they cannot push through the gum completely or because they are pushing through at an angle.  In itself, this may not be a problem, however the knock-on effects of this can cause other dental issues. Firstly, if only part of the tooth has pushed through, this means that its top/bottom edge is not aligned with the rest of the teeth,  This can cause problems with biting, brushing and general dental hygiene. Teeth that push through at an angle may’ crowd’ other teeth in the mouth and lead to their displacement and crooked teeth.

Wisdom teeth usually appear at the age of 17-25 years, although they can sit in the gums and suddenly erupt when somebody is in their 30s or 40s.  The majority of people have four wisdom teeth, the last teeth on the left and right of the upper jaw and the last teeth on the left and right of the lower jaw.  Occasionally some people have five or six. Wisdom teeth, or third molars as they are correctly called, were probably needed, thousands of years ago as ‘replacement’ teeth when our forefathers ate much harder and tougher food.  Nowadays our jaws are smaller and often there is no room for these teeth to push through the gum properly. If they do not cause any pain or problems for the nearby teeth they can be left. However, sometimes they do present a problem, in addition to being a trap for bacteria.  The dentist will discuss with you the reasons why he/she thinks an impacted wisdom tooth should be removed. Impacted teeth extraction can often be done by the dentist using a local anaesthetic. However, sometimes the removal of impacted teeth is more complex or a patient has other medical conditions which could lead to complications.  In these cases, the dentist will often advise that the procedure be carried out by a surgeon at a hospital – usually as an outpatient.

Often there are no symptoms associated with fully impacted teeth (those which are still totally in the gum), however partially impacted teeth symptoms may be:

Bad breath

  • Pain and tenderness of the jawbone and gums – including redness or swelling of the gums
  • Headache or jaw ache
  • Unpleasant taste when biting near the area

Very occasionally, there may also be difficulty when opening the mouth and there may be  swollen lymph nodes in the neck.

The impacted teeth which cause the most problems after wisdom teeth are impacted canine teeth.  Often this is now corrected in children, but there are adults who have impacted canine teeth. The canine teeth are the ‘pointy’ teeth which, in animals, we call fangs.  Permanent canine teeth usually appear between the ages of 11-13 years. If one or more canine teeth do not grow properly it can cause other teeth to become crooked, especially if it grows across the front or back of another tooth.  There are three treatment options for these type of impacted teeth are:

1) Remove them totally i.e. extraction of the impacted teeth, and, if a gap remains in the mouth, fill the gap

 using a denture or bridge

2) An orthodontist or oral surgeon can expose more of the tooth by way of a small operation.  It is possible

 that other teeth may need to be extracted to allow room for the canine tooth. Once fully exposed the

tooth can be gently manoeuvred into place with a brace

3) In exceptional circumstances, where the above procedures cannot be done for some reason, there is an

 option to totally transplant the tooth.  This is used as a last resort treatment as the success rate is

 variable.

Facial disproportion

The two sides of our faces are not symmetrical.  The differences vary from person to person and are usually not significantly noticeable.  However for some people, these differences are very distinguishable, particularly when there is an imbalance between the upper and lower jaws. The reasons for these disproportions are varied, but include disease, genetic disorders and trauma.  In addition to the external disproportionate appearance, differences can also be seen in the internal structure of the mouth. As well as having a physical impact on the patient’s life, this condition can also have a psychological impact. Depending on the complexity, reasons, and severity the surgery is usually delayed until all the bones are developed.

Facial Trauma

Facial trauma, known also as maxillofacial trauma, is often caused by car, motorbike and bicycle accidents, as well as sports injuries and falls. Blunt facial trauma often occurs in fighting when the face is hit by a blunt force as oppose to a sharp force,  The face consists of fourteen main bones – many of which are quite delicate.

The symptoms of facial trauma are varied depending on where the problem is, however these are some of the most common symptoms:

  • Pain
  • Cheeks are misshapen
  • Numbness in any part of the face
  • Bruising
  • Problems with vision (blurry, double-vision or floaters.spots)
  • Swollen eyelids and eyes that are not in their normal position
  • Decreased eye movement.

A fractured facial bone or bones will be confirmed by CT scan, Ultrasound or X-ray. Often bones are left to heal by themselves, however in severe facial trauma an operation may be needed to move the parts of the bone back into the correct position and maintain that correct position with wires, screws or plates.  Occasionally facial trauma reconstruction surgery is required where the face is misshapen. In this case, bone grafts may be necessary. With facial trauma affecting the mouth and jaw area, treatment will need to be followed up by a visit to an orthodontist to assess the need for braces or other appliances to hold the teeth/jaw in place.

According to the International Journal of Clinical Pediatric Dentistry, paediatric facial trauma is far more uncommon than other injuries in children. The most common causes are motor vehicle accidents, accidents such as falls, sports injuries and violence.  Mandibular fractures (fractures to the jaw) are the most common. Wherever possible, facial trauma in children is treated in other ways than surgery. The fact that their facial bones are still developing means that a surgical procedure may have to be repeated as the bones grow. Obviously this is not always possible and the maxillofacial surgeon will decide on the best way forward in each individual scenario.

Orthognathic Surgery

Orthognathic surgery is commonly known as corrective  jaw surgery, or simply jaw surgery. It is used to correct conditions related to the jaw and face.  Often these are conditions which have not or do not respond well to orthodontic treatment.

This surgery can be split into three different types, top jaw surgery –  known as Maxillary Osteotomy, bottom jaw surgery – known as Mandibular Osteotomy and double jaw surgery known as Bimaxillary Osteotomy.  Surgery is usually only undertaken in cases where orthodontics do not solve the condition. However, for 18-24 months before surgery the patient will need to wear fixed braces so the teeth can be gently manoeuvred into position in readiness for the operation.  Post-surgery fixed braces will also need to be worn for upwards of six months.

Maxillary Osteotomy or top jawbone surgery is carried out on the maxilla bone.  This surgery will change the position of the top jaw/teeth in relation to the bottom jaw.  It is used for such conditions as reverse overjet (when the top front teeth sit behind the bottom front teeth and protrude inwards), a gummy smile, an open bite and when the top jaw is narrower than the bottom jaw. often causing crossbite.  In simple terms, the upper jaw or maxilla is cut and then moved upwards, downwards or pushed outwards. With a gummy smile some of the jawbone is just cut out completely. After each operation tiny titanium screws and plates are inserted which hold the jawbone in place.

Mandibular Osteotomy or lower jaw bone surgery is carried out on the mandible bone.  This surgery will change the position of the bottom jaw/teeth in relation to the top jaw.  It is used for conditions where the bottom jaw needs to be positioned more forward or more backwards.  Similarly to the maxillary osteotomy the jaw bone is cut. The ‘cut’ piece can then be moved forward slightly with the use of screws and plates or a piece of the bone can be cut out completely.

Bimaxillary Osteotomy or double jaw surgery is basically surgery which takes place on both the upper and lower jaw at the same time.  Sometimes the correction is too great to move just one jaw so they will both need to be moved towards each other e.g. the upper jaw bone backwards and the lower jawbone forwards.

For all these operations the jawbones will knit back together again over time in their new positions.  Sometimes a surgical procedure called a genioplasty is also required to extend the chin outwards.

At times these operations are carried out because the face is asymmetrical or because of facial disproportion.

Generally all surgery is carried out within the mouth so there are no visible scars.  Facial operations are one of the least painful procedures post-operation, and noticeable swelling and bruising usually disappears in a few weeks.

Cleft Palate Surgery

Cleft palate surgery is performed almost exclusively on babies and young children.  However, when these children grow up, there may still be issues that need to be corrected.    Soft palate surgery is usually performed on adults in connection with sleep apnoea and snoring.

A cleft lip and palate affects about one in every 700 births in the UK.  A cleft is a gap or split in the lip and/or the roof of the mouth (palate) where the baby’s bones have not grown together properly.  There can be one cleft or two clefts.The image opposite shows two clefts. A child may need just cleft lip surgery, just cleft palate surgery or both cleft lip and palate surgery.  The reasons why this condition occurs in babies is largely unknown – things like drinking alcohol or smoking during pregnancy may raise the chances as may a lack of folic acid. Sometimes the condition can be diagnosed while the baby is still in the womb, but when this is not the case it is diagnosed at birth.

Once it is confirmed that a baby requires cleft lip/palate surgery, the parents will be given a schedule of treatment which can take place in a specialist NHS cleft centre. The main treatments suggested by the NHS are:

  • An operation to correct a cleft lip at 3-6 months of age
  • An operation to correct a cleft palate at 6-12 months
  • Close monitoring of the baby’s hearing – children with cleft palates are more prone to glue ear which can affect their hearing
  • speech and language therapy on an ongoing basis where needed

Good dental hygiene and orthodontic treatment when needed.  Sometimes teeth braces may be needed.

Occasionally additional surgery is necessary later.  A cleft in the gum is usually repaired with a bone graft at 8-12 years of age.  If the original surgery did not heal well or the patient continues to have speech problems, there may be further surgery to improve the look and function of the lips and palate.  Infrequently rhinoplasty may be required to change the shape of the nose or orthognathic surgery to improve the appearance of the jaw.

With proper care and treatment, a cleft lip or palate should not present any long-term problems and children grow up to lead perfectly normal lives.  In a minority of cases where adults are not happy with the appearance of their face, jaws or lips, having had a cleft lip/palate as a child, they may be referred back to a NHS cleft centre for further treatment to improve their appearance.

Soft Palate Surgery

Soft palate surgery is something completely different.  This type of palate surgery for snoring is very much a last resort treatment.  Sometimes it is performed in tandem with removal of the tonsils. Palate reduction surgery removes some of the soft palate and/or the chief vibratory tissue – the uvula.

The decision to have soft palate surgery should not be taken lightly.  Surgeons will insist that the patient tries all non-surgical solutions first.  This surgery will not help all cases of snoring. Sometimes the snoring originates from the base of the tongue  and sometimes it is connected with nasal abnormalities. Even when it can be established that the snoring originates from the soft palate, there is no guarantee that the surgery will successfully solve the problem.  Where it is successful, this is sometimes short-lived. This type of surgery is very rarely undertaken for sleep apnoea. Continuous Positive Airway Pressure/Power (CPAP) is a much preferred solution for sleep apnoea.  This is a type of ventilator which keep the airways open.

 Oral Cancer

What is oral cancer?  Oral cancer, or mouth cancer is a type of head and neck cancer. It occurs when a tumour starts to grow in a part of the mouth.  The more common places are on the tongue, inside the cheeks, or on the palate, lips or gums. Less common places are the pharynx (part of the throat connecting the mouth to the windpipe), tonsils and salivary glands. Mouth cancer is actually the sixth most common cancer in the world, however it is much less common in the UK.  Smoking, drinking alcohol and infection with the human papilloma virus (HPV) are thought to increase the risk. Men are more likely to get mouth cancer than women and two out of three cases develop in adults over 55 years of age.  However, that is not to say that young people cannot also develop mouth cancer.

Oral cancer symptoms include:

  • Persistent mouth ulcers
  • Lumps in the mouth or neck
  • Teeth that become loose for no apparent reason, or after tooth extraction, the socket does not heal properly
  • Numbness and odd feelings on the tongue and lip(s)
  • Changes in the way somebody speaks
  • Red or white patches in the mouth or on the tongue

Oral cancer treatment, as with many other cancers is very individual and depends on the type of cancer and how advanced it is.  The usual treatment methods are:

Surgery

The cancerous tissue is cut out

Radiotherapy

Radiation beams are directed towards the cancerous cells

Chemotherapy

Very powerful medicines are used to kill the cancer cells

The oral cancer treatment success rate is very high when the cancer is diagnosed early and surgically removed.  The earlier the stage at diagnosis, the higher the chance of survival after treatment. Overall, 60 percent of all people with oral cancer will survive for five years or more.

Oral and maxillofacial surgeons treat mouth cancers in partnership with oncologists.

Salivary Gland Disease

There are hundreds of minute salivary glands all around the mouth which produce saliva.  Saliva helps to break down food and therefore help with digestion, as well as being a natural ‘cleaner’ for our mouths.  In addition there are six major glands, which are split into three pairs. The largest glands are the two parotid glands.  Each parotid gland is situated below and in front of the ear on each side of the face. In addition a pair of sublingual glands and submandibular glands lie deep down in the floor of the mouth.

Problems with the salivary glands include:

Salivary Gland Malfunction – this term is generally used when the glands don’t produce enough saliva .  This can be caused by disease such as rheumatoid arthritis, infections such as HIV, certain drugs and radio- or chemotherapy used to treat mouth cancers.  Inadequate amounts of saliva can lead to tooth decay and dental problems. There is no real cure for this. For those suffering from this condition it is best to sip lots of fluids throughout the day and pay particular attention to dental hygiene.  At the opposite end of the spectrum, it is very rare that the glands produce too much saliva, and, when they do, it usually rectifies itself quite quickly.

Sjogren’s Syndrome – this is an autoimmune disorder that mainly affects the salivary and lacrimal glands. These are the glands that are responsible for keeping our mouths and eyes moist. With Sjogren’s Syndrome , the body fails to produce enough moisture, but it can affect other parts of the body like joints and organs. In the USA one in four million people are affected, 90% of whom are women. There is no cure for the condition but the symptoms can be treated with drops and lotion to re-moisturise the body and non-steroidal anti-inflammatory drugs to manage joint pain.

Salivary Gland Stones – a salivary gland stone stone can form from the salts in the gland.  This results in a blocked salivary gland. In turn, this means that the saliva produced is backed up along the duct, so this can lead to painful swelling at the site of the gland.  The blocked duct can also become infected. Treatment includes painkillers to help with the pain, drinking extra fluids, massaging the glands and stimulating the flow of saliva by eating sour foods like lemon.  Often the stone will pass out by itself, however, if this is not the case, a dentist can often ‘push’ it out by squeezing it through the duct or he/she may need to use a very fine instrument to pull it through the duct. In exceptional circumstances the stone can be removed surgically.

Salivary Gland Infection – this is most common in the parotid glands.  It most often occurs in people who are in their 50s and 60s, people who have Sjogren’s Syndrome, people who have a chronic illness, and those who have had radiotherapy for mouth cancer or thyroid cancer.  Young people suffering from anorexia are also prone to contracting a salivary gland infection. The gland becomes swollen and very painful and the skin over it can be red and sore. Sometimes an abscess can form in the gland and the pus from it can be tasted in the mouth.  Usual treatment is with antibiotics; an abscess may have to be cut open and drained

Salivary gland swelling – childhood mumps, bacterial infections and other diseases such as AIDS and diabetes may cause the glands to swell.  Tumours, both cancerous and non-cancerous can also develop in the glands and when this happens the swelling is usually much harder to the touch than with an infection.  The treatment varies according to the primary cause.

Dry mouth – many of the above can cause dry mouth .  Sometimes thick saliva is produced because there is not enough water to dilute it and it becomes sticky and stringy.  Reasons for this are varied, including many of the above, when somebody has to breath through their mouth e.g. due to a bad cold, pregnancy, motor neurone disease and cystic fibrosis.  Treatments vary depending on the cause but can include drinking plenty of fluids, eating chewy food to stimulate saliva production and taking over-the-counter saliva substitutes

 Temporomandibular joint disorders

The temporomandibular joint acts like a hinge and allows movement of the jawbone, up and down and from side to side.  Without it we wouldn’t be able to talk, chew or yawn. Temporomandibular joint disorder is often known as TMJ.

Jaw clicking or popping is a painful sensation caused when the joint doesn’t work properly for some reason.  Usually, if there is no pain associated with it and it only happens infrequently it is not a reason for concern.  It can be caused by frequently chewing gum, biting fingernails, and/or clenching or grinding the teeth.

Sometimes, however, it can be a sign of a more important temporomandibular joint disorder, especially when the patient also suffers from jaw pain, headaches and neck ache and particularly pain when opening and closing the jaw.  Temporomandibular joint disorder is the most common non-dental related chronic facial pain and affects more than twice as many women as men. One of the main factors which influence this condition is stress – when stressed we tend to clench our jaws or sometimes grind our teeth (bruxism). Often the pain and discomfort will subside on its own.  Exercising the jaw and practising relaxing the face and jaw will also help.

Occasionally there are more  serious underlying problems such as arthritis in the joint, teeth being misaligned (malocclusion) or jaw dislocation or injury.  Arthritis in the temporomandibular joint may sometimes be accompanied b pain in other joints and will require long-term treatment by a doctor specialising in this condition.  If the suspected cause is a malocclusion your dentist will need to take x-rays and check your bite. If this is a problem you will be referred for orthodontic treatment. Dislocated jaws can sometimes be manoeuvred back into place by a doctor, but if this doesn’t work sometimes surgery is required.  A broken jaw can sometimes be left to heal on its own, otherwise surgery will be required.

Jaw Cyst

A jaw cyst forms inside the jaw bone, around the roots of teeth or around teeth that are still buried in the gums.  It is a cavity filled with fluid which grows very very slowly. Often there are no jaw cyst symptoms and most people may not be aware that they even have a jaw cyst until it shows up on an x-ray taken for a completely different reason.  They usually form because of an infection in a teeth or in the covering of a buried tooth. These cysts may weaken the jaw bone and may become very painful if they become infected. They may also damage nerves, leading to a feeling of pins and needles in the lips and gums.  If they become very large they may become noticeable as a swelling in the jaw. Jaw cysts are not cancerous.

Jaw cyst removal depends on the size and the kind of cyst.  Small cysts can be cut out with a local anaesthetic. Once the cyst is removed damaged, broken and/or buried teeth may also be extracted.  The gum will be stitched with dissolvable stitches and the wound will heal over the next few weeks or months. Sometimes for larger cysts the surgical procedure may need to be done under general anaesthetic.

For very large jaw cysts, it may not be possible to take it all out at the same time.  In this case part of it is cut away but the wound is left open and packed with antiseptic gauze.  The cyst will decrease in size over time until it is possible to remove the whole thing. The hole will be then closed and stitched.

Jaw cyst removal recovery time is fairly short.  For the first few days the jaw/gum may be sore and it is best to eat soft food, after this the patient can return to a normal diet when they feel ready but should take care when brushing near the wound.  The hole in the jaw bone will take approximately six weeks to heal and close up. Full or almost full bone regeneration takes up to two years.

 

Jaw Surgery Recovery

Initial healing after jaw surgery takes about six weeks, but complete healing is about 12 weeks.  Obviously jaw surgery recovery time will depend on the severity of the operation e.g. both jaws or just one jaw and also on actions of the patient.  Clearly, jaw surgery will affect eating and drinking as well as speech. Below is a jaw surgery recovery timeline, to illustrate the sort of things a patient may expect, however be guided by your surgeon – any type of maxillofacial surgery recovery is very individual.

=First 7 days after surgery:

  • Eating/drinking – patients will only be able to drink during the first week.  For the first couple of days just clear liquids and later thicker liquids. It is very important to keep well hydrated.
  • Swelling – usually the swelling will start to subside fairly quickly, about two to three days after the operation
  • Pain – Jaw surgery is actually one of the least painful types of surgery.  However, there will be some pain in the first week. Painkillers may be required.  Ice packs for the first few days may help; after this period, warm packs may be used
  • Talking – this will be quite difficult as there will be very limited movement in your jaw, especially if the surgeon places elastic bands in your mouth to restrict the movement in the jaw
  • Drooling – due to the swelling and the trauma affecting the mouth, patients may drool quite a lot
  • Sensations – there will be some numbness in the mouth
  • Dental hygiene is very important – but difficult to maintain!  Mouthwash or salt water, if the surgeon permits, may be used. A small child’s toothbrush may also be useful

 7-14 days after surgery

  • Eating/drinking – still mainly liquid or soft foods which have been blended
  • Swelling – most of the noticeable swelling will probably have disappeared
  • Pain – any pain from the surgery will have gone
  • Talking – this should improve – people should be able to understand you better
  • Drooling – this should also ease
  • Sensations – more feeling should return
  • Dental hygiene – a toothbrush can probably now be used, taking care around the wound

14-28 days after surgery

  • Eating/drinking – still mainly liquids and soft foods
  • Talking – this should be much easier now
  • Drooling – this should have disappeared
  • Sensations – more and more feeling should be returning to your face

One – two months

  • Eating/drinking – at around two months after the operation the doctor will probably allow normal food to be eaten
  • Sensations – numbness is probably gone – but it can take up to 12 months for some people
  • Talking – no problems now with talking

 Lower jaw surgery recovery time and upper jaw surgery recovery time is about the same, although double jaw surgery may take a little longer.

The next step for most patients will now be a visit to an orthodontist who will advise if some kind of orthodontic device (like fixe braces) will be needed.

Maxillofacial Surgery Cost

In an emergency or where there is a medical need, maxillofacial surgery can be performed free of charge on the NHS.  However, where it is deemed non-essential i.e. regarded as treatment for cosmetic purposes only, then it is not possible to have the procedure done free of charge.  The only option is to have the surgery at a private clinic or hospital. Most often this might apply to jaw surgery. The cost for this type of surgery varies greatly depending on the complexity of the procedure.  It can cost tens of thousands of pounds.

 

Is maxillofacial surgery covered by NHS?

Maxillofacial surgery comes under the umbrella of the hospital NHS service rather than the dental NHS service.  So, where maxillofacial surgery is deemed necessary for medical reasons the treatment is free of charge. . So, for example, children with cleft lips or palates are offered a free treatment programme automatically, likewise any facial trauma caused by an accident would automatically be treated free of charge.  Where jaw surgery is considered to be necessary because of a serious malocclusion this also would be done free of charge, although waiting lists can be very long – up to one year in some places. This surgery can only take place on the recommendation of a dentist or orthodontist. However, when the surgery is required for cosmetic or aesthetic reasons in adults, this will not be considered for free treatment and patients will have to pay privately.

Maxillofacial Surgery Abroad

Due to the very expensive costs of obtaining private surgery in the UK and other western European countries, many patients now choose to obtain treatment abroad.  Even taking into account flight and hotel costs, the prices overseas are considerably cheaper than in the UK. It does pay to choose wisely, however. Maxillofacial surgery is an operation, which like any other operation does carry a small risk.  It is sensible to make sure that you are well informed about the clinic/hospital where the surgery will take place. Read independent reviews where possible, check that the staff speak English and establish that they are using modern equipment and procedures.  What are the qualifications of the surgeon? What after care service do they provide? For overseas treatment you will often have to have a consultation with the surgeon prior to the surgery, as every case is individual. The total cost will be given and details finalised. Your second visit will be when the actual maxillofacial surgery will take place and this visit will probably need to last about five days.  Depending on the surgery, not all of this stay will be in the clinic/hospital so some hotel accommodation may be required.

Maxillofacial surgery in Poland

Polish medical staff are very well trained, and, together with the fact that many of the clinics are well-equipped with modern machines and instruments, makes this a very cost-effective country for treatment abroad.  Most educated Poles speak very good English, and the huge savings available relate only to the labour cost differences between the UK and Poland. Even when up to two return flights and hotel accommodation are factored into the budget, the surgery works out to be considerably cheaper.

 Maxillofacial surgery in Turkey

Similar to Poland, Turkey also has much cheaper labour costs than in the UK.  Many clinics are well-appointed and staff well-trained. It pays to check that the staff in Turkey speak good English – this is not the case in all clinics.  The flight costs toTurkey are usually more expensive from most places in western Europe, however big savings can still be made. One of the advantages of Turkey is that it can be combined with a sunshine holiday on its Aegean or Mediterranean coastline beaches.

Maxillofacial surgery summary

Maxillofacial surgery covers a wide range of different types of surgical procedures from relatively simple tooth extraction to major jaw surgery to the treatment of mouth cancers.  Maxillofacial surgeons are highly qualified and often work together with other specialist surgeons. In the UK, it is normally regarded as an NHS hospital service rather than an NHS dental service, so, when treatment is deemed necessary there is no charge.  Some of the most common procedures undertaken are tooth extraction, repairs to cleft lips and palates in children and jaw surgery. The NHS will not pay for treatment when the surgery required is purely for cosmetic or aesthetic reasons – this would usually include  facial disproportion and dental malocclusions which are not deemed medically necessary.. Such procedures are only obtain through private clinics and hospitals, where, depending on the procedure, costs may be very high. An alternative is to go abroad for treatment and this is becoming a popular option.  Many countries have good levels of equipment and their surgeons are equally well trained to those in the UK, however because labour charges are low, the entire procedure is much cheaper. Good choices are European countries where flight times are not so long and flight tickets are relatively cheap. Both Poland and Turkey are highly regarded for their levels of service, well-equipped modern hospital and clinics and highly trained surgeons, doctors and medical staff.  However, it still pays to choose wisely and gather all relevant information and opinions before booking the procedure abroad.

Sources

British Medical Journal (BMJ) – How to become an oral and maxillofacial surgeon

https://www.bmj.com/content/332/7535/s36

Royal College of Surgeons – Oral and Maxillofacial Surgery

https://www.rcseng.ac.uk/news-and-events/media-centre/media-background-briefings-and-statistics/oral-and-maxillofacial-surgery/

Dental Referrals – Oral Surgery

Oral Surgery

Sharma, Ramesh Kumar – Unfavourable Results in Craniofacial Surgery published in Indian Journal of Plastic Surgery 2013

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901901/

Bagheri, Shahrokh C – Clinical Review of Oral and Maxillofacial Surgery (Second Edition) 2014. Chapter 5

https://www.sciencedirect.com/topics/medicine-and-dentistry/dentoalveolar-surgery

Addenbrooke’s Hospital – Impacted teeth including surgery for canine teeth

https://www.cuh.nhs.uk/addenbrookes-hospital/services/oral-and-maxillofacial-surgery-and-orthodontics/impacted-teeth-including-surgery-for-canine-teeth

Guy’s and St Thomas’ Hospital – Information guide for extraction of third molar (wisdom) teeth

https://www.guysandstthomas.nhs.uk/resources/patient-information/dental/third-molar-(wisdom)-teeth.pdf

Medline Plus – Impacted Teeth

https://medlineplus.gov/ency/article/001057.htm

Mukherjee Chitrita Gupta, Mukherjee Uday – Maxillofacial Trauma in Children published in International Journal of Clinical Pediatric  Dentistry 2012

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155887/

British Orthodontic Society – Jaw Surgery

https://www.bos.org.uk/Public-Patients/Your-Jaw-Surgery/Your-Surgery-Explained/Top-Jaw-Surgery-Maxillary-osteotomy

NHS Information on Cleft Lip and Palate

https://www.nhs.uk/conditions/cleft-lip-and-palate/

British Snoring and Sleep Apnoea Association – Surgery for Snoring

https://britishsnoring.co.uk/snoring_treatment/surgery_for_snoring.php

Macmillan Cancer Support – Mouth Cancer

https://www.macmillan.org.uk/information-and-support/head-and-neck-cancers/mouth-cancer

Cork University Dental School – Jaw Cysts

https://www.ucc.ie/en/media/academic/dentalschool/patientinfoleaflets/JawCysts.pdf

Rubio, Eduardo Daniel, Mombru, Carlos Mariano – Spontaneous Bone Healing after Cysts Enucleation without Bone Grafting Materials: A Randomized Clinical Study published in Craniomaxillofacial Trauma and Reconstruction 2015

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4329039/

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